# Why so few over-the-counter analgesics? **URL:** \ **Category:** Factual Questions\ **Created:** [September 18, 2011, 2:29am UTC](https://boards.straightdope.com/t/why-so-few-over-the-counter-analgesics/596690 "2011-09-18T02:29:02Z")\ **Posts on this page:** 20\ **Page:** 3
**Author:** ![cmyk](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/cmyk/32/3353_2.png) [@cmyk](https://boards.straightdope.com/u/cmyk)\ **Post date:** [September 19, 2011, 11:59pm UTC](https://boards.straightdope.com/t/why-so-few-over-the-counter-analgesics/596690/41 "2011-09-19T23:59:29Z")
Rarely has Vicodin made me nauseous. I think I slightly OD’d one night during really bad kidney stone pain, and puked my guts out, and maybe only slightly if I took them on an empty stomach. Yeh. Those were good times. By now, I don’t think I’d feel anything but the analgesic of codeine at such a low dose. ---
**Author:** ![loshan](https://avatars.discourse-cdn.com/v4/letter/l/ce73a5/32.png) [@loshan](https://boards.straightdope.com/u/loshan)\ **Post date:** [September 20, 2011, 4:55am UTC](https://boards.straightdope.com/t/why-so-few-over-the-counter-analgesics/596690/42 "2011-09-20T04:55:07Z")
Vicodin makes me sick to my stomach and itch, Itch, ITCH…if I don’t have bad pain. Somehow, if I am severe enough pain, those side effects are not there. Hence my conclusion that Vicodin is conscious and “knows” when I really hurt. 😉 ---
**Author:** ![Mama\_Zappa](https://avatars.discourse-cdn.com/v4/letter/m/71e660/32.png) [@Mama\_Zappa](https://boards.straightdope.com/u/Mama_Zappa)\ **Post date:** [September 20, 2011, 6:25pm UTC](https://boards.straightdope.com/t/why-so-few-over-the-counter-analgesics/596690/43 "2011-09-20T18:25:39Z")
> [@kenobi\_65](#): > > When I was first diagnosed with diabetes in 2005, I was suffering from neuropathy in my feet. I was taking two Aleves a day, every day, for about six months…and managed to give myself a stomach ulcer from that. I’m now only allowed to take NSAIDs on an occasional basis. 😃 There are things that can be added to help protect the stomach if you do need an NSAID. I had a scrip for Arthrotec which is diclofenac (Voltaren) plus misoprostol for the stomach. The diclofenac did a much better job on my knee pain than ibuprofen did. Of course, the combo is much pricier than the two components individually for most people. ---
**Author:** ![Backcountry\_Medic](https://avatars.discourse-cdn.com/v4/letter/b/919ad9/32.png) [@Backcountry\_Medic](https://boards.straightdope.com/u/Backcountry_Medic)\ **Post date:** [September 20, 2011, 6:59pm UTC](https://boards.straightdope.com/t/why-so-few-over-the-counter-analgesics/596690/44 "2011-09-20T18:59:36Z")
> [@curlcoat](#): > > In the US. In Canada the products that are OTC with codeine in them also have caffeine in them. I would wager that this is might be something of a safety mechanism, caffeine belongs to a category of drugs known as Xanthines. It works just like you would expect a CNS stimulant, raising pulse and respiratory rate. They sometimes give caffeine or theophylline to premature infants who have a poor respiratory drive. The major concern with giving someone too much opiates is that they slow their respiratory rate to an unacceptable level or they lose the ability to protect their airway. Giving them a little stimulant at the same time probably lessens those effects. It’s just an added bonus caffeine has some pain reducing traits by itself. It would make sense to have a similar safeguard in place if something like that was sold OTC here, but I wouldn’t hold your breath on that one. Drugs are bad m’kay… ---
**Author:** ![AndyLee](https://avatars.discourse-cdn.com/v4/letter/a/898d66/32.png) [@AndyLee](https://boards.straightdope.com/u/AndyLee)\ **Post date:** [September 20, 2011, 7:11pm UTC](https://boards.straightdope.com/t/why-so-few-over-the-counter-analgesics/596690/45 "2011-09-20T19:11:14Z")
I think Orudis sums up why there aren’t any more OTC pain killers. I had my first bad toothache/root canal and they dentist told me to take Orudis which was sold over the counter. It worked great. Much better than Motrin or Tylenol. But then they stopped making Orudis because sales OTC weren’t living up to expectations. Since then no one else has tried to make an OTC NSAID, at least I don’t think in the USA they have. You have enough choices with Aspirin, Motrin (+generics), Aleve (+generics), and Tylenol (+generics). I guess eventually someone will figure out a way to market Orudis again or another NSAID and get it approved for OTC ---
