Over-the-counter painkillers include:
- non-opioid painkillers (eg paracetamol)
- NSAIDs (eg ibuprofen or aspirin)
- mild opioid painkillers (eg codeine)
Over-the-counter painkillers work by acting on chemicals in your body known as prostaglandins. These chemicals are part of your body's defence response – they are responsible for the sensation of pain and for causing a high temperature when you have a fever. They are also involved in the process of inflammation. Your body produces prostaglandins in response to damage or inflammation and they are picked up by nerve cells, which send pain signals to your brain.
NSAIDs block a chemical in your body (an enzyme) called cyclooxygenase (COX), which helps to make prostaglandins. As a result, the damaged or inflamed tissue in your body produces less prostaglandins, and your inflammation, pain or fever is reduced. Paracetamol is also thought to act on the prostaglandins, helping to prevent pain and fever. However, it doesn't have the same anti-inflammatory effects as NSAIDs.
Aspirin is different from other painkillers, as it has a number of other effects in addition to relieving pain. It also works to prevent blood clots – this is why GPs often prescribe aspirin if you have a heart condition.
Over-the-counter painkillers come in various different forms. These may include:
- tablets, caplets (longer tablets that are rounded at each end that may be easier to swallow) or capsules that you swallow
- a powder or tablet to dissolve in water
- a liquid or syrup
- gels that you rub onto your skin
- patches that you place on your skin
You can buy over-the-counter painkillers from a pharmacy, supermarket or other shops, such as a convenience store, without a prescription from your GP. Certain types of over-the-counter painkillers, such as paracetamol, are limited to packets of up to 16 if you buy them in a shop without prescription. This is to help prevent people from accidentally taking too many. However, you can buy them from pharmacies in packs of up to 32 tablets.
Always read the patient information leaflet that comes with your medicine, and if you have any questions, ask your pharmacist for advice. Don't exceed the recommended dose. For paracetamol, this is 500 milligrams (mg) to 1,000mg for adults (usually one or two tablets, depending on tablet strength), every four to six hours, with a maximum of 4,000mg in 24 hours. That usually means a maximum of eight tablets in one day, but make sure you check the strength of your tablets.
For ibuprofen, the recommended dose for adults is 400mg (usually two 200mg tablets), three to four times a day. For aspirin, it's 300mg to 900mg every four to six hours, with a maximum of 4,000mg in 24 hours. You may be advised to take oral NSAIDs with, or after food or milk, to help prevent stomach problems. NSAID creams or gels can be rubbed into your skin three or four times a day. Don’t apply them to broken or infected skin, or near your eyes and mouth.
Over-the-counter painkillers are only meant to be taken occasionally – unless advised otherwise by your GP. If you’re finding you need to take painkillers for a long period of time, or they aren't helping to ease your pain, you should see your GP.
Taking too much
A paracetamol overdose is particularly dangerous because it causes liver damage, which may not be obvious for up to four days after the medicine has been taken. Even if someone who has taken a paracetamol overdose seems fine and doesn't have any symptoms, it's essential that they are taken to hospital urgently. An overdose of paracetamol can be fatal.
Many cold and flu medicines contain a painkiller, sometimes in combination with other medicines, such as a decongestant. So it's very important that you check the amount of painkillers in all the medicines you have taken to prevent accidentally taking too much. If you’re unsure of the amount of medicines contained in a product, ask your pharmacist for advice.
Children and painkillers
Paracetamol and ibuprofen are suitable for pain relief and reducing a fever in children. However, you should only give paracetamol or ibuprofen to babies under the age of three months if advised to by your GP or nurse. The doses for children depend on their age and weight and are clearly given on the medicine container. There are special formulations of paracetamol and ibuprofen available for children, such as syrups and dissolvable powders, which may be easier for children to take.
Aspirin isn't suitable for children under the age of 16, as it has been linked to a condition called Reye's syndrome.
