Q: My 88-year old mother often complains of various aches and pains. What is the safest over-the-counter painkiller for her to take? Aren’t some of them bad for your liver and kidneys?
A: Frequent aches and pains are a common problem for older adults.
If your mother has been complaining, you’ll want to make sure she gets a careful evaluation from her doctor. After all, frequent pain can be a sign of an important underlying health problem that needs attention. You’re also more likely to help your mom reduce her pain if you can help her doctors identify the underlying causes of her pain.
That said, it’s a good idea to ask what over-the-counter (OTC) pain relievers are safest for older people.
That’s because improper use of OTC painkiller tablets is actually a major cause of harm to older adults.
So let me tell you what OTC pain relievers geriatricians usually consider the safest, and which very common group of painkillers can cause serious side-effects in aging adults. I’ve also made a Youtube video cover the topics mentioned in this article:
What’s the safest OTC painkiller for an aging parent?
For most older adults, the safest oral OTC analgesic drug for daily or frequent use is acetaminophen (brand name Tylenol), provided you are careful to not exceed a total dose of 3,000mg per day.
Acetaminophen is usually called paracetamol outside the U.S.
It is processed by the liver and in high doses can cause serious — sometimes even life-threatening — liver injury. So if an older person has a history of alcohol abuse or chronic liver disease, then an even lower daily limit will be needed, and I would strongly advise you to talk to a doctor about what daily limit might be suitable.
The tricky thing with acetaminophen is that it’s actually included in lots of different over-the-counter medications (e.g. Nyquil, Theraflu) and prescription medications (e.g. Percocet). So people can easily end up taking more daily acetaminophen than they realize. This can indeed be dangerous; research suggests that 40% of acetaminophen overdose cases are accidental.
But when taken at recommended doses, acetaminophen has surprisingly few serious side effects and rarely harms older adults. Unlike non-steroidal anti-inflammatory drugs (NSAIDs, see below), it does not put older adults at risk of internal bleeding, and it seems to have minimal impacts on kidney function and cardiovascular risk.
Also safe for pain relief in aging: over-the-counter topical analgesics
Another option to consider are topical analgesics creams; a variety of them are available over-the-counter. I generally recommend trying a few different ones, to see which one seems to provide better relief for a particular person.
Be careful or avoid oral over-the-counter anti-inflammatory drugs
At the drugstore, the most common alternatives to acetaminophen are painkiller tablets such as ibuprofen (brand names Advil and Motrin) and naproxen (brand names Aleve, Naprosyn, and Anaprox).
Both of these are part of a class of drugs known as non-steroidal anti-inflammatory drugs (NSAIDs). Many people are familiar with these medications. But in fact, older adults should be very careful before using NSAIDs often or regularly.
Unlike acetaminophen, which usually doesn’t become much riskier as people get older, NSAIDs cause side effects that are especially likely to become dangerous as people get older. These include:
- Increased risk of bleeding in the stomach, small bowel, or colon. Older adults who take a daily aspirin or a blood thinner are at especially high risk.
- Problems with the stomach lining, which can cause stomach pain or even peptic ulcer disease.
- Decreased kidney function. This can be especially problematic for those many older adults who have already experienced a chronic decline in kidney function.
- Interference with high blood pressure medications.
- Fluid retention and increased risk of heart failure.
Experts have estimated that NSAIDs cause 41,00 hospitalizations and 3,300 deaths among older adults every year.
Recent research has also suggested that NSAIDs cause a small but real increase in the risk of cardiovascular events (e.g. heart attacks and strokes).
Because of these well-known serious side effects of NSAIDs in older adults, in 2009 the American Geriatrics Society recommended that older adults avoid using NSAIDS for the treatment of chronic persistent pain. Today, oral NSAIDs remain on the Beer’s List of medications that older adults should avoid or use with caution. (For more on the Beer’s list, see this article: Medications Older Adults Should Avoid or Use with Caution: The American Geriatrics Society Beers Criteria 2023 Update.)
Now, it’s important to know NSAIDs can also be prescribed as creams or gels. These topical forms are much safer, and can be effective for pain relief. (In fact, as of 2020, the topical NSAID Voltaren gel is now available without a prescription.)
Despite the well-established risks of oral NSAIDs, NSAID painkiller tablets are often bought by seniors at the drugstore. Perhaps even worse, NSAIDs are often prescribed to older adults by physicians, because the anti-inflammatory effect can provide relief from arthritis pain, gout, and other common health ailments.
