by Arun Nagpaul, MD

Dear Doc,

What is the best over the counter pain reliever to take? Is there a real difference between Aspirin, Advil, and Tylenol?

We have so many choices to make every day! Many of the decisions are in the long run inconsequential, what socks to wear to match my outfit, what ringtone to have or should I buy a Chevy or a Ford?  Other decisions are much more significant.  Who do you marry, what do you name your children, and what kind of cereal do you eat in the morning?  Did you know that there are over 387 different types of breakfast cereals available in the U.S. ranging from healthy named “Banana Nut Granola” to unhealthy named “Bart’s Peanut Butter Chocolate Crunch.” Since 69 % of adults in the US are overweight and 18 % of children 6 to 19 are obese, I would conclude we have way too many choices to make and we are not making good breakfast choices!

When it comes to over the counter pain relievers, you have listed the three common choices. They are not the same medications and understanding them is important to avoiding potential side effects.

The chemical name for Tylenol is acetaminophen. You may see other brands of the product (Tempra, Panadol or generic store brands) but they all have the same equivalent medicinal ingredient, acetaminophen.  Acetaminophen has been around for years and is safe for use as a pain reliever and fever reducer in its recommended doses. It can be used in both adults and children.  Acetaminophen does not help with inflammation.

Although usually well tolerated, acetaminophen can cause serious liver damage if the recommended doses are exceeded either accidentally or intentionally. In fact, acetaminophen is responsible for 100,000 calls to poison control centers, 56,000 emergency room visits, 26,000 hospitalizations, and 450 deaths from liver failure each year! The adult dosage should not exceed 4000 mg per day.  Accidental overdoses may occur when people are take multiple medical remedies for the flu, cough or cold as many prescription pain medications and over the counter cold remedies include acetaminophen as one of their active ingredients. Always check to see if acetaminophen is included as an active ingredient and limit your total acetaminophen intake to recommended doses. If you are going to stay on any medication long term, work with your medical provider to ensure that it is safe for you and that you receive the proper monitoring for side effects. Studies have shown that alcohol consumption and fasting due to illness, anorexia or malnutrition increase the risk of liver injury due to acetaminophen.

Advil and Motrin both have ibuprofen as their sole medicinal ingredient. Ibuprofen is one drug in a class of drugs called Non-steroidal Anti-inflammatory Drugs (NSAIDS). Ibuprofen, like acetaminophen, can be used for pain and fever relief. In addition, ibuprofen has an anti-inflammatory action that can reduce swelling and pain due to inflammation. Ibuprofen does alter platelet function (the cells that play a role in clotting) and can prolong bleeding time.  Ibuprofen may irritate the stomach lining causing gastritis or ulcers.   Ibuprofen may also impair kidney function. Millions of doses of ibuprofen are taken each year with most not having any significant side effects. However, if you are prone to bleeding, ulcers or have impaired kidney function this group of drugs should be avoided.

Aspirin’s chemical name is acetylsalicylic acid (ASA) and it is another drug in the NSAID class. Similar to ibuprofen, aspirin can relieve fever, pain and inflammation.  Aspirin also affects the platelet (blood clotting) function, so sometimes aspirin is purposefully prescribed as a blood thinner to prevent heart attacks and strokes. Aspirin has the same potential as ibuprofen to cause gastrointestinal and kidney side effects. If you have ringing in your ears or hearing loss after taking aspirin, it may be an indication of an aspirin overdose. In addition, aspirin should not be given to children as aspirin has been linked to a rare, but serious, metabolic pediatric condition called Reye’s syndrome.

From mismatched outfits to our widening waistline, our decisions have consequences. If you are interested in choosing a healthy cereal, dieticians recommend choosing one with at least 5 grams of fiber, less than 5 grams of sugar and one with at least 3 grams of protein. I would also suggest staying away from anything that has a candy bar or super hero in its name!  When choosing a pain reliever, review the active ingredients, the appropriate dose, and the potential side effects. Be alert to over the counter medications that may include acetaminophen as an ingredient as to avoid unintentionally exceeding the recommended dose of acetaminophen. As always, before starting any medication, consider seeking the advice of your medical provider.

Stay healthy, and remember the quote by Lord Byron, “Always laugh when you can. It is cheap medicine.“