**Author:** ![Qadgop\_the\_Mercotan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/qadgop_the_mercotan/32/83_2.png) [@Qadgop\_the\_Mercotan](https://boards.straightdope.com/u/Qadgop_the_Mercotan)\ **Post date:** [September 20, 2011, 7:38pm UTC](https://boards.straightdope.com/t/why-so-few-over-the-counter-analgesics/596690/46 "2011-09-20T19:38:54Z")
> [@AndyLee](#): > > I think Orudis sums up why there aren’t any more OTC pain killers. I had my first bad toothache/root canal and they dentist told me to take Orudis which was sold over the counter. It worked great. Much better than Motrin or Tylenol. Your experience with Orudis is not universal. As I’ve noted before, good solid studies show that no one NSAID stands out as superior to other NSAIDs in terms of pain relief. I’ve had patients proclaim meloxicam, ketoprofen, naproxen, or keterolac as the absolute best pain reliever ever, while having others say those same ones did nothing for them, instead getting serious relief from ibuprofen, indomethacin, sulindac, or others. It’s really a horse apiece (though naproxen may be safer from a cardiac standpoint and indocin may be the worst culprit for inducing GI bleeding.) ---
**Author:** ![MsRobyn](https://avatars.discourse-cdn.com/v4/letter/m/90ced4/32.png) [@MsRobyn](https://boards.straightdope.com/u/MsRobyn)\ **Post date:** [September 20, 2011, 7:51pm UTC](https://boards.straightdope.com/t/why-so-few-over-the-counter-analgesics/596690/47 "2011-09-20T19:51:42Z")
> [@cmyk](#): > > Maybe meloxicam is still too new, and has to jump through more human trial steps before they can get the FDA to approve it for OTC (assuming they don’t know already if the physiological effects are any worse than ibuprofen, etc.) > > I’d be interested in trying it out, if I could, with the results you state. But it really seems pushed toward treating arthritis, which I don’t have. Meloxicam is bad ju-ju in anything more than 7.5-15 mg per day. Not per dose, per day. I’ve been taking it for my neck pain for about a month now (this time). My doctor made me pinky-swear that I would not take more than one pill twice a day; if the meloxicam didn’t work at that dosage, I was to call her for a new prescription and an appointment for re-evaluation. I’ve also learned to take the stuff on a FULL stomach. Not a small snack or a little glass of milk, but a FULL meal. If I take it with less food than that, it’s uncomfortable. Don’t get me wrong. It’s a fantastic drug that works very, very well. It’s just that most Americans are of the “if one is good, two is better and three is perfect!” mindset and can’t be trusted to follow directions. One extra Advil won’t hurt (much), but an extra meloxicam can and likely will. ---
**Author:** ![curlcoat](https://avatars.discourse-cdn.com/v4/letter/c/ea5d25/32.png) [@curlcoat](https://boards.straightdope.com/u/curlcoat)\ **Post date:** [September 21, 2011, 1:42am UTC](https://boards.straightdope.com/t/why-so-few-over-the-counter-analgesics/596690/48 "2011-09-21T01:42:55Z")
> [@Backcountry\_Medic](#): > > I would wager that this is might be something of a safety mechanism, caffeine belongs to a category of drugs known as Xanthines. It works just like you would expect a CNS stimulant, raising pulse and respiratory rate. They sometimes give caffeine or theophylline to premature infants who have a poor respiratory drive. > > The major concern with giving someone too much opiates is that they slow their respiratory rate to an unacceptable level or they lose the ability to protect their airway. Giving them a little stimulant at the same time probably lessens those effects. It’s just an added bonus caffeine has some pain reducing traits by itself. And I always thought they did it to make it less likely that someone would fall asleep! > [@](#): > > It would make sense to have a similar safeguard in place if something like that was sold OTC here, but I wouldn’t hold your breath on that one. Drugs are bad m’kay… Not for me! Better living thru chemistry! 😃 ---
**Author:** ![salinqmind](https://avatars.discourse-cdn.com/v4/letter/s/3ec8ea/32.png) [@salinqmind](https://boards.straightdope.com/u/salinqmind)\ **Post date:** [September 21, 2011, 2:16am UTC](https://boards.straightdope.com/t/why-so-few-over-the-counter-analgesics/596690/49 "2011-09-21T02:16:55Z")
I do wish they’d get the Tylenol situation straightened out. It’s the only thing that works for my mom, and I find myself checking out every single store I go to in hopes of finding a bottle. Last week I saw one lonely bottle behind the counter at a bodega, $8!!! WTH? ---