(Commonly prescribed NSAIDs include indomethacin, diclofenac, sulindac, meloxicam, and celecoxib. These tend to be stronger than the NSAIDs available without a prescription. However, stronger NSAIDs are associated with higher risks of serious side effects, unless they are used as a cream or gel, in which case the risks are much less.)
Now let me share a true story. Many years ago, a man in his 70s transferred to my patient panel. He had been taking a daily NSAID for several months, prescribed by the previous doctor, to treat his chronic shoulder arthritis.
I cautioned him about continuing this medication, explaining that it could cause serious internal bleeding. He seemed dubious, and said his previous doctor had never mentioned bleeding. He wanted to continue it. I decided to let it slide for the time being.
A few weeks later, he was hospitalized for internal bleeding from his stomach. Naturally, I felt terrible about it.
This is not to say that older adults should never use NSAIDs. They are often more effective pain relievers than acetaminophen, especially for conditions such as arthritis. So even in geriatrics, we sometimes conclude that the likely benefits seem to outweigh the likely risks.
But this conclusion really should be reached in partnership with the patient and family; only they can tell us how much that pain relief means to them, and how concerned they are about the risk of bleeding and other dangerous side effects. (It’s also possible to reduce the risk of bleeding by having a patient take a medication to reduce stomach acid.)
Unfortunately, far too many older adults are never informed of the risks associated with NSAIDs. And in the drugstore, they sometimes choose ibuprofen over acetaminophen, because they’ve heard that Tylenol can cause liver failure.
Yes, acetaminophen has risks as well. But every year, NSAIDs cause far more hospitalizations among older adults than acetaminophen does.
Aspirin: a special NSAID we no longer use for pain
Aspirin is another analgesic drug available over-the-counter.
It’s technically also an NSAID, but its chemical structure is a bit different from the other NSAIDs. This is what allows it to be effective in reducing strokes and heart attacks. It is also less likely to affect the kidneys than other NSAIDs are.
(For more on the risks and benefits of aspirin, see this MayoClinic.com article.)
Aspirin is no longer used as an analgesic by the medical community. But many older adults still reach for aspirin to treat their aches and pains, because they are used to thinking of it as a painkiller. Aspirin is also included in certain over-the-counter medications, such as Excedrin.
Taking a very occasional aspirin for a headache or other pain is not terribly risky for most aging adults. But using aspirin more often increases the risk of internal bleeding. So, I discourage my older patients from using aspirin for pain.
Note: A daily baby aspirin also used to be recommended for the primary prevention of heart disease. However, because research showed that in older adults, the risk of bleeding was often higher than the expected protection of a baby aspirin, the US Preventive Services Task Force no longer recommends a daily aspirin for primary prevention in older adults. (A daily aspirin is still however often recommended for those older adults who have already had a heart attack or stroke.)
FAQ: What’s the strongest OTC painkiller?
I’m also sometimes asked what is the “strongest” available over-the-counter analgesic drug.
To be honest, for many aches and pains, most people seem to find anti-inflammatory analgesic drugs (also known as NSAIDs) more effective for pain relief than acetaminophen. This can be especially true if one takes a higher dose, such as 600mg of ibuprofen.
The problem, of course, is that higher doses (and more frequent doses) of NSAIDs create higher risks for older adults.
For this reason, I discourage older adults and their families from trying to get the “strongest” oral OTC pain reliever.
Tips on safer use of OTC painkillers
In short, the safest oral OTC painkiller for older adults is usually acetaminophen, provided you don’t exceed 3,000 mg per day.
If you have any concerns about liver function or alcohol use, plan to use the medication daily on an ongoing basis, or otherwise want to err on the safer side, try to not exceed 2,000 mg per day, and seek medical input as soon as possible.
It is also generally safe to treat pain with over-the-counter topical analgesics. Although oral anti-inflammatory drugs such as ibuprofen are risky in older adults, an OTC topical NSAID such as Voltaren is usually safe.
You should also be sure to bring up any chronic pain with your parent’s doctor. It’s important to get help identifying the underlying causes of the pain. The doctor can then help you develop a plan to manage the pain.
And don’t forget to ask about non-drug treatments for pain; they are often safer for older adults, but busy doctors may not bring them up unless you ask. For example, chronic pain self-management programs can be very helpful to some people. Physical therapy, massage, and certain forms of exercise can play an important role in pain relief, especially when it comes to chronic pain.
