Over-the-counter painkillers

Your health expert: Madeeha Waheed, Oncology Pharmacist at Bupa, Clinical and Operational Improvement
Content editor review by Pippa Coulter, February 2022
Next review due, February 2025

Over-the-counter (OTC) painkillers are painkillers that you can buy without a prescription from a doctor. You may be able to buy them from a pharmacy or a shop. OTC painkillers include paracetamol, ibuprofen, low-dose codeine, dihydrocodeine and aspirin.

Uses of over-the-counter painkillers

You can use over-the-counter painkillers for short-term relief of minor pain. They can also help to reduce a fever. Examples of when you might want to use them include:

headache
period pain
back pain
earache
toothache and teething
sinusitis
sprains and strains
recovering from minor medical procedures
fever – such as in colds or flu

If you need painkillers to treat long-term (chronic) pain – for example, pain from arthritis – you should see a GP. They may be able to prescribe stronger painkillers or for a longer duration than what you can buy over the counter.

Types of over-the-counter painkiller

The main over-the-counter painkillers are:

paracetamol (for example, Panadol and Calpol®)
non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (for example, Nurofen and Calprofen®) and aspirin (for example, Anadin)
weak opioid painkillers such as codeine and dihydrocodeine – these are usually added to another painkiller such as paracetamol (for example, co-codamol, Paracodol and Paramol)

If you have mild-to-moderate pain, paracetamol is often the best painkiller to try first. But NSAIDs such as ibuprofen can be better for pain associated with inflammation. You can switch to a different painkiller if the first one you try doesn’t ease your pain. You can also take different types together – for example, paracetamol and ibuprofen. You might also choose to try a product that contains codeine if paracetamol or ibuprofen alone are not enough.

Which painkiller suits you will depend on exactly what you’re taking it for. It will also depend on whether or not you have any medical conditions or are taking any other medications. For more information, see our sections on interactions and special considerations.

How over-the-counter painkillers work

Different painkillers work in different ways. Anti-inflammatory painkillers such as ibuprofen and aspirin stop your body making chemicals called prostaglandins. Prostaglandins are partly responsible for causing pain and inflammation in your body. So, reduced prostaglandins can reduce pain and inflammation.

It’s unclear exactly how paracetamol works. But it’s known to reduce production of prostaglandins in your brain and spinal cord. Paracetamol doesn’t reduce inflammation. But it can relieve pain and reduce a high temperature.

Opiate painkillers such as codeine work by blocking pain messages in your brain and spinal cord.

Because painkillers work in different ways, there are some products available that contain more than one type of painkiller. For example, aspirin, paracetamol or ibuprofen can be combined with codeine. If you’re taking several painkillers, read the patient information leaflets that come with your medicines to make sure you don’t accidentally take too much. Ask a pharmacist for advice if you’re unsure.

Taking over-the-counter painkillers

You can buy over-the-counter (OTC) painkillers in several different forms, including:

tablets, caplets (coated and rounded tablets) or capsules that you swallow
a powder or tablet to dissolve in water
a liquid or syrup
suppositories – soft, shaped tablets that you put into your back passage
gels or creams that you rub into your skin
patches that you put on your skin

You can buy OTC painkillers from a pharmacy, supermarket or other shops without a prescription from a doctor. You can only buy packs of 16 tablets of paracetamol or ibuprofen from a shop or supermarket. You can get packs of up to 32 tablets or capsules if you buy them from a pharmacist. Shops and pharmacies legally aren’t allowed to sell you more than two packs at a time. This is to prevent people accidentally or intentionally taking too many.

How much to take

Read the patient information leaflet that comes with your OTC painkillers carefully. This will give you information about the dose – including exactly how much to take and how frequently you can take it. This may also be displayed on the product packaging. You can usually take most over-the-counter painkillers every four to six hours.

Some other types of medicine – for example, cold and flu products – also contain painkillers such as paracetamol. So, if you need to take a painkiller, check the labels carefully on other medicines you’re taking. Ask your pharmacist for advice if you’re unsure.

Only take painkillers containing codeine for a maximum of three days. If you’re still have pain after this time, see your GP.

Taking too much

Any medicine can be dangerous if you take too much of it. If you take too much paracetamol, it can cause serious liver damage, which can be life-threatening. Sometimes, there are no symptoms until a day or so afterwards.

Taking too many NSAIDs can make you feel or be sick and can also cause hearing problems such as tinnitus. Taking too much aspirin can make you hyperventilate (breathe faster than normal). It can also cause hearing problems and make you sweat a lot.

If you think you’ve taken too much of any medicine, get medical advice as soon as you can.

Interactions of over-the-counter painkillers

Non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen can interact with several other medicines. These include medicines to lower blood pressure, treat depression and reduce blood clotting (for example, warfarin). Check with your doctor or pharmacist before taking ibuprofen if you’re also taking steroids, lithium or methotrexate.

