Pick the Right Pain Pill
This year's flurry of conflicting information about pain relievers has triggered plenty of headaches. Some relief: Over-the-counter medications, taken at the recommended dose, are safe for most people. But none are risk free. Consider these differences next time you're at the store:
Aspirin (Bayer, Bufferin): The century-old pain reliever is recommended by many doctors as a first-line therapy thanks to its low degree of risk and beneficial effects on the heart.
Benefits: Technically, aspirin is a nonsteroidal anti-inflammatory (more on this later) and, like the others, can fight fever and inflammation as well as pain. But unlike other NSAID s, aspirin discourages blood clotting and has been shown to protect against a second heart attack or stroke.
Risks: Taking aspirin for a viral illness such as the flu can put anyone under 18 at increased risk for Reye's syndrome, a potentially fatal illness. Like all NSAID s, aspirin can cause stomach ulcers and gastrointestinal bleeding. Also, its anticlotting properties could be dangerous to people with bleeding disorders.
Acetaminophen (Tylenol, aspirin-free Excedrin): Hundreds of over-the-counter medications contain this non-NSAID pain reliever, an alternative for people who are allergic to aspirin or who worry about the risks of nonsteroidal anti-inflammatories.
Benefits: Acetaminophen "seems to me the most benign medication if taken at the right dose," says Joel Bennett, a professor of hematology at the University of Pennsylvania School of Medicine and coauthor of American Heart Association recommendations on pain relievers.
Risks: Taking too much can be toxic to the liver. One study, published this month, noted that about half of all cases of liver failure are caused by an overdose of acetaminophen--44 percent intentional but 48 percent unintentional. "People think, 'If I can buy 500 in a mayonnaise jar, how could it be poison?'" says William Lee, a liver specialist at the University of Texas Southwestern Medical Center. Lee points out that drugs containing acetaminophen and other active ingredients aren't required to say so on the front of the package. So it's extremely important to read the list of active ingredients on any drug. Adults should not take more than 4,000 milligrams of acetaminophen per day--and less if they commonly have more than three alcoholic drinks daily.
Nonsteroidal anti-inflammatories (Advil, Motrin, Aleve): This class of drugs, which includes ibuprofen and naproxen, got a lot of bad press this year after Pfizer pulled Bextra, a prescription NSAID, from the market for fear of heart risks and skin reactions and Merck began fighting some 7,000 lawsuits claiming that another, Vioxx, raises the risk of heart attacks.
Benefits: Ibuprofen and naproxen often work when aspirin and acetaminophen don't. Many women swear by them for menstrual cramps.
Risks: Like aspirin, ibuprofen and naproxen carry an increased risk of stomach ulcers and gastrointestinal bleeding. Recent studies have also linked them to heart problems, though the evidence is still preliminary.
Whichever medication you choose, use it sensibly, advises headache specialist Fred Sheftell of the New England Center for Headache. If you're popping pills more than 10 times in a typical month, he says, it's time to get out of the drugstore and into a doctor's office.
This story appears in the December 26, 2005 print edition of U.S. News & World Report.
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