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Understanding Over-the-Counter Pain Relievers

November 1, 2019

Hugh David Snyder, MD, an American Board of Family Medicine certified family medicine physician at Summit Springfield Family Practice, provides an overview of common over-the-counter (OTC) medications.

On any typical week, among the most common questions I get include some variation of the following:

  • Do you use Aspirin, Tylenol, Advil, Motrin and Aleve interchangeably?
  • When someone asks if you have an aspirin, do you say, “I’ve got Tylenol?”
  • Will taking too much of any of them will damage some organ – liver, kidneys or stomach?

What each of these questions is referencing are analgesics – medicines that reduce the sensation of pain. So for those who are confused by their choices, here’s a quick review to help you know when to take two aspirin and call your doctor in the morning – and when not to:


The original over the counter medicine. It’s been used for headaches, fevers and even heart attacks and strokes. What makes aspirin different from other analgesics is it has other effects as well. It is an antipyretic – a fever reducer. It also has an antiplatelet effect, which means it works to prevent platelets from sticking to one another to form a clot. That is a great benefit for stopping the clot from developing during a heart attack (it is recommended to chew an aspirin if you suspect a heart attack when you are calling 911).

If you have previously suffered a stroke, taking an aspirin daily is also one way to prevent a second stroke by preventing those platelets from bunching up. However, platelets that don’t bunch up well are slower to clot to stop bleeding, and you can discover you bruise more easily after you take aspirin.

Aspirin is also an anti-inflammatory medicine, but if your inflammation comes from an injury, you probably don’t want to take something that could make you bleed more.

Additionally, aspirin should not be given to children who have a viral illness. I know, I know - when don’t they have a viral illness, right? But doing so is associated with Reye’s Syndrome, which can cause brain damage or even death. To be safe, NEVER give aspirin to child under 18. Luckily, there are alternatives.


Non-Steroidal Anti-Inflammatory Drugs (NSAIDS for short) are a group that includes various brands including Advil, Motrin and Aleve along with many prescription-only cousins. Simply put, these are great anti-inflammatory drugs that aren’t steroids or aspirin. Advil and Motrin are both 200 mg of Ibuprofen. This class of analgesics will reduce pain and fever by reducing the body’s inflammatory response. Aleve is similar, but lasts longer. One side-effect is that NSAIDS can cause your stomach to be more acidic. These medications are ultimately eliminated from your body by the kidneys.


This is a favorite for fevers and headaches. It isn’t as effective at reducing inflammation from musculoskeletal injuries like sprains or strains. However, this is the only one that doesn’t make your stomach more acidic. It is processed by the liver.

Hopefully, this helps alleviate any headaches you have choosing a pain-reliever, but of course, if you still have questions about these or any medications, it’s always best to check with your primary care provider.