If you’re taking medicines with codeine in them, don’t drink alcohol or take sedatives. Together, they can make you very drowsy and affect your breathing.

Paracetamol is generally safe to take with other drugs. But check with your doctor or pharmacist if you’re unsure, especially if you have any liver function problems.

The patient information leaflet that comes with your medicine will give you more information about potential interactions with other medicines.

Children and over-the-counter painkillers

Paracetamol and ibuprofen can help to ease pain and discomfort or lower a fever in children and babies. You can give paracetamol from the age of two months and ibuprofen from the age of three months. If you try either of these and they don’t seem to be working, you can switch to the other medicine. You can also alternate between giving paracetamol and ibuprofen. But don’t give both medicines at the same time. Always read the patient information leaflet that comes with the medicine, and if you have any questions, ask your pharmacist for advice.

If your baby is under three months, ask your pharmacist or GP for advice about how much to give.

You can buy paracetamol and ibuprofen as syrups and dissolvable powders, which are easier for children to take than tablets.

Don’t give aspirin to children under the age of 16 because it has been linked to a serious condition called Reye's syndrome. This can be life-threatening.

Special considerations

Some groups of people may need to avoid certain over-the-counter (OTC) painkillers or take special care if they do take them.

For example, you shouldn’t take non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen if you have a condition that causes bleeding. This includes haemophilia and peptic ulcers. You may need to take extra care if you have heart, liver or kidney problems or other long-term conditions such as asthma or inflammatory bowel disease.

Often, you need to be more careful which medicines you take as you get older because they can affect you differently. You may also be more likely to be taking lots of different medicines as you get older.

Most people can take paracetamol without any problems. Paracetamol is the safest painkiller to take if you’re pregnant or breastfeeding. You should avoid ibuprofen in the last three months of pregnancy unless a doctor advises you to take it.

You should always read the patient information leaflet that comes with your medicine to check if you’re safe to take it. This is especially important if you have a long-term health condition or are taking other medicines. Ask your pharmacist or GP if you’re not sure.

Side-effects of over-the-counter painkillers

You're unlikely to get side-effects from taking over-the-counter (OTC) painkillers as long as you carefully follow instructions on how to take them.

Side-effects from paracetamol are rare when you take the recommended dose.

Non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen can affect your stomach. You might get indigestion or heartburn, have diarrhoea or feel sick. It’s strongly recommended to take NSAIDs with food or a glass of milk for this reason. NSAIDs can also worsen asthma, so check with your doctor or pharmacist if you have this condition.

Opioid painkillers such as codeine can cause constipation and may make you feel sick. They can also make you drowsy, so don’t take an opioid painkiller if you need to drive or operate machinery. Some people who take opioid painkillers may become dependent on them. If you find that you need to keep taking them or they don’t work as well as they did, speak to your GP.

This section doesn't include every possible side-effect of OTC painkillers. You can find out more by reading the patient information leaflet that comes with your medicine.

Medicines checklist

Our handy medicines checklist helps you see what to check for before taking a medicine.

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Paracetamol, aspirin and ibuprofen can all ease mild-to-moderate pain. But they work in different ways. Aspirin and ibuprofen work well on pain that’s caused by inflammation. But there are some circumstances when you shouldn’t take them. Paracetamol relieves pain but doesn’t reduce inflammation. If these painkillers don’t control your pain, you can try a combination. For example, paracetamol or ibuprofen with codeine or dihydrocodeine.

For more information, see our sections on types of over-the-counter painkiller and how over-the-counter painkillers work. If you’re unsure which painkiller to take, ask a pharmacist for advice.

Yes, you can take paracetamol and ibuprofen together if either medicine on its own isn't controlling your pain. With children, you can alternate paracetamol and ibuprofen, but it’s best not to give them at the same time. For more information, see our section on types of over-the-counter painkiller. If you’re unsure about what you can take, always check with your pharmacist.

Although paracetamol is a safe medicine if you take it correctly, it can cause serious health problems if you take too much. It can damage your liver and can be fatal. It can be easy to take too much paracetamol because it’s in many different products – for example, cold and flu medicines.

If you think you or your child may have taken too much paracetamol, get medical help straight away. For more information, see our section on taking over-the-counter painkillers.

Paracetamol tends to have fewer side-effects than other over-the-counter painkillers. Ibuprofen and aspirin can cause stomach problems. Paracetamol is often better for people with conditions that cause bleeding. Paracetamol is also the safest painkiller to take during pregnancy. But any medicine can be dangerous if you take too much. For more information, see our section on side-effects of over-the-counter painkillers.

Codeine is a weak opioid painkiller. It can be added to other painkillers such as paracetamol to help relieve pain. It can be worth trying if paracetamol or ibuprofen on its own is not enough. You shouldn’t take painkillers containing codeine for more than three days at a time. For more information, see our section on types of over-the-counter painkiller.

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