Over-the-counter painkillers: What to take when

(funky energetic soul music) – From allergies to zinc
deficiencies, hangry to hay fever, we provide easy to absorb information to improve your health. It’s Sounds Like Health
on Texas A&M Health Talk. (funky energetic soul music) Howdy, welcome to Sounds Like Health. This is Mary Leigh Meyer. – And I’m her cohost, Sam Craft. – And we are here with Dr. Eric Grayson. – Thank you, howdy. – Howdy. – So, today we’re gonna talk
about the different kind of over-the-counter pain relievers, and when we know when to use
one type versus the other type, and what, kind of, is
best practice for those. – So, like acetaminophen, ibuprofen. – Mm-hmm. – That kind of stuff. – Yes.
– Okay. – Yes.
– All right. – What do we have first? – Dr. Grayson, so is there
certain types of circumstances that would lead you to pick
acetaminophen over ibuprofen, or another type of anti-inflammatory? – Human beings, physiologically,
are very distinct, so some patients may get more pain relief, or better fever relief
with one versus the other. But in general, we kind of like to separate
the over-the-counter products into two big, kind of broad categories. One being acetaminophen
and the other one being what we term NSAIDs, which would be non-steroidal anti-inflammatory drugs. Typically, acetaminophen acts
more centrally in the brain, and so it’s a pretty good pain reliever. And the NSAIDs act in a
completely different way, working on what we call COX enzymes, or the moderators of inflammation. And so, that makes NSAIDs,
like ibuprofen, naproxen, there is another one called ketoprofen, that people may be less familiar with. – Yeah, what drug is that last one? I’ve never heard of that one before. I mean (gurgling), is it just
a regular anti-inflammatory, like some of the other ones you mentioned? – The only difference is
what dose you use (laughs). – Okay, okay. – So, there’s aspirin, and
ibuprofen, and ketoprofen, are really the only ones that I’m aware of that are over-the-counter, and ketoprofen is a very
small portion on the shelf, so it wouldn’t surprise me
that you haven’t noticed it. – Okay. – So when it comes to
NSAIDs, or nonsteroidals, we typically think of
those as a little better at reducing inflammation. And since inflammation
is secondary to injury, or something is going on with the body, like rheumatoid arthritis, typically, we’re going
to reach for an NSAID to treat that kind of pain. If we’re talking about
headache pain or back pain, or something that really
doesn’t involve inflammation, then acetaminophen is
actually a pretty good choice. So, trying to tease out what
type of pain you’re treating can kind of put you in the right direction as far as what to select. – I’m really bad about
choosing the right kind of drug when my head hurts or
when my ankle’s sore. I know if my ankle’s sore
or if any joint pain, I’m going to take an ibuprofen, because it takes the swelling out, that’s what everybody always tells me, and it’s anti-inflammatory, but are there any other benefits to an anti-inflammatory than just that? – Not really. Decreases the inflammatory
process may shorten an injury, the time frame that you experience
the pain with the injury. But, not by as much as you might think, because the anti-inflammatory action only lasts for a few
hours, and so, typically, there’s a lot of similarities between acetaminophen and NSAIDS. – So would I be okay
taking, say, an ibuprofen, and then also, some
acetaminophen on top of that to kind of, I mean, do they work together to get rid of my pain and the swelling? – Generally, what we
recommend is one or the other. In situations where a patient’s just really not getting
the relief that they need, on occasion with a
doctor’s recommendation, we can recommend staggering doses. In other words, the acetaminophen, you can give that every six hours, you can generally give
the ibuprofen every, depending on the dose, six to eight hours, and just put the doses
in between each other so that they’re spaced out evenly. If you’re still not
getting relief from that within a few doses, you really need to
probably see the physician about what’s going on
with causing the pain. – And so, for our listeners
that may or may not know, acetaminophen is most, we most commonly use the word
Tylenol for acetaminophen? – Yes, that’s a common brand name, there’s a number of brand names, but that’s probably the one
that’s most recognizable. – And then, the word ibuprofen
is common brand of Advil. – Or Motrin, too.
– And Motrin. – (mumbles) Motrin, too.
