Taking Tylenol or Advil? 3 Questions to Ask Before You Do

Seek pain relief, but know your risks

Could Ibuprofen Help You Live Longer? Maybe

In your medicine cabinet right now, you probably have bottles of over-the-counter pain relievers, such as acetaminophen, aspirin, ibuprofen or naproxen. But do you know whether you can safely take these drugs? For many people, if you follow dosing instructions, the answer is yes.

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However, the U.S. Food and Drug Administration (FDA) has issued warnings about pain relievers, and research often calls their safety into question.

Most recently, the FDA boosted its warning that non-steroidal anti-inflammatory drugs (NSAIDs) may raise the risk of heart attack and stroke, even as early as the first few weeks of use. That applies to ibuprofen and naproxen, but not aspirin or acetaminophen.

Warnings such as these don’t mean you should clear out your medicine cabinet. Acetaminophen and NSAIDs are valuable in a lot of cases for relieving aches and pains and bringing down your fever or your child’s.

But before you reach for relief, have a chat with your doctor — and consider the following questions.

1. What other conditions do I have?

Your current health plays a big role in the risks that come with drugs.

If you suffer from digestive diseases, consult a doctor before taking a NSAID. NSAIDs, such as Advil and Aleve, can be hard on the digestive system. Risks can be short-term (upset stomach) or long-term (severe ulcers).

And because NSAIDs can decrease blood flow to the kidneys, consult your doctor first if you have kidney disease too.

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A little expert advice on drug interactions can help you get the pain relief you need while avoiding unwanted side effects.

The latest FDA warning about NSAIDs specifically mentions those who have recently had bypass surgery or a heart attack. If you fit into those categories, it’s all the more reason to consult a doctor before taking a pain medication. Acetaminophen might be a better choice than NSAIDs for you.

On the other hand, if you have liver disease, you might need to avoid taking acetaminophen (drugs such as Tylenol), because of its potential effects on the liver.

These are just a few examples among many. If you’re in good health, such concerns may not apply to you. But any chronic conditions you have will play a part in drug safety.

2. What other medications am I taking?

Your other treatments play a part, too.

For example, if you are taking a blood thinner such as warfarin, adding NSAIDs into the mix can increase your risk of bleeding. Although acetaminophen in higher doses may have a mild interaction with warfarin, it may be a better choice if your doctor advises it.

The main point is this: When you are managing a chronic condition, such as heart disease, don’t be afraid to ask doctors and pharmacists for advice.

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Also, be sure to check whether any other over-the-counter drugs you’re taking contain acetaminophen or ibuprofen. That way, you won’t exceed the maximum dose.

It’s hard to process all the information on the inserts that come with prescription medications and the labels on over-the-counter drugs. A little expert advice on drug interactions can help you get the pain relief you need while avoiding unwanted side effects.

3. Why do I need the medication?

As a rule, you want to take the lowest dose of any medication to treat your symptoms. You also want to take the most effective medication possible.

For example, studies suggest acetaminophen is highly effective at relieving headaches and the aches and pains of osteoarthritis. And it doesn’t come with the same concerns regarding cardiovascular or digestive diseases.

On the other hand, NSAIDs may pack a punch against certain muscle aches for some patients, as well as menstrual cramps.

For fighting fevers, there’s debate about what’s most effective. Ibuprofen may work for longer in single doses, but you can achieve similar results with acetaminophen by taking it more frequently. Because it comes with fewer risks overall, I typically recommend acetaminophen for children’s fevers. The same goes for elderly patients, for whom kidney function is often a concern.

The bottom line: Once you know you can safely take an over-the-counter medication, pick the one that works best for you. Even then, take it only when you need to — and take the least amount that controls your symptoms.

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Michael Rabovsky, MD

Michael Rabovsky, MD, is Medical Advisor for the Health Essentials blog. He chairs the Department of Family Medicine in Cleveland Clinic’s Medicine Institute and actively promotes wellness and disease prevention.
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