Now if your older parent is taking acetaminophen often or every day, you’ll want to be sure you’ve accounted for all acetaminophen she might be taking. Remember, acetaminophen is often included in medications for cough and cold, and in prescription painkillers. So you need to look at the ingredients list for all medications of this type. Experts believe that half of acetaminophen overdoses are unintentional, and result from people either making mistakes with their doses or not realizing they are taking other medications containing acetaminophen.
Last but not least: be sure to avoid the “PM” version of any OTC painkiller. The “PM” part means a mild sedative has been included, and such drugs — usually diphenhydramine, which is the main ingredient in Benadryl — are anticholinergic and known to be bad for brain health. (See 7 Common Brain-Toxic Drugs Older Adults Should Use With Caution for more about the risks of anticholinergic drugs.)
My own approach, when I do house calls, is to check the older person’s medicine cabinet. If I find any NSAIDs or over-the-counter anticholinergic medications (e.g. antihistamines, sleep aids, etc), I discuss them with my older patient and usually remove them from the house unless there’s a good reason to leave them.
If acetaminophen isn’t providing enough pain relief
If acetaminophen doesn’t provide enough relief for your mom’s pains, then it may be reasonable to consider over-the-counter (or sometimes prescription) NSAIDs, preferably for a limited period of time. But be sure to discuss the risks and alternatives with the doctor first, and be sure to discuss possible non-drug approaches to lessen pain.
You may also want to ask about prescription topical painkillers, such as gels, creams, and patches. These are generally safer than oral medications, because less of the body is exposed to side effects.
For severe pain, it may also be reasonable to discuss other prescription drug options. Depending on the type of pain, in some cases it can be reasonable to consider using very small doses of opioids, or other types of painkillers. That said, bear in mind that all prescription pain relievers come with risks and can cause serious side effects. In older adults, most will affect brain function and balance.
The truth is that it’s often not possible to treat pain effectively and 100% safely, when it comes to using oral painkiller tablets. But by being informed and proactive, your family can help your mom get better care for her pain, while minimizing the risk of harm from pain relievers.
Good luck!
This article was last reviewed in March 2026.
[As we are approaching 200 comments, comments have been closed.]
Ashwani Sharma says
Dear Leslie ! Thanks for an excellent and exhaustive narrative covering almost all aspects of treatment of pain with NSAIDs and other OTC prescriptions. I am 63 suffering from arthritis and knee pain. I have no other issues except that I take THYRONORM 50 for elevated TSH levels (T3 & T4 are NORMAL). My blood sugar levels are normal and BP is also normal. I take an occasional NSAID to relieve knee pain. I never exceed one pill per 24 Hrs period and never beyond three days at a stretch. All I want to know is which is better among ETORICOXIB, DICLOFENAC, PARACETAMOL & SERRATIOPEPTIDASE. Regards !
Leslie Kernisan, MD MPH says
Paracetamol is called acetaminophen in the US, it is not an NSAID, and I explain the pros and cons in the article.
I can’t say which medication is best for you, especially since two of the ones you mention are not used in the US. I would recommend you discuss further with your usual clinicians. Good luck!
Janice Abbott says
When I had ulcers caused by the combined treatment of aspirin with NSAIDs I was told that Acetaminophen was “NSAID-like” and that I should never take it or NSAIDs. This perspective may be helpful to consider under circumstances where NSAIDs are not recommended.
Nicole Didyk, MD says
I’m sorry to hear about your ulcers, and they can be associated with NSAIDs or aspirin. Taking an NSAID can increase the risk of a peptic ulcer fourfold in fact.
Acetaminophen doesn’t affect platelets (blood clotting factors in the blood) the way that NSAIDs and aspirin can, so it isn’t a cause of bleeding in the gastrointestinal tract. Most people who’ve had ulcers can safely take acetaminophen, unless there’s another issue like a liver problem.
A discussion with a doctor or pharmacist should be able to clarify is acetaminophen is OK for you.
Tom Snyder says
I am 69 years old and am having trouble staying asleep at night. Falling asleep is no problem, but I usually wake up about 4 a.m. and my mind is racing with thoughts about things I have to do during the week. I usually lie awake for hours before I fall asleep again.
I started taking 5mg. of melatonin (OTC). Is this harmful to my health?
Leslie Kernisan, MD MPH says
Melatonin actually seems to be pretty safe in older adults, and is likely safer than most other sedative or sleeping pill options that are available.
That said, if you are waking up at 4am and then experiencing racing thoughts, I would also encourage you to look into some non-drug techniques that can help you quiet the mind and relax enough to fall back asleep. Online cognitive behavioral therapy programs, such as SHUTi and Sleepio, have been proven to be effective. I also know of a chronically wound up person who greatly improved his insomnia using the Headspace meditation app (there is a series specifically designed to help people improve sleep).