– Yeah, that’s right. – Okay, well ibuprofen–
– And again, again, there’s several brand names of ibuprofen, but Motrin or Advil is
probably going to be the most commonly recognizable. – Mmhmm. So which one would you use
for some sort of chronic pain? – You know, chronic pain is
a little bit different story. When it comes to chronic pain, I avoid recommending
over-the-counter products. And, the reason for that is chronic pain really needs to be thought
of and treated differently from an acute pain like a
headache or a sprained ankle or even a muscle injury, because those events are acute and they last for the life of the injury, and then once the injury has healed, then there’s no more need for pain. Chronic pain, you’re
talking about something that is a physiological state that is ongoing for long periods of time. That’s a completely different
pain process, and I think, clinicians kind of like to approach how we address chronic pain a
little bit more holistically, because there are long
term effects that come from the use of pain medications. – You know, a lot of
us out there, you know, we go out, we like to go out. Let’s say we’re at a sporting event, or like tailgating or something, and you know, we might go
out and have a few beers, and you know, torque up
our ankle a little bit, or hurt my shoulder throwing a football, what, yeah, can you take any
of these drugs with alcohol? I know it’s probably
not advised, you know, but the average everyday
person, they’re probably, “Oh, my shoulder hurts, I gotta
take something right now.” – Mmhmm.
– Yeah. – But what’s your thought on that? – Well, if tailgate
gatherings are anything like they used to be, I would
say, probably don’t mix them, because the general rule of thumb is if you have more than
two or three drinks, or if you have more than
two or three drinks daily, then you really need to
stay away from these drugs. And, to explain way, acetaminophen
is cleared by the liver. And, alcohol tends to have
quite an effect on the liver. And, you take the two together, and you have the potential
for liver damage, especially if it’s done
on a routine basis. For the nonsteroidals, it’s a
completely different reason. Nonsteroidals tend to be
very rough on the stomach, and cause damage to the stomach lining. Alcohol is really, really
good at doing the same thing, you combine the two together, and you can really get some
significant GI irritation, and possibly, damage as well. Alcohol basically ups the
severity of the side effects from these medications. – You mentioned the liver. Do any of these affect the kidney? Because, I’ve always heard ibuprofen has the chance of hurting
your kidneys, as well. Is that just an urban myth,
or is that true as well? – Oh no, that’s very true. In fact, we pay close attention to what we call
over-the-counter medication use whenever we bring a
patient to the hospital, because it helps us
identify those patients that may have an occult or hidden problem with their kidneys. Nonsteroidals, like ibuprofen
and naproxen, over time, with repeated dosing, can
cause problems with the kidney, there’s no doubt about that. – And you said that
nonsteroidals typically are hard on the stomach. Does that mean you have to
eat before you use them? – Generally, the upset
stomach part, you know, the stomach irritation
and maybe the discomfort that you feel with medication sometimes can be alleviated by taking it with food, but I’d still like to point out that that doesn’t prevent
the stomach damage in the lining of the
intestines or the stomach, so doses can still cause problems. – And is there any other
kind of drugs or medication that you should not take with
these kinds of pain relievers? – Well, we would be here
for the rest of the podcast if I were to list them for you. There are a number of medications. Probably, the most expeditious
way for me to handle that is to say really, if
you’re on medications, or if you frequent herbal medications and that sort of thing, probably the best approach is to just walk up to
your pharmacist, you know, at whichever pharmacy you go to, or wherever you’re
buying the pain reliever, and just have a conversation
with your pharmacist there. He’s got the tools, or
she’s got the tools, to look that up specifically, and give you a real detailed answer as to what happens when you
combine those medications. – Okay, okay, and, are there
certain kind of conditions that people may have where they should not take
one or the other of these? – Absolutely. If you have any measure of liver damage, I think you need to be cautious
about using acetaminophen. Acetaminophen, and nonsteroidals as well, you really need to be cautious. But, acetaminophen, you know,
we generally look at somebody that’s got cirrhosis or hepatitis, when it comes to acetaminophen, we like to limit the dose to
two grams, where normally, you or I might be able to
tolerate up to four grams a day for short periods of time. Someone with hepatitis or liver damage, we want to cut that maximum in half. – So, I got a question, since
we’re talking about doses, growing up, playing football, I always had a sore knee
or elbow or something. I took like 800 milligrams of ibuprofen and that was not a big deal for me. What’s your thought on
weight versus dosage? – Well, I would say that you were younger and much healthier then. – (laughing) That is true. – And so, your ability to
tolerate higher doses is there. I hesitate very much giving
any advice about doses beyond the over-the-counter directions, and I’ll tell you why– – Well, I (mumbles) that’s
what I’m asking, yeah, because the bottle says take three a day and call me in the
morning, or whatever it is, and that’s a pretty generic
