Among over the counter pain relivers, which is best for what?-- Headache, muscle pain, joint pain, injuries?
Whatever works best for you. Both acetaminophen and the NSAIDS (aspirin, ibuprofen, ketoprofen, naproxen) are good all-around pain relievers. If you’ve got a sensitive stomach, you may prefer acetaminophen (tylenol). If you need to take something very regularly to fight inflammation (arthritis, etc) then you’d prefer an NSAID (nonsteroidal antiinflammatory drug). Otherwise, try 'em and find what works best for you.
However, if you’ve got a migraine, one of the compounds with caffiene added might work better than the others.
Qadgop, MD
Thanks, Qadgop! (Cool name. Where is Mercot?)
So, everything that isn’t Tylenol is a NSAID? And the NSAIDs are all pretty much alike?
Also, is it really risky to take a non-prescription pain reliver when one has been drinking alcoholic beverages? If so, is there a safe time zone, like, don’t drink until X hours after taking the pain reliever, or don’t take the pain reliever until X hours after finishing one’s last drink?
Without getting too technical, yes, most everything over the counter for pain that isn’t acetaminophen (Tylenol is the best known brand name of this) is an NSAID. In the US, I think there are only 3 NSAIDS available over the counter, ie Ibuprofen (Advil, Motrin), Ketoprofen (orudis), and naproxen (Aleve). In addition, there are dozens of prescription only NSAIDS, including the new Cox-2 NSAIDS, like Celebrex, and Vioxx, which, it is claimed, are less likely to cause stomach bleeding (the main side effect of NSAIDS, but not for acetaminophen). Frankly, I’ve seen a fair number of GI bleeds from the Cox-2 meds too. Which NSAID is best? Depends on the individual.
As for Alcohol, both these classes of meds tend to have a small risk of liver toxicity if taken with alcohol, and it’s hard to figure out what dose or drink number or interval is really “safe”. Basically, if you’re taking pain meds, “less” alcohol is better, and none is best. If you’ve got a history of liver disease, don’t drink at allwhile taking these meds (you shouldn’t be drinking anyway if you’ve got a history of liver disease), otherwise I tell my patients not to drink within 4 hours of taking acetaminophen or NSAIDS, and don’t take more than 2 drinks. Others may tell their patients differently, and many studies say many different things.
And Mercotan is not a place, it’s a state of being. 
I agree with everything Qadgop says (as usual!) but I’ll add one thing. Don’t assume that just because a drug is available over the counter (OTC) it is perfectly safe. I have seen people die (horribly) from inadvertant overdoses of Tylenol. More is not better. If whatever pain medicine you’re taking isn’t doing the trick, don’t take more than the recommended dose in hopes of eliminating the pain. Call your doctor.
Three Excedrine (or a clone) for a headache.
Two Excedrine and One Aleve for a hangover.
Two Orudis KT for a back ache or other muscle ache.
Man, I must be getting old when I have 4 types of pain relievers in my medicine cabinet.
For tooth pain, I stumbled over a half dozen different things before I found what worked for me:
2 Aleve followed by one Aleve per 8-10 hours with an Advil every 4 hours between the Aleve doses.
YMMV, but if I can help anyone else out until you get that dentist appointment. Do NOT exceed the recommended dosage of Aleve on the bottle (which is listed above) unless you want some massive stomach cramping.
Not to be a pain, but I’ve never heard of a Tylenol overdose causing death. Any site links to back this up? I just wonder because, as far as I know its damn near impossible to die from an overdose on OTC painkillers. I’d just like to see some evidence. Even the book Final Exit says it’s damn near impossible to overdose on OTC painkillers or sleeping pills.
For menstrual cramps, I’ve found that ibuprofen works quite lovely, and Tylenol is no use at all. My understanding is that NSAIDS are prostaglandin inhibitors, which work better for muscle cramps. If you could eleborate a bit on this, Qadgop, specifically to the old heave-ol’-monthly-ho, I’d most appreciate it.
