Avoid high doses of pain relievers
DEAR DOCTOR: Which over-the-counter pain reliever is safer? They all carry some risks.
DEAR READER: Acetaminophen (Tylenol) has been used since 1955; it is available in multiple products, works well for pain and is for the most part safe. However, at high doses — specifically, above 4,000 milligrams a day, or eight tablets of Extra Strength Tylenol — the medication can cause liver damage, or even death, especially in those who are malnourished, drink alcohol in excess or consistently take more than 4,000 mg per day.
Ibuprofen (Advil, Motrin) has been used for pain since 1974. It is one of many medications classified as non-steroidal anti-inflammatory drugs. NSAIDs work by inhibiting formation of mediators of pain and inflammation, and they’re notably effective at decreasing inflammation in swollen joints related to arthritis.
Naproxen (Aleve) was first marketed in 1976 and works similarly to ibuprofen. But it has a longer half-life, giving it a longer-lasting effect. Both ibuprofen and naproxen decrease the formation of prostaglandins in the
stomach. The decrease of prostaglandins can injure the stomach lining, leading to stomach inflammation, ulcers and possibly severe bleeding.
Celecoxib (Celebrex) is a more selective NSAID and does not decrease prostaglandins in the stomach. This translates into significantly less likelihood of creating ulcerations.
All NSAIDs also reduce prostaglandins in the kidneys, which can lead to kidney injury, and the chronic use of highdose NSAIDs has been linked to an increased risk of heart attacks.
Of the drugs you listed, my feeling is that acetaminophen is the safest when used regularly and at no higher dose than 4,000 mg per day.
The NSAIDs — ibuprofen, naproxen and celecoxib — are needed by some who have inflammatory arthritis, and they are good medications in the short-term.
Robert Ashley, M.D., is an internist and assistant professor of medicine at the University of California, Los Angeles.
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