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Over-the-counter painkillers

This factsheet is for anyone taking over-the-counter painkillers, or who would like information about them.

Over-the-counter painkillers are pain-relieving medicines that can be bought from a pharmacy or shop, without a prescription from your GP. They include paracetamol, ibuprofen and aspirin.

Why would I take over-the-counter-painkillers?

You can take over-the-counter painkillers to relieve a variety of common aches and pains, including headache, muscle and joint pain, backache, toothache and period pain.

Over-the-counter painkillers also lower a high temperature caused by an infection, such as a cold or flu. Some painkillers, called non-steroidal anti-inflammatory drugs (NSAIDs), can also reduce inflammation. These are particularly useful for pain associated with inflammation, such as arthritis or muscle sprains. NSAIDs that you can buy without a prescription from your GP include ibuprofen and aspirin. You can also buy some low-dose forms of diclofenac and naproxen from a pharmacist.

What are the main types of over-the-counter painkillers?

Over-the-counter painkillers include:

  • non-opioid painkillers (eg paracetamol)
  • NSAIDs (eg ibuprofen or aspirin)
  • mild opioid painkillers (eg codeine)

How do over-the-counter painkillers work?

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.

How to take over-the-counter painkillers

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.

Special care

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.

Side-effects of over-the-counter painkillers

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.

Interactions

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.

Names of common over-the-counter painkillers

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

Produced by Stephanie Hughes, Bupa Health Information Team, February 2012.

For answers to frequently asked questions on this topic, see Common questions.

For sources and links to further information, see Resources.


  • This information was published by Bupa's Health Information Team and is based on reputable sources of medical evidence. It has been reviewed by appropriate medical or clinical professionals. Photos are only for illustrative purposes and do not reflect every presentation of a condition. The content is intended only for general information and does not replace the need for personal advice from a qualified health professional. For more details on how we produce our content and its sources, visit the about our health information page.

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  • Publication date: February 2012

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