Yes to Ibuprofen for menstrual cramps! Ibuprofen is the best anti-prostaglandin (the demon responsible for cramps). Ibuprofen is also best for muscle aches, I think.
[[Not to be a pain, but I’ve never heard of a Tylenol overdose causing death. Any site links to back this up? I just wonder because, as far as I know its damn near impossible to die from an overdose on OTC painkillers.]]
Well duh, Cecil has talked about it:Does Tylenol + alcohol = liver failure?
…“So let me put the issue as objectively as I can. Tylenol is the most popular pain reliever in the U.S. Tens of billions of doses of it and other acetaminophen-based products are consumed each year. For the overwhelming majority of users these medicines work as advertised and are completely safe. However, you do face the slight chance of abrupt death.
Acetaminophen overdose is the leading cause of acute liver failure, even if we leave alcohol out of the picture.”
[Edited by JillGat on 05-06-2001 at 07:40 PM]
My perfect combination is one Tylenol III every fifteen minutes with a shot of Jack Daniels.
See link above, AcidKid. Dumb idea.
Sorry Jill, but even Cecil didn’t supply a link. And accute liver disease is not an immediate death. The post made it sound like they’ve heard of someone dying from an “overdose” of Tylenol. Accute liver disease is something that takes some time to kill you. An “overdose” kills you because of the immediate effects of the drug (i.e. you drop 60 Tylenol and die and don’t wake up.)
Sorry Gazoo, but Jill is pretty accurate.
First off, the condition involved is not acute
liver disease, but acute liver failure. According to the link, the survival rate is in the 98% range, which means that every 50th time you try this, you’ll die. Normal time of death is 72-96 hours after ingestion, which is close enough to instant for me. Maybe it won’t kill you instantly, but I’d rather have more than four days to live.
This page about a drug called felbamate says that the incidence of acute liver failure in the U.S. is about 2,000 cases a year. 20-30 percent of that (the range cited by Cecil) is 400-600 deaths a year that are acetaminophen related.
Is that enough figures for you?
Cecil don’t need no stinkin’ links. But here’s a few:
http://www.longerliving.com/acetaminophen.htm
Although at therapeutic doses (typically two 500mg tablets every 4-6 hours), acetaminophen is an extremely effective and safe analgesic, if taken in overdose the drug leads to massive liver failure that can result in death if appropriate treatment is not administered quickly.
http://ne.essortment.com/tylenoloverdose_rtev.htm
Recent publications show that Tylenol overdoses have been correlated with hundreds of tragic deaths and serious liver injuries. And apparently, a relatively small extra dose can have potentially huge repercussions.
http://www.mc.vanderbilt.edu/peds/pidl/acute/acetamin.htm
http://www.nando.net/newsroom/ntn/health/101697/health33_10908_body.html
(October 16, 1997 5:46 p.m. EDT http://www.nando.net) – Accidental acetaminophen overdose is more likely to be fatal than use of the drug in suicide attempts, researchers say. Overdose from the popular pain-reliever can cause death from liver damage, especially when alcohol is an added factor.Studying overdose patterns at one urban hospital, the researchers found that even though patients who accidentally took too much of the common non-prescription pain reliever took an average dose less than half that taken by people attempting suicide, the accidental overdoses more often resulted in severe liver damage and death.
http://www.biomed.lib.umn.edu/hmed/971016_liver.html
Newspaper Article Synopsis:
A new study showed that people who accidentally overdose on acetaminophen have a higher mortality rate than those who took the overdose during a suicide attempt. The reason could be that the accidental overdose group had a high rate of alcohol abuse.
http://www.whale.to/drugs/acetaminophen1.html
They even are seeking data from Britain, where so many people used
acetaminophen for suicide that British health authorities now
restrict how many tablets are sold at once.
