Once upon a time if you had a headache, a pulled muscle, a cold or a backache, it was fairly simple to choose an over-the-counter painkiller. There was aspirin and the non-aspirin substitute acetaminophen.
But now the shelves of most drugstores are groaning under the weight of gaudy packages of over-the counter analgesics targeting an array of symptoms from allergies, sinus, colds and flu to arthritis, migraines and menstrual pain.
Is it necessary to buy a pain remedy for each possible malady?
Probably not.
“Combining medications, from my perspective, is purely economic,” said Dr. Jerrold Leikin, associate director of Rush Presbyterian St. Luke’s Medical Center’s emergency services.
“Analgesics are used for multiple purposes. They may be used for colds, for example, for muscle spasms, for sports injuries.”
Regular strength Tylenol, for example, contains 325 mg of acetaminophen, its active ingredient. Extra Strength Tylenol has 500 mg per tablet. Tylenol Arthritis Pain Extended Relief contains 650 mg and like the lower dosage versions can be used for arthritis, toothache, muscular aches, backache, menstrual cramps and fever reduction. Two regular strength tablets would produce the same dosage.
Excedrin’s Extra Strength formula contains 250 mg aspirin, 250 mg acetaminophen and 65 mg caffeine. So does Excedrin’s Migraine Formula.
Plain old Motrin provides 200 mg of ibuprofen per tablet; so does Motrin Migraine Pain. Motrin Sinus Headache formula combines 200 mg of ibuprofen with 30 mg of pseudoephedrine, a nasal decongestant.
Is taking one higher dosage pill better?
Products are marketed in regular and extra-strength versions, said Dr. Anthony Temple, vice president of medical affairs for McNeil Consumer healthcare, the company that manufactures Tylenol and Motrin products, to give consumers the choice of taking smaller doses more often or larger doses less frequently.
Many analgesics targeted for colds, flu, sinus and allergies are combinations of ingredients, adding to the dilemma of what to choose.
“There has always been an issue: Is it better to take one or all?” acknowledged Temple.
“It’s largely a matter of convenience. You could take one of each and have the same effect. By putting them all into one form, [consumers] have to take fewer tablets.”
Products with more than one ingredient are called, in industry parlance, “convenience combinations.”
But practically all of them contain acetaminophen, aspirin, ibuprofen, ketoprofen or naproxen sodium and then add other ingredients.
Ibuprofen, ketoprofen and naproxen sodium originally were prescription drugs, but once they were approved by the Food and Drug Administration for over-the-counter sales, a marketing frenzy was unleashed.
In fact, more than 700 OTC products use ingredients and dosages available only by prescription less than 30 years ago, according to the Consumer Healthcare Products Association.
Tylenol’s Cold Complete, for example, includes four ingredients: acetaminophen for aches, pains and fever; a decongestant to shrink nasal membranes and make breathing easier; an antihistamine to dry watery eyes and runny nose, and an antitussive to diminish coughing.
John Coleman, administrative director of pharmacy and nutrition at Loyola University Medical Center, noted that consumers can achieve prescription-strength versions of such products as ibuprofen and naproxen sodium simply by taking more of the over-the-counter versions. But they would be doing so, possibly at their own peril.
“I believe when one takes over-the-counter drugs under the guidelines listed on the product, hopefully, under a physician’s supervision, it’s very safe,” said Rush’s Leikin.
“I’m also a toxicologist and the problem is overdoses. Combinations of drugs make drug overdoses and toxicity much more difficult to handle medically.”
Overdoses of analgesics are one of the most common reasons people call the Illinois Poison Center, he said.
Taking over-the-counter remedies involves self-diagnosis, and Leikin warned that could have serious repercussions.
“For example, you might have some chest pain and think it’s a muscle spasm,” he said. “Or you could take a medication that interacts badly with a disease process such as asthma, high blood pressure and kidney problems.”
Even aspirin isn’t necessarily benign. “Of the three commonly known drug allergies, aspirin is one, along with penicillin and sulfa,” said Loyola’s Coleman.
“Aspirin-allergic people can develop asthmatic attacks. Aspirin can actually interfere with other medications. Most pharmacists will recommend staying away from aspirin products.”
Coleman also is cautious about recommending products with multiple ingredients.
“Most of the time they stay in a person’s medicine cabinet,” he said. “And then when they have a cold of any kind, they take it and they’re not really in need of all of those ingredients.”
WHAT’S IN THAT PAINKILLER?
Just because drugs are available without prescription, it does not mean that they can’t cause problems. It’s best to err on the side of caution by consulting a pharmacist or a physician about side effects and drug interactions — and to read lists of ingredients carefully. You might find some surprises.
Here’s a list of ingredients commonly found in many over-the-counter pain relievers:
Acetaminophen: This gentle compound, first used in the 1880s, has been available over the counter since 1955. It works in the brain to dull the perception of pain. It is relatively free of side effects, but overdoses can lead to severe liver damage.
Nonsteroidal Anti-inflammatory drugs (NSAIDs) work at the site of pain or injury to reduce discomfort and inflammation. They also may help reduce fever, but can have serious side effects if the dosing instructions are not followed to the letter. NSAIDs include:
Aspirin: A compound classified as a “salicylate,” this all-purpose pain reliever has been around since Bayer introduced it 100 years ago. But its use dates back to Hippocrates’ time. It reduces blood clotting by inhibiting platelets from sticking together. That’s why low doses are recommended for some patients at risk of heart attack and stroke, and, conversely, why patients scheduled for surgery are asked to refrain from taking it before and after operations.
Ibuprofen: This anti-inflammatory agent was approved for prescription use in 1974 under the brand name Motrin. Ten years later it was granted over-the-counter status.
Ketoprofen: A drug similar to ibuprofen but longer acting was approved for over-the-counter sales in 1995 under brand names Actron and Orudis KT.
Naproxen sodium: Advertised heavily by Bayer Corp. as Aleve, this drug formerly was available as the prescription medicine Anaprox. It’s a fast-acting form of the medicine in Naprosyn, a prescription arthritis remedy. Its effect lasts longer than ibuprofen.
Added ingredients in combination products:
Caffeine: The same substance in a cup of strong coffee is often used to enhance effectiveness of aspirin or acetaminophen for headache pain.
Chlorpheniramine: The least sedating of the antihistamines, agents that dry up sinuses.
Dextromethrophan: Cough suppressant.
Diphenhydramine: Antihistamine with a sedating effect.
Doxylamine succinate: Antihistamine.
Guaifenesin: Cough suppressant.
Pamabrom: Diuretic often included in menstrual formulas.
Phenylpropanolamine: Raise the red flag! This decongestant has been linked to increased risk of hemorrhagic strokes. Last fall the FDA advised consumers to stop using cold and cough remedies that include it.
Pseudoephedrine: Nasal decongestant.
Tripolidine: Antihistamine.
