Why so few over-the-counter analgesics?

Factual Questions
1

Minor to moderate pain is a problem for almost everybody. Whatever the issue or illness, be it acute or chronic,* there’s not a whole lot of choices when it comes to OTC pain-relievers.

We have only about 4 choices, and really only 2 classes as far as I can count: NSAIDs (Ibuprofen, aspirin, and naproxen), and acetaminophen.

All of which I find to be effective for only very minor aches, or fever reduction. And, IME, not much difference between the four.

Of course, there’s a host of medicine and drugs that have analgesic properties, but are either toxic with extended use or addictive/mind-altering, and have to be dolled out with a prescription (narcotics/opioids).

There seems to be no middle ground. Also, even the OTC choices are toxic to your liver over extended periods, overdose, alcohol or other drug related combos, or just because you might have a crazy-rapid metabolism.

I can’t imagine the pharmaceutical companies aren’t trying to design an analagesic that’s at least as effective as hydrocodone, but mitigating any addictiveness, tolerance, toxicity, or withdrawal symptoms to acceptable OTC levels.

So, I suppose my question is, while certainly this is something that is probably undergoing continual research; in over 100 years, has there been any new avenues, interesting developments, or novel chemistry in this category?
*I deal with leg cramps, head aches, back aches, TMJ, etc. almost every day. I cringe at the amount I take a day, which is still under the recommended dosage, but I’ve been eating these things like Tic Tacs for years, and still these drugs barely give much relief.

2

I’m going to guess that there aren’t more because between acetaminophen and ibuprofen (and the handful of others that you mentioned along with Excederin which has caffeine in it) most people are pretty well covered and beyond that the rest of them go to the doctor for something stronger.

Have you tried taking Tylenol and Advil together?
You can do it in one of two ways.
A)Alternate doses so that every two hours or so your taking one or the other that way as one is starting to wear off you’re taking the other one
B)Take them at the same time (1000mg Tylenol/400mg Advil). They potentiate each other. That is, the sum of the two is greater then the individual parts. IOW taking them at the same time will provide more pain relief then taking them separately. Sometimes called the multiplier effect.

3

Thanks, Joey P. I didn’t know that about Advil + Tylenol. I’ll give it a shot. I’ve alternated between the two, but was never sure if taking the two together was unhealthy.

In general, I’ve been on Vicodin for kidney stones several times. After I passed the stones, I’d usually have plenty of Vicodin left. One 5/500, would last me practically all day, as opposed to taking 3,000 mg of Tylenol, which only alleviated about 50% of my aches/pains.

But, I don’t like the slippery slope of opiates. Its euphoric effects scare me; I can see why it’s addictive. But the analgesic effects are incredibly effective.

On top of this, I like to drink occasionally. I love beer and wine with some meals, or just hanging with friends. It pisses me off to have to try and schedule my pain around the times where I’d like to have a drink or three.

It’s a weird thing to try and balance. I’ll be 40 in another year+, so I can imagine general pain issues will only increase, despite any exercise or diet regimens; our bodies wear out, and I work behind a desk at a computer for 10 –20 hrs out of the day. I guess I’m still surprised to see no new OTC pain-relief medications that are compatible with these common issues.

There’s has to be some big-time research going on in the last 100 years or so. Pain-releif is a huge issue. I suppose I’m half bummed, half surprised to see no middle ground by now (i.e. the better of both worlds: NSAIDs/Tylenol vs. Narcotics/Opiates).

4

Nope, not unhealty, if alternating isn’t working, I’d give this a shot.
If I want the pain relief to last all day I alternate*, if I want to knock out some nasty pain, I take them both at the same time.
I’m having trouble digging up some reliable sites**, but if he sees it, Qadgop should back me up on this.
*used to anyways. I almost never take ibuprofen anymore since even one pill causes really, really bad heartburn. The only way I’ll take ibuprofen (or really any NSAID) is as a last resort, on a very full stomach with as much water as I can tolerate and right before I go to bed with a couple of Tums, so the heartburn will hopefully happen while I’m sleeping.

**For me, reliable sites WRT medical stuff are things that end in .gov or .edu, sometimes even .org, ya know, as opposed to wikianswers or random geocities pages.
If you search this board for potentiate and Tylenol I’ll bet you’ll find other threads on the same subject.

5

I trust you know what you’re talking about when it comes to OTC stuff (and even medical issues… I recognize your username, and long posting history to intuit you know what you’re talking about; albeit such things are discouraged on message boards). However, I’d welcome any sites.

In fact, I have a bummer of a headache, I might just take a couple Tylenol and an Advil right now. :wink:

6

http://www.zocdoc.com/answers/5651/can-i-take-advil-and-tylenol-together

Here’s the best one I could find. It’s a oral surgeon’s website directing patients to take Advil in addition to their pain killers instead of more Tylenol if they need additional relief since Vicodin and Percocet already have Tylenol in them.