Fifty-three deaths resulted from overdoses of acetaminophen alone.4 Acetaminophen overdose is the second most common cause of hepatic failure requiring liver transplantation in the United States.5 Published information primarily pertains to acute overdose of acetaminophen in adults and adolescents.
http://index.truman.edu/issues/20002001/0412/news/pain12.asp
Failure to properly use the over-the-counter drug acetaminophen can cause serious health problems and even death.
http://www.acsh.org/publications/booklets/pain_relievers.pdf
According to the A m e r i c a nAssociation of Poison Control Centers, there were128 deaths attributed to aspirin overdose and 124deaths attributed to acetaminophen overdose between1988 and 1993.
http://www.postgradmed.com/issues/1999/04_99/salgia.htm
). In 1996, according to the annual report of the American Association of Poison Control Centers (3), 50,911 cases of acetaminophen poisoning were treated in healthcare facilities; 113,883 cases of poisoning that involved acetaminophen alone or along with one or more coingestants (eg, aspirin, narcotic) were reported to poison control centers; 52 deaths were directly related to use of acetaminophen alone; and 50 deaths involved acetaminophen plus one or more coingestants.
Tylenol overdose is an very common way that people try to kill themselves.
A 7 gram dose (20 extra-strength pills) is enought to put you at serious risk of toxicity. Higher doses carry worse prognoses.
Tylenol overdosage is treatable with favorable outcomes in most cases if therapy is begun within 8 hours of ingestion.
As far as what kills you, an overdose or the liver failure, I think this is a semantic issue. Tylenol kills you by killing your liver.
Gazoo, IMHO your definition of “overdose” is overly narrow, applying only to substances whose ingestion immediately impairs the function of an organ system indispensible for life on a moment to moment basis (eg. brain, heart, lungs). Try to keep more of an open mind, Gazoo, there are many toxins that don’t work this quickly but leave you good and dead nonetheless.
[sub]:::Realizing this post pales in comparison on preview. Damn that Jill, she’s so efficient:):::[/sub]
Generally, aspirin is good for all minor aches and pains. Acetominophen for moderate aches and pains. ibuprofen for things like a tension headache, sprains, joints, sore muscles. I take them all depending on what hurts, sometimes in combination (half dose advil, half dose tylenol). Aspirin or tylenol will work on a tension headache, but not as well as advil, and advil will work on a burned finger, but not as well as an aspirin or tylenol. Basically, if it’s simple pain, go with aspirin or tylenol. If its something due to inflammation, go with advil. Some people swear by naproxin for inflammation, but I’ve never tried it myself so I don’t know how good it works on what.
Thanks Jill, for supplying all the great links. It’s all true, acetaminophen is the chief cause of acute liver failure, and acute liver failure kills. Period. I have seen it. I’ve treated enough tylenol OD’s in the ER, some successfully, some not. It can cause liver failure and coma in hours, and death can rapidly follow.
Gazoo I don’t know where you get your misinformation that acute liver failure does not kill, but it is wrong wrong wrong
Qadgop, MD
And by the way, not only does Tylenol (acetaminophen) in overdose kill, it does so in a horrible, gross way.
Victims are delirious for a while, then, as Qadgop mentioned, they lapse into a coma. Simultaneously, they begin to turn yellow. A sick, rotten yellow. This is accompanied by bleeding. From every orifice, and under every surface in the body. And, they stink. With the liver shot, the smell of ammonia and its compounds pervades the patients’ rooms. An assault on the senses of even the most experienced health care worker.
Usually they die in a day or two. It is not quick. And not painless. Hardly a way to choose to end one’s life.
In the UK, there is a law preventing you from purchasing more than a small quantity of acetaminophen at once. Since the law came into effect, the number of deaths from acetaminophen overdose have dropped dramatically.
Thank you, Jill, for supplying the links.
I’ve also seen patients die from Tylenol OD; the most memorable was a guy who took approximately 25 extra strength tabs (that would be 12,500 milligrams) for a toothache. Karl’s description of what this looks like is accurate. It took several hours for him to die, but fortunately he was so demented from the ammonia in his blood that he probably didn’t feel too much of it. I hope.