Advil, Tylenol and other painkillers come with many risks
They are as simple to buy as a carton of milk, but taking these drugs improperly can be harmful
Whether you have a throbbing headache or aching joints, a pulled muscle or menstrual cramps, it’s easy to reach for a pill to blunt the pain.
Tylenol, Advil and other over-the-counter pain medications are almost always close at hand. Although these medications can be as simple to buy as a carton of milk, the pills are not without risks.
A recent study by Danish researchers suggests ibuprofen, the active ingredient in Advil, can increase the risk of cardiac arrest in some people. The study’s authors call for restrictions on the drug, including limiting the sale of ibuprofen to pharmacies so that people can consult with a pharmacist about its safety.
Tylenol, too, continues to make headlines that link the common painkiller, when taken at higher-than- recommended doses, to increased risk of liver damage. In 2016, Health Canada issued new labelling rules for acetaminophen, the ingredient in Tylenol, in part to stress the importance of taking the lowest possible dose to prevent harm.
Rather than frighten people away from using painkillers, reports of harms associated with them should be reminders that all drugs should be used with some caution, says Michelle Arnot, an associate professor of pharmacology and toxicology at the University of Toronto.
“Everybody should have a pause before taking these drugs,” she says. “But I don’t think we do because they are so ingrained in our culture. We see advertisements for them everywhere, they are over-thecounter; we believe they are safe.”
But, as with any drug, over-thecounter pain relievers are only safe when other factors, such as the dose and an individual’s health conditions, are taken into account.
“They are safe for the majority of the population at a particular time in their lives,” Arnot says. “But it depends on what else is going on healthwise.
“It comes down to taking the right medication, at the correct time, for the correct period of time.”
Allan Malek, a Toronto pharmacist with almost three decades of experience, says people with any drug questions or concerns should speak with their family doctor or pharmacist.
“Even if you are home and have a question, pick up the phone and call,” says Malek, who is senior vice-president of professional affairs at the Ontario Pharmacists Association.
The biggest problem Malek sees at his pharmacy is people buying multiple over-the-counter medications that contain acetaminophen to help them feel better.
“If someone takes eight tablets of extra-strength Tylenol in one day, plus a cold medicine with Tylenol, they are over the daily maximum limit. That’s when you get to toxic levels and risk of liver damage.”
Arnot agrees that people need to closely read over-the-counter drug labels to ensure they are not inadvertently doubling or tripling a dose of a particular medicine.
She also recommends people be mindful of how many days in a row they reach for painkillers.
“Unless you are in the care of a physician, you shouldn’t be taking ibuprofen every day long-term, particularly if you have cardiovascular issues or a family history of cardio- vascular issues . . . You want to get the maximum amount of benefit from a drug with the least amount of risk.” Acetaminophen (Tylenol) How it works: Acetaminophen works by blocking the pain associated with inflammation, but does not reduce inflammation itself. When to use it: A good choice for headache, general aches and pains and will reduce fever that comes with influenza or common colds. It is considered gentler on the stomach than other painkillers. When to avoid it: Acetaminophen is broken down by the liver. That’s why people with liver or kidney disease may want to avoid it. If the liver is not working well, the medicine won’t be properly broken down, which can lead to toxic buildups of the drug.
Choose a different painkiller for hangover headaches to give your liver a break, since it’s already working hard to break down alcohol in your system. People who drink three or more alcoholic drinks every day should also avoid acetaminophen to reduce the risk of liver disease. Maximum daily dose for adults: 4,000 mg; the equivalent of eight extra-strength Tylenol pills or 12 regular-strength pills. Ibuprofen (Advil, Motrin) How it works: Non-steroidal antiinflammatory drugs (NSAIDs) like ibuprofen work by targeting specific enzymes in the body involved in inflammation and pain. It reduces pain because it reduces inflammation. When to use it: For pain due to osteoarthritis, muscle strains and aches, headache, fever, menstrual cramps, dental pain and other pain caused by inflammation. When to avoid it: Ibuprofen and other NSAIDs target the same enzymes that also help protect the lining of the stomach and gastrointestinal (GI) tract. In high doses, it can lead to GI bleeding and stomach ulcers. Those with inflammatory bowel disease, including Crohn’s, colitis and ulcers, should avoid this drug. So should those with kidney and liver problems and bleeding disorders. Long-term use of NSAIDS can increase the risk of heart disease and stroke. Consult with your doctor or pharmacist if you or your family have a history of cardiovascular disease. Maximum daily dose for adults: 1,200 mg; the equivalent of three extra-strength tablets. Health Canada says ibuprofen “be used for a short duration of time (seven days or less).” Aspirin (Acetylsalicylic acid or ASA) How it works: Aspirin is also a NSAID and reduces inflammation. When to use it: At higher doses for mild to moderate aches and pains, headache, fever. At a low daily dose, Aspirin is a blood thinner and can be used to reduce the risk of blood clots, heart attack and stroke. When to avoid it: As with other NSAIDs, Aspirin can irritate the stomach and GI tract and slow blood clotting. Avoid it if you have a history of ulcers or bowel disease, blood disorders or are prone to bleeding and have liver or kidney disease. Consider another painkiller if you have heartburn or a sensitive stomach. Some versions are coated to reduce stomach irritation. Maximum daily dose for adults: 4,000 mg; the equivalent of eight extra-strength pills or 12 regularstrength pills.
“It comes down to taking the right medication, at the correct time, for the correct period of time.” MICHELLE ARNOT PHARMACOLOGY PROFESSOR