I cover proven treatments for insomnia in this post:
5 Top Causes of Sleep Problems in Aging, & Proven Ways to Treat Insomnia
Good luck!
Charles Tart says
Sometimes I wake at night with my mind dwelling on some issue and getting stuck in it. I’ve found a generally useful treatment is to do a crossword puzzle. My mind is racing, like it “wants” to operate fast, but it’s stuck on topics that cause more excitement, so around and around we go. A crossword puzzle gives my mind a chance to work well, but there’s no emotionally arousing theme, and after 10 to 20 minutes I’m more tired and can go back to sleep.
You probably know of recent historical research about “first sleep” and “second sleep.” Seems that people usually went to bed when it got dark (pre electric lights), woke after a few hours, did something useful but calm for an hour or so, then back to sleep. Like put some wood on the fire to discourage predatory animals from sneaking into camp and eating someone. But basically I find I feel better telling myself I’m experiencing a natural sleep cycle thing in being awake for a while rather than “I have a bad problem!”
Nicole Didyk, MD says
That’s an interesting way to look at sleep! I’m sure there are many ancient memories in our human minds that we’ve turned into “problems”. Thanks for sharing your perspective and stay well.
Marie says
What are you considering “older”…40..50…55…?
Leslie Kernisan, MD MPH says
In the US, the term “older adult” is often used for people who are aged 65+, in part because that is when they qualify for Medicare.
I generally think that it’s sensible to become careful about medications once one reaches one’s early sixties.
Smith says
Thanks for sharing Leslie. The warning signs are really helpful. The side effects of NSAIDs are an eye-opener. A high dose of daily medication can cure one thing and damages another. Most of the people nowadays use pain killers very frequently. Self medication can be dangerous sometimes, and seniors often make bad judgments and the family members should be careful about it. I would like you to write about the common myths of senior medications too. That`s a wide topic too I know, but do think about it though.
Leslie Kernisan, MD MPH says
I think the problem is less about “bad judgments” and more that people simply aren’t informed enough about the risks of certain medications, and safer ways to manage pain.
Glad you find the article helpful.
Janice Kettle says
I am 87 years old and in good health except for a pacemaker which causes no problem. My doctor did tell me 2 weeks ago to reduce Ambient from 10 mg to 5 mg because of potential balance issues. I was unable to walk with one foot directly in front of the other. Sure enough I fell twice last week. I did not trip over anything or slip on a wet surface. I was stepping up on a curb, then was walking on a carpet. I have never fallen before. I hesitate to name my medications here but would very much like to talk to you about them and get your thoughts.
Leslie Kernisan, MD MPH says
Sorry to hear of your falls but glad you are trying to take action.
Zolpidem (brand name Ambien) is indeed a medication associated with falls in older adults, so in most cases it’s a good idea for seniors to work with their doctors to taper off of this medication if at all possible. Insomnia can be successfully treated with cognitive-behavioral therapy and other approaches. For more on this, see:
10 Types of Medication to Review if You’re Concerned About Falling
5 Top Causes of Sleep Problems in Seniors, & Proven Ways to Treat Insomnia
Many people your age can also improve their leg strength and balance by doing a structured physical therapy program, such as Otago. You may want to talk to your doctor about whether a physical therapy evaluation might be helpful for you. More on Otago is here: Otago & Proven Exercises for Fall Prevention.
Unfortunately, I cannot speak or email with you or anyone else privately about their medical concerns. But I am happy to provide information by answering comments.
I also sometimes offer a live fall prevention workshop, which allows the audience to ask me questions in real-time. For more see How to Personalize Your Fall Prevention Plan.
Good luck and do keep working with your doctor to address this important health issue. The process of evaluating and address fall risk factors often takes weeks to months, when done correctly.
Carol Wasteneys says
Thank you for this article. Would you please write one about medications for rash/eczema relief. My doctor prescribed a 1% cortisone which doesn’t help. I ‘m taking a generic 20mg loratadine tablet no more than once in 24 hrs, less if possible, and I’m also using acetaminophen, especially at night. I’ve avoided benadryl since I read a previous article by you about dementia.
Thank you.
Leslie Kernisan, MD MPH says
Sorry but dermatology is not a strong point for me. Dry skin is indeed common in older adults, but otherwise there is a looonnnggg list of things that can cause rash, so it’s not feasible for me to write about medication to treat rashes.