prescription, so to speak. – Sure, so when it comes to
over-the-counter products, I’d like to point out that they are, we think of it in two terms, and that’s the same terms
that the FDA looks at it, which is number one, safe, in other words, can a patient take this as labeled or as directed on the packaging, and it be considered, for the most part, safe for most patients in the population. And the second thing is
efficacy, you know, does it work? Can the drug company that manufactures it demonstrate that it has a positive effect for what it claims it’s treating? And so, with those two things in mind, there is as labeled on the container that dose and that
frequency and the maximums, and the cautions that go along with that. All of that taken into consideration, if you take the medication that way, it’s generally considered
to be safe for the patient. When you start exceeding
that with larger doses, you tend to increase side effects and possible long-term consequences, and so, there’s certain
monitoring requirements that go along with that, or time constraints go along
with those higher doses, and so consequently, those
doses, those higher doses, are reserved for prescription processing. And, the reason for that is the
physician has prescribed it, and in theory, is
monitoring your progress, both with the condition
that’s being treated, and any side effects that
you might be experiencing. – Sure, well that makes a lot of sense. I never thought about it like that. – So if you’re a bigger guy, you don’t get a pass on the dose, no. – (laughing) Well, that’s good to know. I mean, even now, I still tend to do that. When I need to take them like that, I take them like that, because
it’s what I’ve always done, and I’ve always just heard
that because I’m a bigger guy, you need more medicine, and it’s nice to hear that
that’s not always the case. – Not always, I think, you know, the exposure to the medication
circulating and the blood is still affecting the kidneys
and the stomach lining, you know, just like the smaller doses do, and so, you know, there are
consequences to the higher dose, and time constraints on how
long you can dose it that way, and how often you can give the dose have to be expertly determined. There’s a general belief that if it’s over-the-counter,
it’s safe, and so, you know, I can take whatever I want, and it’s still going to be safe, and that is myth. – So, that’s really a great point. Can you kind of elaborate on how they may or may not
be as safe as we all think? – Sure. I’ll give you an instance. Acetaminophen itself is
really quite well tolerated, and has very, very, very low toxicity until you start exceeding
the maximum dosages, and then, there’s a pathway in the liver that breaks up the acetaminophen so that the body can clear it out. If you take too much acetaminophen, either in dosing, single doses, or in total doses in the day, that liver process that
breaks up that acetaminophen so that the body can get rid of it gets saturated, and so, the acetaminophen stays in
the system much, much longer, and goes through an alternate pathway to get broken up and
taken out of the body. And, that pathway can cause serious harm, because of the metabolite
of the acetaminophen. And so, it’s very safe,
it’s very effective, but if the dose is received,
it can become deadly. – How do fevers and
headaches play into all this? I feel like those are two
pretty common ailments that we reach for these
kind of medicines for. – Well, yeah, the first thing that I was, “Oh, I think I have a fever,” and the first thing
I’m always told’s like, “Oh, take some acetaminophen, you know, “it’ll knock it out of the
way, it’ll drain it out.” I guess, is that a normal, common practice for that drug, specifically? – Well, it is effective as
what we call an anti-pyretic. It’s very effective for that, but so is the nonsteroidals, as well. – So ibuprofen will actually
help with the fever as well? – Yes, it will. In fact, it is very common in pediatrics to prescribe the ibuprofen
for fever as well, so it’s a well known anti-pyretic, and it works just as well. I wouldn’t say one is
better than the other, but if a patient has a preference for one reason or the other
for one of the products, they should receive some
benefit with either one. However, let me just inject
one little point here. When it comes to fever, just because you’re a couple
of points on the thermometer higher than normal, doesn’t mean necessarily that you should treat the
fever with medication, because the body’s response
to a viral infection or even a bacterial infection is generally to increase
the body temperature, and so, what that does is, is it ramps up the body’s
ability to fight that infection. White blood cells work better, they tend to circulate better in the body, there’s just a whole lot of benefit to the slightly higher body temperature. And so, to squash and press down, and diminish every single fever is maybe not the best approach. If you can tolerate it for a little while, you know, not treating it
might be a good way to go. – Well, that’s interesting, I’ve never heard, I guess, I’ve never heard it put that way. Is there any difference to say, a younger person taking
acetaminophen over ibuprofen, is there a benefit to
one of those two things when specifically you’re
talking about fever? Because that could be one or the other. – It can be one or the other. Either medication can,
will help with the fever. They’re both pretty effective. Pediatrics, we tend to
prefer the ibuprofen, but that could just be because
it tastes better in a syrup, because acetaminophen is not
the best tasting medication. But they’re actually both pretty