Don’t take ibuprofen or aspirin if you have severe heart failure, if you have ever had a stomach or duodenal ulcer, or if you have previously had a reaction to any NSAID.
Check with your pharmacist or GP before taking aspirin or ibuprofen if you:
- have asthma
- are over 65
- have poor kidney or liver function
- are pregnant or breastfeeding
- are taking tablets for high blood pressure
You should also check with your GP or pharmacist before taking paracetamol if you have kidney or liver disease. Paracetamol isn't known to be harmful in pregnancy. As with any medicine though, it's best to talk to your pharmacist or GP before taking it. Only very small amounts of paracetamol get into the breast milk, so it's usually safe to take if you're breastfeeding.
You're unlikely to get side-effects from taking over-the-counter painkillers occasionally and at the recommended dose.
The most common side-effects of NSAIDs, such as aspirin and ibuprofen, are effects on the stomach, such as feeling sick, vomiting, abdominal (tummy) pain, indigestion and diarrhoea. These effects are less common with ibuprofen compared to other NSAIDs. Aspirin and other NSAIDs can also be associated with bleeding from the stomach, which can cause you to vomit blood or pass blood in your faeces. If you have these symptoms, contact your GP immediately.
If you have asthma, NSAIDs can make you more likely to have an asthma attack.
Side-effects of paracetamol are rare when you take it at the recommended dose, and one advantage of paracetamol over NSAIDs is that it doesn't affect your stomach. However, very rarely, some people have an allergic skin reaction after taking paracetamol. Paracetamol can cause liver and kidney damage if you take too much.
This section doesn't include every possible side-effect of over-the-counter painkillers. Read the patient information leaflet that comes with your medicine for more information.
Talk to your GP or pharmacist if you take an anticoagulant medicine, such as warfarin for heart problems, before taking paracetamol or an NSAID. NSAIDs and regular long-term use of paracetamol can increase the blood-thinning effects of these medicines. So your GP may advise you not to take them, or he or she may adjust your usual dose of your anticoagulant medicine before you take them.
All medicines have a generic name. Many medicines also have one or more brand name. Generic names are in lower case, whereas brand names start with a capital letter.
Over-the-counter painkillers are often combined with other medicines, such as codeine or decongestants. Some of these can only be prescribed by a GP. Here we list products containing paracetamol, ibuprofen or aspirin, which you can buy without a prescription. This isn't a comprehensive list of products. Many supermarkets and shops also sell their 'own brand' versions.
Generic name Brand names aspirin (some products also include other medicines)
Anadin, Beechams powders, Co-codaprin, Disprin, Nu-Seals ibuprofen (some products also include other medicines)
Anadin products, Calprofen, Cuprofen products, Fenbid Gel, Ibuderm, Ibugel, Ibuleve products, Ibumousse, Ibuspray, Nurofen products, Orbifen for Children, Phorpain Gel, Proflex Pain Relief Cream paracetamol (some products also include other medicines) Alka Seltzer XS, Anadin Paracetamol/Anadin Extra, Beechams Cold and Flu products, CalCold Six Plus, Calpol products, Day Nurse, Day & Night Nurse, Disprol, Feminax, Hedex, Lemsip, Medinol, Migraleve, Night Nurse, Panadol products, Paracodol, Paramol, Resolve, Solpadeine, Ultramol, Veganin, Vicks Cold and Flu Care
What is the best medicine for pain relief – paracetamol, ibuprofen or aspirin?
This depends on who the medicine is for, as well as the type of pain the medicine is being used to treat.
Paracetamol, aspirin and ibuprofen are all commonly used medicines and they have a similar ability to relieve pain.
NSAIDs, such as aspirin and ibuprofen, are mainly effective against pain associated with inflammation or tissue damage, while paracetamol is thought to have very little, if any, anti-inflammatory action. NSAIDs are therefore more appropriate for pain associated with conditions causing long-term pain and inflammation, such as rheumatoid arthritis. Ibuprofen is less likely than aspirin to cause stomach problems, such as feeling sick, vomiting, abdominal (tummy) pain, indigestion and diarrhoea.
