Over-The-Counter Pain Relievers | Types, Effects, & Warnings Of Misuse

Most people understand the risks of misusing prescription opioid painkillers. However, it’s also dangerous to misuse over-the-counter (OTC) painkillers, especially nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen. 

Here’s what you should know about OTC NSAID and acetaminophen misuse.

Types Of Over-The-Counter Pain Relievers

The two main types of the OTC pain relievers, NSAIDs and acetaminophen, are both used to relieve pain and are available without a prescription.

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

NSAIDs are medications that ease pain, inflammation, and fever. They’re used to treat symptoms of conditions such as:

• the common cold
• flu
• headaches
• muscle sprains and strains
• painful periods
• arthritis
• cystic fibrosis 

The most common over-the-counter NSAIDs include: 

• aspirin (brand name Bayer, Bufferin, or Excedrin)
• ibuprofen (Advil or Motrin)
• naproxen (Aleve)

NSAIDs are among the most popular medications in the world. According to Harvard Health Publishing, about 15% of Americans take an NSAID on a regular basis.

Acetaminophen

OTC acetaminophen is an non-aspirin pain reliever found in the brand names Tylenol, Paracetamol, and Panadol. It is also available in OTC generic forms.

Like NSAIDs, acetaminophen reduces fever and pain. Unlike NSAIDs, however, acetaminophen does not reduce inflammation. In general, acetaminophen treats similar conditions as NSAIDs, such as:

• colds
• headaches or migraines
• menstrual cramps
• arthritis
• toothaches
• sore throats
• muscle aches and pains

While OTC acetaminophen products are ideal for headaches and other common pains, prescription acetaminophen is often combined with opioids for a stronger pain-relieving medication.

Effects Of OTC Pain Relievers

Both acetaminophen and NSAIDs work by decreasing your body’s production of prostaglandins. Prostaglandins are hormone-like compounds that increase body temperature and dilate blood vessels. These effects can contribute to pain, inflammation, and fever.

Since acetaminophen does not reduce swelling or inflammation like NSAIDS, the full extent to how acetaminophen works is unknown.

When used as directed, both NSAIDs and acetaminophen are safe and effective. However, like other over-the-counter medications, they can have side effects. 

The most common side effects of NSAIDs and acetaminophen may include:

• headache
• dizziness
• drowsiness 
• constipation 
• diarrhea
• high blood pressure

Warnings Of OTC Pain Reliever Misuse

Some people misuse over-the-counter NSAIDs and acetaminophen by using them in a manner not recommended on the label. For instance, they might:

• take more than the recommended dose
• take them for an extended period of time to treat chronic pain 
• take them with alcohol or other drugs

All forms of OTC painkiller misuse can have serious side effects, including: 

Gastrointestinal Bleeding

Gastrointestinal bleeding is bleeding that occurs in the digestive system. Common symptoms include:

• paleness
• fatigue
• dizziness
• weakness
• shortness of breath
• stomach cramps
• black or tarry stool
• blood in vomit or stool

NSAIDs are more likely to cause gastrointestinal issues than acetaminophen. If you or someone you know experiences these symptoms, seek medical help right away. When left untreated, gastrointestinal bleeding can be fatal.

Ulcers

Ulcers are sores that form on the lining of your esophagus, stomach, or small intestine. Common symptoms include:

• stomach pain
• nausea
• bloating
• heartburn
• appetite changes
• black or tarry stool
• blood in vomit or stool
• unexplained weight loss

When left untreated, ulcers can have life-threatening complications, including gastrointestinal bleeding.

Liver Damage

Due to how the body processes acetaminophen, taking too much can increase the risk of severe liver damage. Symptoms of liver damage may include:

• jaundice, or the yellowing of your skin
• pain in abdomen
• vomiting/nausea
• fatigue
• bruising and bleeding
• dark stools and urine
• loss of appetite

Kidney Damage

OTC painkiller misuse can contribute to various types of kidney damage, including hemodynamically mediated acute kidney injury (AKI), acute interstitial nephritis (AIN), and papillary necrosis. All of these conditions can be fatal when left untreated.

Common signs of kidney damage include:

• loss of appetite
• nausea and vomiting
• fatigue
• trouble sleeping
• muscle cramps
• chest pain
• shortness of breath

Cardiovascular Problems

People who misuse OTC pain relievers face a higher risk of life-threatening cardiovascular problems, including heart attack and stroke. Common signs of a heart attack or stroke include:

• chest pain
• shortness of breath
• confusion
• slurred speech
• sudden weakness or numbness, especially on one side of the body

Pregnancy Problems

According to the United States Food and Drug Administration (FDA), using NSAIDs at week 20 or later of a pregnancy can cause kidney problems in a developing fetus. 

These kidney problems can cause low levels of amniotic fluid, which may hinder the development of the baby’s lungs, muscles, and digestive system. 

Overdose

Taking more than the recommended dose of acetaminophen or an NSAID may result in a life-threatening overdose. Common symptoms of an overdose may include:

• drowsiness
• dizziness
• headache
• blurry vision
• ringing in the ears
• sweating
• nausea and vomiting

You may also experience more severe symptoms, including:

• low blood pressure
• trouble breathing
• seizures
• loss of consciousness 
• rash, hives, or itching

If you think you or someone you know is overdosing, seek medical attention immediately. 

Addiction

Regular misuse of OTC painkillers can lead to addiction. Addiction (also called substance use disorder) is a serious condition that makes you feel unable to stop using a drug. Other symptoms may include:

• frequent drug cravings
• mood swings
• loss of interest in activities once enjoyed
• tolerance (needing increasingly higher or more frequent doses of a drug to feel the desired effects)
• physical dependence (experiencing unpleasant withdrawal symptoms when you don’t use a drug)

OTC medication addiction is treatable. 

If you or someone you know experiences the above symptoms, seek help at a substance abuse treatment program. Available on an inpatient or outpatient basis, these programs offer a variety of treatments to help you stop using OTC pain relievers, including:

• behavioral therapy, in which a mental health professional can help you change unhealthy beliefs and behaviors that contribute to your drug abuse
• medical detox, in which doctors can help you stop using with minimal withdrawal symptoms
• support groups, in which you can discuss your experiences and coping skills with other people in recovery from addiction

To learn more about addiction treatment options, please reach out to an Ark Behavioral Health specialist. Our board-certified healthcare providers offer personalized, evidence-based treatments to help you recover from various types of drug use, including acetaminophen NSAID use.