Knowing the difference between OTC pain medications can be a matter of life and death.

I get many questions from patients about over-the-counter (OTC) pain medications and there is often confusion about the difference between Acetaminophen, Ibuprofen, and Aspirin. It is very important to understand the difference between these medications. Just because it is sold over the counter doesn’t mean it is safe. I have seen patients die of liver failure from Tylenol and others die of kidney failure or bleeding ulcers from taking Ibuprofen.

Acetaminophen (most common brand name: Tylenol): This is an analgesic which acts as a pain and fever reducer. It does not reduce inflammation.

• Tylenol is processed by the liver and can occasionally cause liver inflammation and (rarely) liver failure.
• Don’t take Tylenol regularly if you are a heavy drinker (more than 2 drinks per day) or if you have hepatitis, other liver disease or increase in liver enzymes.
• Never take more than 8 extra strength Tylenol (500mg) per day (Maximum adult dose – 2 Extra Strength Tylenol every 6 hours).
• Tylenol is the pain/fever medication of choice in those with kidney disease and those who take certain blood pressure medications that affect kidney function (*ACE inhibitors, Angiotensin Receptor Blockers, and diuretics – especially in combination).

Ibuprofen (most common brand names Motrin and Advil) and Naproxen (Aleve): These are anti-inflammatory medications (also known as NSAIDS) that reduce inflammation, pain, and fever.

• NSAIDS are processed by the kidneys and can compromise kidney function and rarely cause kidney failure.
• Avoid NSAIDS if you have kidney disease.
• Avoid taking NSAIDS on a daily basis if you also take certain blood pressure medications (ACE Inhibitors, angiotensin receptor blocker, and diuretics especially in combination). If you do, it is important that you see your doctor and have your kidney function monitored with periodic blood tests.
• Do not take NSAIDS is you have a history of gastrointestinal problems such as stomach ulcers, gastritis, or heartburn (unless approved by your doctor). NSAIDS increase the risk of gastrointestinal bleeding, especially in elderly patients.
• Don’t take more than 6 tablets of OTC Ibuprofen (200mg) or 2 tablets of OTC Naproxen (220mg) per day unless advised by your physician (your physician may recommend more – maximum adult dosage of Ibuprofen is 2,400 mg/day and Naproxen is 1,000 mg/day.) Note: there are higher strengths of Ibuprofen (400/600/800 mg) and Naproxen (500mg) that are available by prescription.

Aspirin (Acetylsalicylic Acid): Aspirin is commonly confused with Ibuprofen. Aspirin is also an NSAID which reduces inflammation, pain, and fever. It is unique in that it also decreases blood clotting. Aspirin reduces risk of heart attack and stroke at low doses (81-325mg once daily). Aspirin has also been shown to decrease the risk of certain cancers and possibly dementia.

• Ask your doctor if you would benefit from taking a daily aspirin.
• Do not take aspirin regularly if you have a history of gastrointestinal problems such as stomach ulcers, gastritis, or heartburn (unless approved by your doctor). NSAIDS increase the risk of gastrointestinal bleeding, especially in elderly patients.
• Do not give aspirin to children for fever. It can cause a rare condition called Reye’s Syndrome.

*The generic name for ACE Inhibitors end in “pril” such as Lisiopril and Benazapril. The generic name for Angiotensin II Receptor Blockers (ARB’s) end in “tan” such as Losartan and Valsartan. These medications are often combined with diuretcs, most commonly Hydrochlorothiazide (HCTZ) and will have “-HCT” at the end of the name (Ex: Benazepril-HCT or Losartan-HCT). If you take blood pressure medications, make sure you know if you take this class of medication and let your doctor know if you are taking any NSAIDS on a regular basis. Keep in mind that the brand name of these drugs don’t always have the same ending. Check out lists of ACE-Inhibitors and ARB’s.