What You Should Know About OTC Pain Relievers

(2nd of two-part series)

To further understand and prevent the possible dangers of the misuse and abuse of OTC (Over-The-Counter) analgesic drugs, here are the following commonly used OTC pain relievers -

Aspirin

The oldest of analgesics, aspirin or acetylsalicylic acid, is classified under the traditional type of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs). NSAIDs block the enzyme cyclooxygenase (COX), which is needed to create prostaglandins. Prostaglandins are hormone like substances that are responsible for many physiological responses in the body, including those brought about by injury or infection. This type of prostaglandin (COX-2 produced) accounts for the pain and swelling experienced after an injury or an infection. Another type of prostaglandin (COX-1 generated) naturally protects the stomach lining from the stomach acid. Taking aspirin and other NSAIDs long term may inadvertently cause gastro intestinal upset, ulcers, even bleeding.

Because aspirin can interfere with blood clotting, people who take aspirin have an increased risk of bleeding. Anyone who has had a bleeding disorder or uncontrollable high blood pressure should avoid using aspirin unless under medical supervision. Generally, aspirin should not be used in the week prior to a scheduled surgery. Aspirin should never be given to people with dengue or H-Fever. Nor should it be given to children or teenagers below the age of 16, particularly those who have or may have influenza or chickenpox. Although rare, there is a possibility that the child may develop Reye’s syndrome, a disease affecting the brain and liver, sometimes causing death. Aspirin can also aggravate asthma, people with nasal polyps may also develop wheezing.

Ibuprofen, Ketoprofen, Naproxen

Ibuprofen was reclassified from prescription to OTC status in 1984. Prescription- strength ibuprofen usually comes in 300-, 400-, 600-, and 800-milligram tablets; OTC ibuprofen comes in 200-milligram tablets.

Ketoprofen was approved for OTC sale in 1995, available only in its 25-milligram formulation. Prescription-strength ketoprofen comes in 25-, 50-, and 75-milligram capsules, and in the 100-milligram sustained-released capsules.

Naproxen was approved for OTC sale in 1994, available only in the 200-milligram formulation. Prescription-strength naproxen comes in 250-, 375-, and 500-milligram formulation. Dosing instructions for OTC naproxen caution against using more than 3 caplets in 24 hours unless directed by a doctor.

Like aspirin - ibuprofen, ketoprofen and naproxen are NSAIDs that can cause

indigestion, nausea, diarrhea, heartburn, stomach pain, and ulcers. Other adverse effects include drowsiness, dizziness, ringing in the ears, visual disturbances, fluid retention, and shortness of breath. Although ibuprofen, ketoprofen, and naproxen generally don’t impair blood clotting as much as aspirin does, patients should not combine these drugs with anticoagulants like warfarin except under close medical supervision. Likewise, close monitoring is needed when used by people with kidney or liver problems, heart failure, or high blood pressure. Some heart and blood pressure medicines may not work as well when used together with these drugs. Also, people who regularly drink alcoholic beverages may be at a greater risk of stomach upset, ulcers, impaired liver function. People who are allergic to aspirin may also be allergic to ibuprofen, ketoprofen, and naproxen, symptoms like skin rash, itching or breathing difficulties may occur requiring immediate attention.

By and large, OTC analgesics are safe and effective when used properly. All medicines are known to have side effects, and these may vary in degree depending on individual reactions to the medications. People should still exercise common sense and responsibility when using OTC drugs. Read the labels, follow instructions, and don’t be afraid to ask the pharmacist or doctor. Remember, analgesics were made to relieve pain and should not cause more of it. It is not enough to treat the symptom (like headache, pain, fever, etc.). If possible, it is important to further identify the possible root cause of it. Many diseases have common outward symptoms, but have different underlying causes thereby requiring different modes of treatment. Simple errors in diagnosis can prove harmful, even lethal to the patient. When in doubt, it is best to consult a physician.



For comments and insights, please write to Pain Management Information Agency (PMIA) P.O. Box 3485 Makati, fax 892-3968 or e-mail at paincare@pmia.com.ph. PMIA was established primarily to increase public awareness and understanding of pain and to recommend appropriate medical and practical ways to manage and control pain.