The Hazards and Benefits of Over-the-Counter Acetaminophen, Ibuprofen, and Naproxen

Over the counter (OTC) acetaminophen, ibuprofen, and naproxen are commonly used to treat pain and fever. Because they are labeled and packaged for OTC use most people consider them safe. This is not true. In addition, many people also believe that more is better. This is also not true. In fact all three medications have the potential for serious side effects. Aging further increases the risk of serious side effects as older people, especially those over the age of 65, often have a decrease in liver and kidney function and are mildly dehydrated. 

In addition to its therapeutic effects, acetaminophen is a dose-dependent liver toxin; patient who take acetaminophen with alcohol or while fasting-due to illness, anorexia, or malnutrition-are at serious risk for liver failure. Even if taken at the current OTC recommended dose (not to exceed 4 g/day), the drug can be toxic. The FDA expert panel recommends lowering the standard dose from 1,000 mg to 650 mg and the maximum dose/day to 3 g/day. Accidental overdose send roughly 80,000 people to the emergency department each year; at least 500 are fatal. Part of the problem is that acetaminophen is found in more than 600 OTC medications including cold, flu, sinus, and in Rx codeine-based medications (Vicodin® or Percocet®). Patients unaware of the potential for serious complications often mix and match drugs containing acetaminophen and easily exceed the maximum daily dose. Forewarned is forearmed.

Ibuprofen and naproxen also have serious side effects. Chronic use of both, including aspirin, may cause indigestion, gastric or duodenal ulcers, and fluid retention. In addition, ibuprofen use slightly increases the risk of a heart attack or stroke. Renal damage is also possible and significantly increases if the patient is dehydrated (as is often the case in an outdoor setting). Not surprisingly the risk of adverse effects increases substantially with dose and course. Note that while many athletes take ibuprofen or naproxen for general muscle soreness, neither drug has been shown to be effective. Remember that the GI side effects of both drugs increase if the drug is not taken with food and the renal effects increase if the patient or athlete is dehydrated.

Follow the following simple guidelines greatly reduces your chance of adverse effects:

• IF you must take one of these medications, take the lowest therapeutic dose for the shortest period of time.
• Make sure you are hydrated before taking any medication.
• Take ibuprofen or naproxen with food to decrease the risk of developing GI problems.
• Do not take ibuprofen or naproxen for muscle aches; instead, increase your water and electrolyte intake and rest.
• If you choose to carry and take acetaminophen, remember that it is used in numerous cold, flu, sinus, and sleep medications. Keep track and don't exceed 3 g/day; use less if possible.
• Do not drink alcohol if you are taking acetaminophen.
• Do not take acetaminophen if you are fasting or cannot keep food down due to nausea and vomiting. 

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