**Author:** ![Mama\_Zappa](https://avatars.discourse-cdn.com/v4/letter/m/71e660/32.png) [@Mama\_Zappa](https://boards.straightdope.com/u/Mama_Zappa)\ **Post date:** [September 21, 2011, 2:28am UTC](https://boards.straightdope.com/t/why-so-few-over-the-counter-analgesics/596690/50 "2011-09-21T02:28:42Z")
> [@salinqmind](#): > > I do wish they’d get the Tylenol situation straightened out. It’s the only thing that works for my mom, and I find myself checking out every single store I go to in hopes of finding a bottle. Last week I saw one lonely bottle behind the counter at a bodega, $8!!! WTH? What’s the problem with Tylenol? I bought some store-brand acetominophen last month with no problem. ---
**Author:** ![abbeytxs](https://avatars.discourse-cdn.com/v4/letter/a/eb9ed0/32.png) [@abbeytxs](https://boards.straightdope.com/u/abbeytxs)\ **Post date:** [September 21, 2011, 2:47am UTC](https://boards.straightdope.com/t/why-so-few-over-the-counter-analgesics/596690/51 "2011-09-21T02:47:29Z")
> [@Mama\_Zappa](#): > > What’s the problem with Tylenol? I bought some store-brand acetominophen last month with no problem. Brand name Tylenol has been recalled. Nothing serious. The store brands are still just fine to use and widely available. ---
**Author:** ![aruvqan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/aruvqan/32/2891_2.png) [@aruvqan](https://boards.straightdope.com/u/aruvqan)\ **Post date:** [September 21, 2011, 9:13am UTC](https://boards.straightdope.com/t/why-so-few-over-the-counter-analgesics/596690/52 "2011-09-21T09:13:15Z")
> [@Ferret\_Herder](#): > > Those who haven’t tried naproxen may wish to give it a shot - for strong pain they recommend starting with two tablets rather than one. I’ve always found it extremely effective for things like debilitating menstrual cramps, migraine (well, as effective as anything - migraine pain is tricky), etc. Normally I would, except I am genetically tweaked that naproxen is about as usefull as a blue M&M with less calories. I was tried on celecoxib, but apparently ankles swelling to the size of volleyballs is not a good thing … for some reason codeine is pretty ineffective as well. Sucks, but at least my doc trusts me enough to give me real painkillers and that I will only use them when I need them. ---
**Author:** ![salinqmind](https://avatars.discourse-cdn.com/v4/letter/s/3ec8ea/32.png) [@salinqmind](https://boards.straightdope.com/u/salinqmind)\ **Post date:** [September 21, 2011, 4:20pm UTC](https://boards.straightdope.com/t/why-so-few-over-the-counter-analgesics/596690/53 "2011-09-21T16:20:05Z")
> [@abbeytxs](#): > > Brand name Tylenol has been recalled. Nothing serious. The store brands are still just fine to use and widely available. Mom’s real old and kind of losing it, has it in her head it’s got to be brand-name Tylenol or nothing. I say, look - the store brand has the same ingredients! Nope. Store brand is ‘inferior/ they’re lying/ it doesn’t work as well as ‘real’ Tylenol.’ :rolleyes: Every so often Tylenol DOES show up on the shelves for a while, then it’s recalled again. ---
**Author:** ![Mama\_Zappa](https://avatars.discourse-cdn.com/v4/letter/m/71e660/32.png) [@Mama\_Zappa](https://boards.straightdope.com/u/Mama_Zappa)\ **Post date:** [September 21, 2011, 4:30pm UTC](https://boards.straightdope.com/t/why-so-few-over-the-counter-analgesics/596690/54 "2011-09-21T16:30:44Z")
> [@salinqmind](#): > > Mom’s real old and kind of losing it, has it in her head it’s got to be brand-name Tylenol or nothing. I say, look - the store brand has the same ingredients! Nope. Store brand is ‘inferior/ they’re lying/ it doesn’t work as well as ‘real’ Tylenol.’ :rolleyes: Every so often Tylenol DOES show up on the shelves for a while, then it’s recalled again. Does she have a bottle of it around the house? Refill it surreptitiously with the generic, if you think you can do so without her noticing the different pills. I personally doubt I’d notice the difference unless I had a mix of them together. ---
**Author:** ![salinqmind](https://avatars.discourse-cdn.com/v4/letter/s/3ec8ea/32.png) [@salinqmind](https://boards.straightdope.com/u/salinqmind)\ **Post date:** [September 21, 2011, 9:50pm UTC](https://boards.straightdope.com/t/why-so-few-over-the-counter-analgesics/596690/55 "2011-09-21T21:50:06Z")
I think I might try refilling with the store brand, as long as they look like regular Tylenol. I don’t think she would notice, she takes so many pills of all sorts anyway. ---