Paracetamol is often a better option for short-term pain relief and/or a fever in people who are at greater risk of side-effects with NSAIDs – such as those with asthma or people over 65 years of age. Women who are pregnant or breastfeeding are also able to take paracetamol.
Children can be given either paracetamol or ibuprofen, but not aspirin, which has been associated with a rare condition called Reye's syndrome in children.
Can I take paracetamol and ibuprofen at the same time?
You can take paracetamol and ibuprofen together if the recommended dose of either medicine alone isn't controlling your pain.
You can take paracetamol and ibuprofen together for particularly severe pain, such as dental pain, that isn't controlled by either medicine on its own. This isn't usually necessary for minor aches and pains or for a minor illness such as a cold. If you’re taking paracetamol or ibuprofen alone to treat symptoms of a cold and it isn't helping, you should see your GP to check whether your symptoms may be caused by something else.
If you do need to take paracetamol and ibuprofen together, you can try alternating doses of either medicine. However, some people find it easier to take both medicines at the same time, every six hours. Always read the patient information leaflet that comes with your medicine and make sure that you don't take more than the recommended dose of each medicine. If you’re unsure about what you can take, always check with your pharmacist or GP.
What should I do if I take too much paracetamol?
The recommended dose of paracetamol is 500 milligrams (mg) to 1,000mg (usually one or two tablets, depending on tablet strength), every four to six hours, with a maximum of 4,000mg in 24 hours. If you take more than this, you should seek urgent medical attention.
Paracetamol is a safe medicine if you take it correctly. However, if you take too much it can cause serious damage to your liver and kidneys, which can be fatal.
Taking too much paracetamol without realising it can be easily done, as many different products that you can buy contain paracetamol, such as dissolvable cold and flu medicines. You need to be careful to include all products you have used when working out how much paracetamol you have taken. Always read the patient information leaflet that comes with your medicine and ask your pharmacist if you have any questions.
You may feel sick or vomit if you have taken too much paracetamol. However, there are often no obvious symptoms of a paracetamol overdose for up to four days after you have taken it. You may feel fine, even though the paracetamol will already be causing damage to your liver. So if you realise you have taken too much, either on one occasion or over a prolonged period, you should seek urgent medical attention.
- electronic Medicines Compendium
- The British Medical Association. New guide to medicines & drugs. 6th ed. London: Dorling Kindersley; 2004:80–81
- Managing your pain effectively using 'over-the-counter' (OTC) medicines. British Pain Society. www.britishpainsociety.org, published 2010
- Joint Formulary Committee. British National Formulary. 62nd ed. London: British Medical Association and Royal Pharmaceutical Society of Great Britain; 2011
- Rang HP, Dale MM, Ritter JM, et al. Pharmacology. 5th ed. London: Churchill Livingstone; 2003:247
- What are NSAIDs? American Academy of Orthopaedic Surgeons. www.orthoinfo.aaos.org, published January 2009
- Aspirin. electronic Medicine Compendium. www.medicines.org.uk, published 12 January 2011
- Paracetamol (disprol, panadol, calpol). CancerHelp UK (Cancer Research UK). http://cancerhelp.cancerresearchuk.org, published 13 June 2011
- Feverish children. Prodigy. www.prodigy.clarity.co.uk, published December 2008
- Common cold – prescribing information. Prodigy. www.prodigy.clarity.co.uk, published November 2011
- Paediatric Formulary Committee. BNF for Children 2011–2012. London: BMJ Group, Pharmaceutical Press, and RCPCH Publications; 2011
- Lemsip. electronic Medicine Compendium. www.medicines.org.uk, published 11 August 2011
- Dental abscess. Prodigy. www.prodigy.clarity.co.uk, published January 2008
- electronic Medicines Compendium
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