Taking the pain out of choosing a painkiller Taking the pain out of choosing a painkiller

Most of us use over-the-counter analgesics (painkillers) from time to time to alleviate headaches, toothaches, muscle pains and joint pain.

In the past, the only over-the-counter painkillers that could be bought from retail outlets such as supermarkets and corner stores were paracetamol and aspirin. All other painkillers had to be bought from pharmacies. However, this situation changed earlier this year when ibuprofen was added to the list of painkillers that could be sold outside pharmacies.

Paracetamol, aspirin and ibuprofen all effectively relieve mild to moderate pain and reduce fever. Ibuprofen and aspirin also reduce inflammation. However, like all medicines, they can have serious side effects when used inappropriately, so it is important that we choose and use them wisely.

The information in this article refers to the use of paracetamol, ibuprofen and aspirin in adults only. Consult your doctor or pharmacist for information about giving analgesics to infants and children.

Paracetamol

Australians have been using paracetamol for pain relief since the 1950s. In general, it is a safe medicine when taken at the recommended doses for a few days or less. However, it can cause severe and irreversible liver damage when taken in excess.

One paracetamol product only
Many over-the-counter medicines besides painkillers contain paracetamol. For example, some cold, cough, sinus congestion and period pain medicines contain varying amounts of paracetamol as well as other ingredients. Therefore, it is possible, inadvertently, to take more than the recommended dose of paracetamol if you are taking more than one over-the-counter product at a time. Before taking a paracetamol-based medicine for pain relief, check the label of any other over-the-counter products being used to make sure they do not contain paracetamol. If unsure, ask your pharmacist.

Overdose
Paracetamol overdose is serious and can be fatal. If someone you know has taken an overdose, immediately take them to a hospital accident and emergency centre or ring the Poisons Information Centre (13 11 26). Take immediate action even if the person still feels well. The effects of paracetamol overdose are usually delayed, so the person may appear unaffected for the first day or so but become very ill after that. If treatment is given early enough, there are usually no permanent ill effects.

For most people, paracetamol is the preferred painkiller for mild to moderate pain.

Ibuprofen and aspirin

Ibuprofen is one of a group of medicines known as non-steroidal anti-inflammatory drugs or NSAIDs, which alleviate pain and reduce inflammation. Even though ibuprofen has been judged safe enough to be sold in limited quantities in retail outlets, it can still cause serious side effects, especially when used in large doses or for more than a few days at a time. Aspirin is another NSAID that has been used for decades. Being an NSAID, it has similar side effects to ibuprofen.

Gastric bleeding
One of the most serious side effects of NSAIDs, including ibuprofen and aspirin, is gastric bleeding, which is bleeding of the lining of the stomach or duodenum (first part of the small intestine). Signs of gastric bleeding include mild to severe abdominal pain, blood in the stools, and dark coffee-coloured vomit. Gastric bleeding and other problems are more likely to occur if you:

• are taking certain medicines, such as blood thinners (warfarin and aspirin), corticosteroids, etc
• have had or have certain medical conditions,
• such as gastric ulcer, gastric bleeding, kidney damage, etc
• are over 65 years of age
• are taking another NSAID at the same time
• drink more than five glasses of alcohol a day
• take more than the recommended dose
• take it for more than a few days at a time.

Gastric bleeding should always be regarded seriously, because it occasionally causes death. If you have any of the above risk factors, paracetamol should be your preferred painkiller.

Asthma
Aspirin exacerbates some people’s asthma. If you have asthma and need a painkiller, talk to your
doctor first.

One NSAID product only
Ibuprofen and aspirin are only two of the many NSAID products on the market. Taking two NSAIDs at the same time will increase your likelihood of developing gastric bleeding and other side effects. Before taking ibuprofen or aspirin, check the label of any other prescription and over-the-counter products being used to make sure they do not contain another NSAID product. If unsure, seek advice from your pharmacist or doctor.

Choosing an analgesic

In general, for most people, paracetamol is the preferred painkiller for mild to moderate pain. Compared to ibuprofen and aspirin, there are fewer situations where it should not be used, and it has less potential to cause serious side effects when taken at the recommended doses.

Guidelines for use (adults only)

Taking a painkiller is not always the only way to relieve short-term pain. Before taking a painkiller, consider whether there might be another way to relieve the pain. For example, pain from a joint or muscle injury might be better treated by applying an ice pack at regular intervals (no more than 15 minutes every hour). Similarly, rest and relaxation might be an effective treatment for a headache. If you decide to use a painkiller, following the guidelines below will reduce your likelihood of developing serious side effects.

• If you have any of the risk factors for gastric bleeding, take paracetamol or talk to your doctor or pharmacist before taking ibuprofen or aspirin.
• Make sure you are not taking more than one paracetamol or NSAID product at a time.
• Read and follow the directions on the label.
• Take no more than the recommended dose.
• Take for no more than a few days at a time unless directed by your doctor.
• If pain persists, see your doctor.

Paracetamol, ibuprofen and aspirin are sold under their generic names as well as many brand names. Listed below are a few of the more common brand names.

Paracetamol	Ibuprofen	Aspirin
Dymadon	Actiprofen	Aspro
Herron Paracetamol	Advil	Aspro Clear
Lemsip	Brufen	Bayer Aspirin
Panadol	Bugesic	Disprin
Panamax	Nurofen	Herron Aspirin
Parahexal	Tri-Profen	Solprin
Paralgin
Setamol
Tylenol

NB Most pharmacy chains and supermarkets also have their own home brands.