I will say that 1% cortisone is quite low potency, and I believe it’s common for clinicians to start with a low-potency cream and then consider a stronger one if necessary.
If a rash or itching is bothering you, it’s important to bring it up to your doctor; let him/her know the treatment doesn’t seem to be working well enough. You’ll want to check on whether your rash has been correctly evaluated/diagnosed, because correct diagnosis helps determine an effective treatment. If your rash so far has been managed by a generalist, you might consider asking for a referral to a specialist.
Re Benadryl, if your doctor thinks your skin might benefit from an anti-histamine medication, then it might be possible to get an antihistamine in a topical form rather than oral form, which will help avoid many of the anticholinergic side-effects.
Good luck finding answers and relief.
Anne M says
Florasone cream org natural made by B&T excellent for rashes, itching.
Nicole Didyk, MD says
Hi Anne. From doing a quick look up on Florasone, they report that the active ingredient is cardiospermum, which is derived from the soapberry plant. It isn’t marketed for pain relief, but it might relieve the discomfort from itchy, dry skin. It also contains glycerin, which is a humectant (moisturizer). If it works for you, I’m glad and thanks for sharing this info.
Alix says
Your articles are much appreciated. Could you comment on paracetamol please, the most popular over the counter choice in Australia? Thank you.
Leslie Kernisan, MD MPH says
Whoops. Acetaminophen is the term used in the US for paracetamol. So presumably in Australia paracetamol would generally be the safest OTC medication for an older person, but you should check with your local geriatricians to confirm.
Sorry for the confusion; I actually mentioned paracetamol in an earlier draft of this article but somehow that detail was edited out. I have updated the post with this information.
Govinda Goswami says
In India the government has recently banned the manufacture and sales of PARACETAMOL combined with 50mg caffeine. If it is safe, why they have banned it?
Leslie Kernisan, MD MPH says
Not sure. A health provider in India might be better able to answer your question.
Sharon says
What about using NSAIDs in cream form. You say that aspirin is not used for pain anymore but I find that it is the only thing that works for me if I am avoiding ibuprofens—would something like aspercreme be safer than aspirin tablets for occasional arthritis pain. Acetominphen does absolutely nothing for me.
Leslie Kernisan, MD MPH says
Yes, topical NSAIDs are certainly safer than oral NSAIDs, because most of the body is spared from the NSAID. A recent Cochrane review concluded they are effective, see here.
However it’s important to distinguish between topical NSAIDs, which here in the US are prescription only, and what we call “topical rubefacients,” which are the OTC pain creams — such as Aspercreme — available in the drugstore. Although those products do contain salicylates, their main action is to dilate small blood vessels in the skin and create a sensation of heat. This does seem to bring some people a sense of relief but apparently is not anti-inflammatory in the same way that prescription topical NSAIDs are. This Cochrane review on topical rubefacients concludes that “in chronic conditions their efficacy compares poorly with topical non-steroidal antiinflammatory drugs (NSAIDs)” and “Topical salicylates seem to be relatively well tolerated in the short-term, based on limited data.”
In terms of safety, yes topical is safer than oral, and aspercreme for occasional arthritis pain is likely to be safe for most people.
But as always I would encourage you to talk to your doctor about your pain and also ask about a more comprehensive and holistic approach…there are many non-drug approaches recommended by the American College of Rheumatology, including exercise and weight loss. You can learn more in this Arthritis.org article, which notes that “Despite the availability of treatment guidelines and recommendations, only 5 to 10 percent of clinicians manage patients in a way that is consistent with them.”
Elizabeth says
It would be helpful if you included more natural types of remedies. For example, what’s your take on such things as turmeric as an anti-inflammatory which is often the cause of pain?
Leslie Kernisan, MD MPH says
Natural remedies are a bit outside the scope of my expertise. I mostly write about what I know best, which is helping older adults avoid the many harms they often experience from commonly used allopathic (also known as “western medicine”) treatments.
If you are interested in nutritional approaches then I would recommend working closely with a clinician who has training and experience in that area. To learn more you might also take a look at NutritionFacts.org, which seems well researched, and has several videos on turmeric research.
Eric Auerbach says
Thanks for your articles…..they are definitely helpful, as was this one. But an article on pain relief meds that barely mentions narcotics? I recently had a biopsy that was really painful the next day. I happened to have some leftover oxycontin and took one (only one). That got me through the night, and the next day the pain was tolerable.
Leslie Kernisan, MD MPH says
Pain medication is a big topic so it’s really not possible to address all types in a single article. This one focuses on over-the-counter analgesics.
