Over-The-Counter Pain Management Medication Tips: Ibuprofen, Acetaminophen

This is not a complete list of instructions, risks, or considerations. Follow the manufacturer’s instructions and recommendations for use, as well as those instructions by your provider. This is to serve as an additional reference.

NSAIDs [Ibuprofen (Motrin, Advil), Naproxen (Aleve), Celecoxib (Celebrex)]

Do not take an NSAID on an empty stomach or after an acidic beverage/meal. NSAIDs increase the risk for stomach ulcers, gastric bleeding, or a gastric perforation. Take NSAIDs with non-acidic food to reduce this risk. Elderly patients will have a greater risk for serious gastrointestinal events. Caffeine and tobacco smoking are also large risk factors for developing an ulcer. Do not consume alcohol while taking an NSAID.

Do not take NSAIDs if:
You have asthma, as this can induce and exacerbate an attack.
You are pregnant or nursing. Aspirin and NSAIDs should be be strictly avoided as they can cause constriction of the ductus arteriosus, and increase the risk for postpartum hemorrhage, as well as delayed labor. Acetaminophen is best during pregnancy (Tylenol regular or extra strength).
You have a history of a hiatial hernia, a bleeding disorder, long-term steroid use, or are on a blood thinner.
If you have a history of a stroke or myocardial infarction – as the risk of another occurrence is increased with NSAIDs.

NSAIDs cause salt and water retention, can raise blood pressure, and may inhibit antihypertensive medications. Avoid prolonged use (>1 week).

In diabetics, aspirin & NSAIDs can enhance the ability of some oral hypoglycemic drugs, such as sulfonylureas: [glipizode (Glucotrol), glyburide (micronase, glynase, DiaBeta), and glimepiride (amaryl)]. Monitor blood glucose levels.

NSAIDs can make the control of thyroid disease more difficult. Avoid prolonged use (>1 week).

Avoid using aspirin and NSAIDs if you have ulcerative colitis or Crohn’s disease; use acetaminophen instead. If you have to use an NSAID, request a prescription for Celecoxib/Celebrex.

Avoid prolonged use (>1 week) of aspirin or NSAIDs if you are taking sertraline (Zoloft), valproic acid (Valproic), or carbamazepine (Tegretal), as these can increase your risk of bleeding.

Kidney function is lowered when taking NSAIDs. Do not take aspirin or NSAIDs if you have advanced renal disease unless consulting with your doctor, as well as heart failure, uncontrolled diabetes, or liver disease.

Dosages are determined by your doctor.

Acetaminophen (Tylenol)

It only takes a few days exceeding the recommended dose of acetaminophen to cause liver damage. Contact your provider if use is needed for more than 3 days.

DO NOT consume/ingest alcohol while taking this medication. Acetaminophen and alcohol are extremely sensitive together and can lead to rapid liver damage or failure.

Do not take if you have a history liver disease or injury.

Acetaminophen is an effective over-the-counter pain management medication during pregnancy. Avoid aspirin and NSAIDs because they can: constrict the ductus arteriosus, cause a risk for postpartum hemorrhage, as well as delayed labor.

In patients taking warfarin (Coumadin), acetaminophen will raise the INR and increase the effect of the blood-thinning medication. Use acetaminophen for the shortest time possible. In patients taking isoniazid (INH), rifampin (Rifadin), or pyrazinamide, acetaminophen may increase the risk for liver toxicity. If you are taking Zidovudine (Retrovir), acetaminophen may further decrease white blood cell levels and precipitate anemia.