4 Nonopioid Analgesics
Compare acetaminophen and NSAIDs, their uses and risks, and the precautions that help guide safer use of nonopioid pain relievers.
What do
relieve pain without opioids. Two widely used groups are and nonsteroidal anti-inflammatory drugs (). Both can also reduce fever, but additionally reduce inflammation.
uses and liver safety
is used for mild to moderate pain, including headache, muscle aches, toothache, and menstrual cramps, and for fever. Because it does not meaningfully reduce inflammation, it may be less useful when swelling and inflammation are major parts of the problem.
The main medication-specific risk is liver injury from taking too much. appears in many prescription and nonprescription products, including some cold and combination pain medicines. Check the active ingredients in every product and add together the from all sources.
The FDA lists 4,000 mg in 24 hours as the maximum for adults and children 12 years and older. Product directions may set a lower limit, so follow the label or a clinician’s instructions and never exceed them. People with liver disease or those who regularly drink three or more alcoholic drinks per day should consult a health professional before use.
A suspected overdose requires immediate medical help or a call to Poison Help, even if the person feels well. Serious liver injury may not be apparent at first.
NSAID effects and risks
reduce pain, fever, and inflammation by blocking enzymes involved in the production of inflammatory chemicals. They can be useful for inflammatory pain, such as a sprain, arthritis symptoms, or menstrual cramps. Common include ibuprofen, naproxen, , and prescription medicines such as celecoxib.
Use only the labeled or prescribed amount, at the lowest effective dose for the shortest necessary time. Common adverse effects include indigestion, heartburn, and nausea. More serious risks include stomach or intestinal ulcers and bleeding, kidney injury, increased blood pressure, fluid retention, and heart attack or stroke. Some serious gastrointestinal events can occur without warning.
Risk is higher for some people, including those with a history of ulcers or bleeding, kidney or heart disease, high blood pressure, or older age. Blood thinners, corticosteroids, and some antidepressants can increase bleeding risk. Ask a clinician or pharmacist before use if these factors apply, and do not combine multiple unless specifically directed.
Pregnancy and precautions
Pregnancy requires special caution with . The FDA advises avoiding them at 20 weeks of pregnancy or later unless a health professional specifically recommends them; use at about 30 weeks or later should be avoided. Low-dose 81 mg prescribed for certain conditions in pregnancy is an exception to this NSAID warning.
has an additional effect on platelets that can increase bleeding. Do not give to children or teenagers with a viral illness unless a clinician specifically directs it, because of the risk of . Prescribed low-dose for cardiovascular prevention is a separate use; do not stop it without consulting the prescriber.
Choosing and using pain relievers safely
The appropriate choice depends on the kind of pain, health conditions, other medicines, and treatment goals. For example, may help a headache or fever when an NSAID is unsuitable, while an NSAID may be considered for pain accompanied by inflammation if the person’s risks allow it. These examples are not a personal treatment recommendation.
Before taking an over-the-counter pain reliever, read the , check for the same active ingredient in other medicines, and ask a clinician or pharmacist about relevant conditions or interactions. Seek urgent care for warning signs such as vomiting blood, black stools, chest pain, sudden weakness, or trouble breathing.