Thank you for commenting and for your interest in the site.
Mike Kruger says
Hi,
I have serious heath and pain issues!
In the last 3 years…severed Achilles’ tendon,reverse shoulder replacement, pulmonary embolisms due to a gene defect-PAi-1, c-diff colitis, pneumonia,strangulated intestines,severed rotator cuff-all 4 in the other shoulder, severe osteoarthritis in the knees, spinal stenosis.
I take hydocodone, tzanidine, naproxen sodium and acetaminophen for pain relief.
Ambien and trazadone to -sleep.
Xarelto for the PE’s, Paxil for OCD and lovastin for cholesterol and diovan for blood pressure.
I have listed all medication and I would like to find a replacement for naproxen sodium that is compatible!
Thanks,
Mike K.
Leslie Kernisan, MD MPH says
Well, you don’t say how old you are, but it sounds like your health situation is quite complicated. As you are taking a blood thinner, that would increase your risk of bleeding from an NSAID and so it probably does make sense for you to try to find an alternative to using naproxen.
You will have to work with your own health providers to try to identify alternatives. I would especially recommend looking into non-pharmacological approaches to managing chronic pain. Exercise, cognitive therapies, mindfulness practices, and other lifestyle approaches can make a big difference and can enable people to reduce their use of pain medication, although they do require time and effort to implement. For some people, changing their diet and nutrition also helps.
Here is a proven program, you could see if it’s available in your area:
Chronic Pain Self-Management Program
There has also been increasing interest in cannabis as an option for managing pain. Research suggests it can be effective in some circumstances, however the short and long-term risks are not yet well understood (especially when it comes to older adults).
The therapeutic effects of Cannabis and cannabinoids: An update from the National Academies of Sciences, Engineering and Medicine report
Generally, it is better and safer to minimize the use of medication and pharmacological substances. Good luck!
Marc McNab says
If you’d like find out about the long term effects of cannabis then come visit me in Alaska, where I have a couple of friends (62 and 66 yrs old) who have been using it since the early ‘70s. I am 63 and have been using cannabis for about 3.5 years and can say it is very effective in relieving pain, swelling, RLS, helps me sleep!
Leslie Kernisan, MD MPH says
For geriatricians, the “long-term effects” means how does it affect a person who takes it for years when they are in their 80s, or 90s? We also don’t yet know how taking it for decades during one’s middle years will affect one’s later experience. Or, for that matter, how starting to use cannabis for pain at age 60 will affect one’s brain (and the rest of the body) when one is 75, 80, 85, or 90.
I expect we will eventually have the research data we need to understand this better, but it’s likely to take years.
Bo says
It’s interesting that you reference dosage for Tylenol but say nothing about dosage levels for NSAIDs and their relation to studies done and findings. I seriously doubt it’s an all or none scenario. I have been taking Celebrex since 2005,
200mg and exams show me to be a physical specimen. I sense either bias or a hole in your research. As a matter of fact, I have followed findings very closely since Booz etc.
Leslie Kernisan, MD MPH says
I have just published an article on the latest update of the Beers Criteria: Medications Older Adults Should Avoid or Use with Caution: The American Geriatrics Society Beers Criteria (2019 Update).
For all NSAIDs, the recommendation is “avoid chronic use, unless other alternatives are not effective and patient can take gastroprotective agent,” irrespective of dose.
That said, I would say that the risk of NSAIDs is related to the dose and potency, so smaller doses are less risky. For those who conclude they must use NSAIDs (ideally in partnership with their health providers), I would recommend asking to be on the lowest dose necessary. This may require telling the clinician you want to try a lower dose, and then reporting on how the symptoms were on the lower dose.
cam says
I use excedrin + extra strength tylenol foe severe gout pain. I now read that Calif is thinking of banning Tylenol and Excedrine which contains tylenol because of heart and liver problems. How can you still recommend people take these OTC drugs in amounts that would combat severe chronic pain?
Nicole Didyk, MD says
Well, my take on the “ban” is that consideration is being given to having a warning placed on acetaminophen, regarding its potential to increase cancer risk – a potential that is not very clearly established.
As Dr. K points out in her answer to some of the other comments, acetaminophen is a fairly weak analgesic (“pain-killer”) so for severe pain, it is usually not 100% effective, and at doses recommended by the manufacturer and most pharmacists and doctors, it’s not likely to cause significant liver injury (and it’s considered to be heart safe).