In short, two Tylenols, two Advils, you should be just fine.
Also, I’m sure you know this since but don’t double up on NSAIDs at the same time. Taking two Advils and two Motrins is the same as taking 4 Advils. Taking two Advils and a Naproxen is taking 3 pills from the same class. But Tylenol and Advil are different drugs.

7

Again, much thanks. Knowledge is power and power kills pain. Or something.

Anyway, yes. I’m aware that Ibuprofen, aspirin and naproxen can’t be doubled up on, as they’re in the same class (non-steroidal anti-inflammatories) and acetaminophen is basically in a class all it’s own (as a relatively safe OTC pain-killer, that is), but it’s good to point out such things if not to cover your ass, but for whomever else may be reading. We don’t want people’s livers falling off!

I’ll give this method a go, and see if there’s a noticeable improvement.

8

Are you dead?

9

I’d also mention that some of the prescription medications are moderate. I know the OP asked about OTC specifically…but for some people’s drug insurance plans, it can actually be cheaper to be on prescription. So just in case it applies to someone else out there who finds this thread…read on.

Various NSAIDS work differently for different people. Ibuprofen works for me. I was taking it like tic tacs, as the OP says, for a variety of problems (knees, hands, bunion…) Without getting into the details and hijacking the thread a bit, I ended up going through a series of NSAIDS until we found a good combination of a low dose and high effectiveness.
Naproxen sodium tends not to help me. I ended up on Mobic 7.5mb, which is one tiny pill a day.
Stayed on that for about a year with no side effects - my GP had me do blood work every three months and things looks fine.

Also not an option for your scenario, but working well for me right now - I got off the Mobic, and now have occasional pain in either one specific joint in my hand, or at the bunion on my right foot. Most of the time it is minor, but occasionally one or the other causes me to not be able to type comfortably (I’m a programmer…I type for a living) or not be able to walk without pain. My ortho gave me Voltaren Gel. I use it when needed, and get near immediate relief.

-D/a

10

Depending on your insurance plan, often it can be cheaper to get the OTC meds by prescription. For example, if you have a $5 copay, it might be worth it to ask the doc for 180 200mg (2 pills 3 times a day, 30 days) Ibuprofen by prescription that way it costs $5.00 and something similar for Tylenol rather then spending $15 dollars buying it OTC. If you’ve hit your deductible for the year, it might even be free.
When my old GP wanted me on a high dose of Motrin for some back pain I asked him to do this and he refused. This is one of the reasons why he’s my old GP.

I recently found out that my insurance plan allows a handful of OTC meds to be acquired for free if I have a script with their ‘zero tier’ program. Luckily I found out about just as I was about to go and buy some Zyrtec so all I had to do was have my ENT call a 90 day supply into Walgreens and I walked out with the pills an hour later, no charge.

11

I died. But I got better.

12

Huh. I did not know that (RE: paying on the cheap for OTC via Rx). Thanks Digital’ and Joey P.

Although, I’m self-employed and have shitty insurance, so I have copays up the wazoo. Interesting though. Next time I’m at the docs, I’m sure he’ll write up a script for Ibuprofen (unlike other GPs who are dicks—what was his beef with writing an Rx for frikkin’ Motrin?! Good on you for dumping him.)

Speaking of GPs, a couple years ago, he did write me an Rx for naproxen, and I followed the regimen for a couple months, but it didn’t seem to work well for me. I’ve given the stuff a few more shots since then even, just to be sure, and despite the lure of “one pill a day” (or seven), well, it must not work for everyone…

…and then I died.

13

I was originally I was going to ask you “Did you get better” but I didn’t think the joke would come through without the setup.

Shitty copays or not, check the math first. Also, I don’t know what his problem was. Also, once he told me to take Benadryl for something (hives) and I mentioned that I had just picked up some generic Simply Sleep. He told me he would rather I went out and purchased the Benadryl. Even after I explained to him that “they are both Diphenhydramine Hcl in 50mg pills” he replied “Yeah, I would still rather you took Benadryl” That was another strike against him. I thought if I tossed the drug name his way so he knew I knew what the hell I was talking about he would let it go (so he knew that I wasn’t taking something else) but nope. Anyways, that was another strike. A few other issues and that was the end of it.