**Author:** ![abbeytxs](https://avatars.discourse-cdn.com/v4/letter/a/eb9ed0/32.png) [@abbeytxs](https://boards.straightdope.com/u/abbeytxs)\ **Post date:** [September 21, 2011, 9:50pm UTC](https://boards.straightdope.com/t/why-so-few-over-the-counter-analgesics/596690/56 "2011-09-21T21:50:51Z")
> [@salinqmind](#): > > Mom’s real old and kind of losing it, has it in her head it’s got to be brand-name Tylenol or nothing. I say, look - the store brand has the same ingredients! Nope. Store brand is ‘inferior/ they’re lying/ it doesn’t work as well as ‘real’ Tylenol.’ :rolleyes: Every so often Tylenol DOES show up on the shelves for a while, then it’s recalled again. Your Mom is not alone. Many people have a hard time believing that store brands are the same as the brand, (technically, they are bio-equivalent but no need to really fuddle Mom). If you took your Mom to the pharmacy and had the Pharmacist assure her, would that make any difference? ---
**Author:** ![snailboy](https://avatars.discourse-cdn.com/v4/letter/s/97f17d/32.png) [@snailboy](https://boards.straightdope.com/u/snailboy)\ **Post date:** [September 21, 2011, 10:19pm UTC](https://boards.straightdope.com/t/why-so-few-over-the-counter-analgesics/596690/57 "2011-09-21T22:19:05Z")
> [@salinqmind](#): > > Mom’s real old and kind of losing it, has it in her head it’s got to be brand-name Tylenol or nothing. I say, look - the store brand has the same ingredients! Nope. Store brand is ‘inferior/ they’re lying/ it doesn’t work as well as ‘real’ Tylenol.’ :rolleyes: Every so often Tylenol DOES show up on the shelves for a while, then it’s recalled again. I don’t know about acetaminophen but I have had vastly different reactions from different brands of hydrocodone. I took _four_ of the 7.5 mg ones from CVS and didn’t feel anything, while a _single_ 10 mg from Walgreens gave me a bit of a buzz and _two_ had me unable to stand up without getting light-headed. I can’t explain it but it happened. ---
**Author:** ![curlcoat](https://avatars.discourse-cdn.com/v4/letter/c/ea5d25/32.png) [@curlcoat](https://boards.straightdope.com/u/curlcoat)\ **Post date:** [September 21, 2011, 10:50pm UTC](https://boards.straightdope.com/t/why-so-few-over-the-counter-analgesics/596690/58 "2011-09-21T22:50:06Z")
> [@snailboy](#): > > I don’t know about acetaminophen but I have had vastly different reactions from different brands of hydrocodone. I took _four_ of the 7.5 mg ones from CVS and didn’t feel anything, while a _single_ 10 mg from Walgreens gave me a bit of a buzz and _two_ had me unable to stand up without getting light-headed. I can’t explain it but it happened. That stuff is OTC in Texas??? ---
**Author:** ![abbeytxs](https://avatars.discourse-cdn.com/v4/letter/a/eb9ed0/32.png) [@abbeytxs](https://boards.straightdope.com/u/abbeytxs)\ **Post date:** [September 21, 2011, 11:22pm UTC](https://boards.straightdope.com/t/why-so-few-over-the-counter-analgesics/596690/59 "2011-09-21T23:22:52Z")
> [@curlcoat](#): > > That stuff is OTC in Texas??? Good lord, no!! CVS and Walgreens buy their hydrocodone from different manufacturers. We have quite a few patients who state that they have reactions to the different inert ingredients that are used in the tablets. Some prefer the “white ones” some prefer the “yellow”. ---
**Author:** ![salinqmind](https://avatars.discourse-cdn.com/v4/letter/s/3ec8ea/32.png) [@salinqmind](https://boards.straightdope.com/u/salinqmind)\ **Post date:** [September 21, 2011, 11:39pm UTC](https://boards.straightdope.com/t/why-so-few-over-the-counter-analgesics/596690/60 "2011-09-21T23:39:45Z")
> [@abbeytxs](#): > > Your Mom is not alone. Many people have a hard time believing that store brands are the same as the brand, (technically, they are bio-equivalent but no need to really fuddle Mom). If you took your Mom to the pharmacy and had the Pharmacist assure her, would that make any difference? I don’t think so, maybe her primary doctor would have some say. She seems to admire that doctor a whole lot. It’s mainly arthritis, muscle pains, bad back - she’s 84 and her body is just breaking down. If a bottle of real Tylenol is her preference, I’d like to be able to get it for her. [Previous page](https://boards.straightdope.com/t/why-so-few-over-the-counter-analgesics/596690.md?page=2) [Next page](https://boards.straightdope.com/t/why-so-few-over-the-counter-analgesics/596690.md?page=4)