Now, excedrin contains caffeine (which can exacerbate some heart issues, like irregular heart rhythm) and aspirin (which can irritate the stomach and increase bleeding risk), as well as acetaminophen. It may be that these non-acetaminophen compounds are what is helping your gout pain, although we often use colchicine (an alkaloid) or prednisone (a corticosteroid) to reduce the inflammation of gout flare ups.
Henry Connor says
What can you use for a swollen hand
Nicole Didyk, MD says
Swelling can be a sign of inflammation, especially if there has been an injury, or if there’s a chronic joint issue, like osteoarthritis. On the other hand (no pun intended), swelling of a limb can indicate a problem with drainage of fluid, from a vein or a lymph vessel. If it’s related to arthritis, I would try to use acetaminophen, as it is safest. Topical treatments (like a capsacin or NSAID ointment) might also be helpful. But determining the cause is the first step.
Ajmal says
What about for tooth painkiller meds like panadolForte 500ng who bad is it for older people
Nicole Didyk, MD says
I haven’t hears of that before but I think “panadol” is also known as paracetamol, which is the same as Tylenol (generic name acetaminophen), so you could consider it as being similar to the acetaminophen discussed in the article.
Anil says
I am having pain in my ribs and slightly cough and white mucus and sometime not full breath I think it inflammation in my chest acetaminophen tab is advisable. I am 63 years old.
Nicole Didyk, MD says
Hi Anil and I’m sorry that you’re having these symptoms. Acetaminophen can help with pain from inflammation of a muscle or other tissue in the chest, but if I saw a patient with this kind of pain along with trouble breathing, cough, and mucus, I’d want to do a full physical examination to see if a chest x-ray or other intervention is needed. I’d advise someone in your situation to see a doctor or health care provider right away.
Renee says
Hi Dr. Kernisan,
I am an adult daughter of a mom who recently turned 95 years old. She fell and hurt her shoulder and an MRI showed rotator cuff tears as well as arthritis. She is in horrific pain. Her GP and heart doctor prescribed 5 pack Medrol which she took according to directions. It had no effect on her pain. Instead, she experienced and is still experiencing debilitating side effects: dizziness, nausea, insomnia, blurry vision, foggy brain and EXTREME WEAKNESS.
My mother is an amazing woman. She had eleven children, is very selfless, quite religious and loved by all. Previous to her fall, she had some balance and dizziness issues and she used a walker. She is also very cognitively aware.
We are beside ourselves. The doctors want to give her a steroid shot in her shoulder. We don’t understand why they are suggesting that considering her strong reaction to the Medrol. Now they are suggesting Trammadol for pain. Another drug with serious side effects similar to the Medrol and she refuses to take it.
We are considering Tylenol with codeine and are wondering what your opinion of that would be.
Here are her other medications:
Tylenol, extra strength which she takes regularly–I’m afraid too much. She usually takes two at a time, two or three times a day. It has not helped her shoulder pain.
Ativan 0.5 mg as needed for occasional anxiety.
Heart/BP medications:
Tykosyn 125 mcg 1 twice daily
Hydralazine 25 mg 1/2 tab in the morning, 1 pill in the afternoon and 1 and 1/2 at night
Isisorbide mononitrate ER 30 mg tablet extended release 24 hr, a by mouth twice daily
Allergy:
Azelastine 0.15% (205.5 mcg) nasal spray (which she stopped because it is a steroid)
She has been instructed to also take:
Vit D 2000 units 1/day
calcium-magnesium moo mg each as needed
Vit B12
B complex
Vit C 100 mg tablet 1/day
Mother also needs to urinate frequently and especially frequently during the night. The doctor prescribed Trospium. Do you have any experience with this. Side effects are awful and considering mom’s sensitivity to drugs, she doesn’t want to take it.
And finally, we would seriously consider cannibis as an option if we knew what kind to give her. Any thoughts on this.
She lives in San Antonio, Texas. Do you know of any good geriatric doctors there?
I look very much forward to your reply.
In sincere gratefulness,
RLR
Nicole Didyk, MD says
Thanks for the detailed information about your mom. It sounds like she is really suffering after that fall and injury to her shoulder.
As Dr K mentions in the article, acetaminophen is the safest OTC pain reliever for most older adults, but it isn’t effective for everyone. We usually discourage codeine in older adults, as it is more likely to be ineffective and cause nausea and constipation. Tramadol is also in the opioid family but has actions on other cell receptors as well, and is often used for acute pain. Opioids can be used in older adults with some caution. For example, I often use very low doses of hydromorphone (0.5 to 1 mg) when I am treating an older adult with severe pain.