effective as anti-pyretics. It all depends on the extent of the fever. Now, all of that said, we will all get cranky and
irritable and very uncomfortable, and not be able to sleep. – Well that’s definitely what
a fever is for me, it’s awful. – Especially for (mumbles), too. – Yeah. – So, when it gets to that point, it’s okay to take
something for your fever. But, until it gets to that point, I would say let your body
work on that infection. It may decrease the time
length or the time course of how long you’re sick. – Okay, and do people ever get
used to these kinds of pills, you know, if you take
two ibuprofen every day for little headaches here and there, do you ever need to increase your dose? – Yeah, I guess, does
your body become immune to the medication at some
point, to its good effects? – Not really, there’s
no built-in tolerance to the medication. My first thing is when you
said take two ibuprofen every single day, my first
response is don’t do that. (laughing) – One-hundred percent good advice. You’re talking about do not
take two ibuprofen a day, obviously for the health
risks that that could pose. What about taking an aspirin
a day for say, heart purposes, or anything like that? Is that still advised? I know growing up, that
was always a thing. Is that still a common practice? – Absolutely. In fact, I would say we need to do that under a physician’s supervision, and the reason I say that is the size of the dose
and how often we give it is vastly reduced as far
as the benefits from it. And, in fact, the literature’s changing. I’ve seen a couple of things
come across, you know, on my inbox on aspirin and
the dose that’s required, very recently, that would
maybe indicate that the dose that we’re using every day for everybody that has heart disease
or cardiovascular disease or coronary artery disease, that that dose may be, at some
point, in the near future, the next three or four years, a little different than what
we’re currently recommending. So, when it comes to that daily aspirin, I would strongly urge people
to seek out the advice of their physician. – So, what are some of
the biggest misconceptions about these kinds of drugs? – Well, one that comes to
mind right away would be combining some of the other
over-the-counter medications like famotidine or an antacid
to decrease the stomach upset that comes along with ibuprofen or some of the other nonsteroidals. I generally don’t recommend doing that, because that takes away the
patient’s pain response, and it blocks their ability to perceive any damage that’s being
done by the nonsteroidals to the stomach lining or
the intestinal lining, and so, those patients that
do that on a routine basis, when they present with an ulcer
or gastric reflux disease, or some of the other intestinal disorders, their problem tends to be more advance. And so, my recommendation
is don’t do that. It’s a common practice,
and on an acute basis, over a very short course, maybe it’s okay, but on
a regular ongoing basis, probably not the best plan. – And what we’re talking about
here is mainly about taking, say acetaminophen with
antiacid of some sorts, or some sort of anti, what’s the word, like heartburn kind of medicine, is that–
– Yeah, acid blockers. – Okay, well Dr. Grayson,
we’re about to wrap up here, is there anything else that
you might need the public to know about acetaminophen
or ibuprofen in general, you know, some dos, some
don’ts, or maybe just a general, “Hey look out for this,” kind of thing? – Well, yeah, let me add in one
be on the lookout for thing. – Sure. – And, that would be that
a number of medications, both over-the-counter
and prescription as well, have acetaminophen as a
component of their formulation. – It’s just another
piece of that one drug, so you might be taking
drugs that don’t even know that it has acetaminophen in it? – Correct, correct, but it’s generally on the
prescription drug label typically. Or, it’s in the ingredients list, if it’s an over-the-counter product. And, let me give you an example. When it comes to a popular
nighttime cold remedy, it has 1,000 milligrams, or a full gram, of acetaminophen in it.
– Wow. – We generally recommend
your entire daily dose be limited to three to
four grams of acetaminophen on acute administration, so one dose of the cold
remedy will give you an easy one-fourth of your
entire day’s dosing regiment. And so, some of these
products have got quite a bit of acetaminophen in it, so
to prevent the toxicity, the liver toxicity that’s
associated with those medications, you’ve really got to read
the ingredients label, and make sure that the total
daily dose of acetaminophen is limited to that three to four grams. – That’s really good advice, you know, when I’m sick and I’m taking, some cold and flu medicine at night, I never think about the
other medicine that I’ve had earlier in the day, kind
of stacking up on itself. – Absolutely. You know, when we’re sick, the goal is, “I want to feel better.”
– Oh, for sure. – But we really need to be cautious, because these medications do have side effects and toxicities. – Alright. Well I think that’s all the
time we have today, Dr. Grayson. Thank you so much for coming on the show. – Oh, it’s my pleasure. – Thank you for listening
to another episode of Sounds Like Health. Join us again in a few weeks,
when we talk about diabetes. – Thank you for joining us
on Texas A&M Health Talk, a production of the Texas A&M University Health Science Center. Visit us on the web at
vitalrecord.tamhsc.edu, where you’ll find answers to
all of your health questions. Until next time, stay healthy. (energetic electronic music)

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