Also, speaking of shitty copays I have a high deductible and everything (office visits, ER visits, drugs) are REALLY expensive. My insurance people pointed me to a place called BidRx.com. You have to call them to get set up. But what you do is plug in the name of the drug you are looking for (based on the script you have (or the one you are planning to get or refill)) along with the dose and amount of pills and a bunch of pharmacies within something like a 250 mile radius ‘bid’ on it, including shipping. You pick the cheapest one and that’s it. It’s saved me a shit ton of money.
I was paying about $50 per dose for imitrex and got it down to $38.
I’m on Topamax. Walgreens was charging me $30 dollars per month and I just got a 3 month refill for, are you ready, $12. That’s a savings of $72 over three months. My doc recently upped my script from 2 pills a day to three pills, the three month script went from $12 to $16. I assume Walgreens would have gone from $30 to $45.

Now, for me, personally, BidRx works closely with my insurance company. Anything I do through BidRx applies to my deductible. From what I understand, that’s not the case for every insurance company so you might want to find out from yours. If it doesn’t happen automatically, you might want to find out if you can have anything you pay the pharmacy applied to your deductible (assuming it’s less then you would have paid) since you’re saving the insurance company money. I could be wrong on this, it’s just something I ‘gathered’ since I was once getting a script filled and I mentioned to the pharmacy that won the bid that it might be too early to refill it and she told me not to worry since they don’t work with the insurance companies so it won’t be an issue. But like I said, I know they DO work with mine.

Also, FTR, I just put out a bid for 270 400mg (same as 2 200mg pills 3 times a day for 90 days) Ibuprofen and the lowest pharmacy is coming back at $10.40. Can you get 500+ count bottle of (generic) Advil for $10? Actually, yeah, you probably can, so maybe it’s a wash on the Advil, (with my plan) but it’s still good to know if you have a $5.00 copay or you’ve hit your deductible.

–270 800mg pills came back at $13.10 That’s the equivalent of a bit over 1000 Advils. Might be a bit much, but sometimes it’s fun to play with the numbers.

14

It sounds like you answered your own question. A painkiller more powerful than acetaminophen but with none of the toxic side effects of other painkillers (in fact even acetaminophen and ibuprofen are toxic with extended or heavy use) would likely be very popular and profitable. So the reason no one has developed it is because no one has been able to invent one. I remember a poster - a doctor - saying in a thread on this board a few months ago that for treating severe pain, medicine almost literally hasn’t changed in 100 years - opium.

15

It may be worth pointing out that a safe OTC pain reliever that reliably knocked out severe pain would be a mixed blessing, since it would likely result in some people self-treating their pain instead of seeing a doctor for treatment of the possibly dangerous condition that the pain was a symptom of.

16

I think there are so few options for the same reason thers are so few effective diet drugs. Trying to shut off pain (or hunger) is very difficult. These feelings are in place for a reason, and are tied in to several systems in your body. We may feel there are times when we would be better off without them, but as far as your body is concerned you’re just trying to shut down a very important process necessary for your continued survival.

17

They developed some new drugs (COX-2 inhibitors: Vioxx and Celebrex) a few years ago for daily management of arthritis and pain that were very effective, but unfortunately the pesky side effects included stroke and death.

There are quite a variety of prescription pain medications, if the over the counter drugs aren’t working for you then I recommend you talk to your doctor.

18

There are so few choices for OTC pain killers because there are so few choices for pain killers as a whole.

There’s NSAIDs like aspirin, ibuprofen, naproxen, celebrex and dozens of others (and no single one of them has been shown to be superior in relieving pain overall).

There’s acetaminophen.

There’s opioids (not OTC in the US.) Potency varies from one type to another, but they all work at the opiate receptors in the human nervous system.

And that’s really it.

The human pain system is very sophisticated and complex, and turning it off is neither easy nor generally desirable (for the long term).

19

Are combination analgesics (eg ibuprofen + codeine) available OTC in the US? We can get OTC combination meds with codeine up to 8mg without a prescription in Australia. Anything stronger (eg Panadeine Forte) needs a script.

20

Bookmarks BidRx with indelible pixels

Sweeet. We pay hundreds of dollars a month for meds between the four of us in my family. This could certainly be a huge boon!

So, I’m not overweight, I eat healthy enough, My cholesterol is okay, my BP is normal, I’ve cut down on caffeine, and drink plenty of water. I’m barely 40, and have no diseases (unless you count the kidney stones) that I know of, and yet I just hurt everyday. Perhaps I don’t exercise enough, but I’m not sure that’s going to do a whole lot, unless I become a full-time athlete. It really seems to be a complication of being chained to this desk for hours a day and my posture, ergonomics be damned.

I suppose I can ask my GP for a regimen of codeine or vicodin, That is if he doesn’t :dubious: and laugh me out of his office. It just doesn’t seem to even be considered a real option, unless there’s something you can point to and say, “There! That’s what’s causing you pain! That’s pretty serious.”

I’ll imagine I’ll get the ‘exercise more’ spiel, which, outside of 10 - 15 mins a day, isn’t much of an option for me at this juncture.