Medrol (solumedrol) is a powerful anti-inflammatory steroid, and a form of steroid can also be injected directly into the joint which is often the way it’s used in a rotator cuff tear. Some types of rotator cuff injury require a surgical repair unfortunately.
Urinary frequency can be related to many different issues and not all types of incontinence get better with medications like trospium, which can cause dry mouth and constipation, as you may have already experienced. Check out the article on incontinence for more information.
And finally, cannabis shows promise in the treatment of pain and anxiety, but it’s not currently considered a mainstream treatment for acute pain due to an injury. And just like more traditional medications, cannabis can have side effects too.
If you’re looking for a Geriatrician, the American Geriatrics Society has a helpful tool, which you can find here: https://www.healthinaging.org/find-geriatrics-healthcare-professional
You might also be interested in the Helping Older Parents Membership. The membership provides ongoing guidance from Dr. Kernisan and her team of professional geriatric care managers, to help you more easily get through your journey helping your aging parents. It also includes access to her popular Helping Older Parents Course and live QA calls with her. You can join the waitlist here if you’re interested.
Janice Abbott says
Using the “endless loop flow chart” to effectively cancel opiates covers it. It is Medi Cal’s answser.
Kristi Fahsholz says
My Dr. says DON’T TAKE ACETAMINOPHEN it is bad for your liver. My liver function test results show high enzyme rates in Alk Phos, Alt, and SGOT. We are working to discover why they are so high. How can Dr.s have so many, completely different, opinions? Patients can be stressed enough without having to debate which opinions are correct. It is most confusing.
Nicole Didyk, MD says
I can understand that there’s a lot of information out there and some of it can seem conflicting.
Acetaminophen (aka Tylenol) is metabolized in the liver, and at very high doses, or if a person has specific metabolic, medical, or genetic factors, the metabolic pathways can get overwhelmed and lead to the formation of toxic substances. In cases of extreme overdose or poisonings, this can cause serious liver failure.
Therapeutic doses of less than 3000-4000 mg per day are considered safe for the liver in most cases. If a person has a liver issue, or consumes a lot of alcohol for example, then they should avoid acetaminophen, but for everyone else, it’s reasonable to continue to use it as directed by your doctor or pharmacist.
Monica says
Thank you for information I will Keep in mind these important values when taking anti-inflammatory medication.
Sam Baker says
Taking NSAIDs… really caused my face to break out in blisters, rash… quite painful….
Joan says
I am having knee problems and have been told to bring the inflammation down with either A level or Ibuprofen. I’m 63, have a history of IBS abd I’m worried about taking these drugs, but I can’t just keep limping around. I guess my question is which is worse, in all respects — Aleve or ibuprofen? I have to take an anti-inflammatory, not just a pain killer. Thanks very much.
Leslie Kernisan, MD MPH says
Alleve is the brand name for naproxen. Both naproxen and ibuprofen are NSAIDs. Research studies suggest that there is a higher risk of gastrointestinal bleeding with naproxen than with ibuprofen.
Given your history of IBS (I’m assuming you mean inflammatory bowel disease), I would recommend talking with your gastroenterologist before starting an NSAID for knee pain. NSAIDs do often help with knee pain however there are other ways to manage knee pain and I would recommend trying as many of those as possible. Even a topical NSAID cream will be safer, as you won’t be exposing your bowel to the medication. Good luck!
Peter Zimmer says
Joan,
I lived several years with a couple of arthritic knees. Now at 76, both are replaced.
Pre-op at my request my personal doctor prescribed a topical liquid NSAID (Diclofenac Sodium solution, 1.5% w/w), 40 drops rubbed on my knee up to 4 times a day. PENNSAID was the original brand name, now less expensive generic versions are available.
It gave me both near-immediate (t<10 minutes) local pain relief and reduced my joints' inflammation. While the product sheets said "use 4 times a day" I found I could use it much less frequently, as needed (most often at bed-time). It also served during recovery after surgery.
There are OTC creams with the same but less concentrated active NSAID (Voltaren is one such brand) but I did not care for its smell, feel or less precise dosing… and our drug insurance plan does cover the prescription but not the OTC.
I'd appreciate hearing a bit more from Dr. Kernisan about the comparative side effects and other uses of these topical NSAIDs vs "treat the whole body" NSAID pills.
Leslie Kernisan, MD MPH says
Thanks for sharing your story. Yes, topical painkillers can be effective and certainly are safer, because they don’t expose the entire body to the action of the drug. I share some more information on topical painkillers in this comment, and have also recently added a few updates to the article itself.