Each drug is sometimes combined with other drugs to relieve various symptoms. ASA, ibuprofen and naproxen sodium all belong to a class of medications called NSAIDS (non-steroidal anti-inflammatory drugs).

ASA

For centuries, we have known about a chemical with effects similar to ASA. Roman soldiers used willow bark, which contains salicylates, to relieve pain. The modern form, ASA, was first sold as Bayer Aspirin. Today, ASA is available in varying strengths, as both uncoated and enteric-coated tablets. Uncoated tablets dissolve quickly and are used for speedy relief of minor pains. Enteric-coated tablets have a covering on the outside that makes the drug easier on the stomach. Arthritis sufferers who take ASA regularly use this version. Your health care professional may also recommend enteric-coated ASA daily to prevent heart attacks, depending on your personal risk factors.

Think about whether any of the following concerns apply to you. If so, check with your pharmacist or doctor before taking ASA.

You have a history of peptic ulcer disease (ulcers in the stomach or beginning of the intestines).
You have reduced kidney function or liver disease.
You will be having surgery in the near future. (This is elective or planned surgery, not emergency surgery.)
You have asthma or another lung disease.
You are taking prescription drugs, especially if it is a blood thinner like warfarin.
You are allergic to ASA or NSAIDs (non-steroidal anti-inflammatory drugs).

ASA is not recommended for children or young adults because of a link to Reye’s Syndrome, which can be a very serious condition. Pregnant women should only use ASA on the advice of their doctors. Take ASA with food to reduce the chance of stomach upset.

Acetaminophen

Acetaminophen, first sold as Tylenol, is the most commonly used pain reliever. It can be used by all ages, does not react badly with most other drugs, and of the three OTC pain relievers is easiest on the stomach. It works well for pain and fever, but does not affect inflammation. Some use it for arthritis as it treats the pain of this condition. Acetaminophen comes in many forms and brands, including liquid for a child’s pain and fever, regular tablets and caplets, and a timed-release tablet.

Over the last few years, Health Canada has released a number of recommendations, statements and reports about acetaminophen. This drug has been identified as the leading cause of all serious liver injuries in Canada, mostly due to unintentional overdoses.

Acetaminophen is safe for treating pain, provided that you avoid unintentionally taking too much. According to Health Canada, if you're taking products containing acetaminophen, you should do the following.

Read the product label and follow the instructions.
Understand how much to take, how frequently to take it and when to stop.
Keep track of how much you've taken and when.
Avoid taking more than one product containing acetaminophen at the same time. Be aware that many cough and cold products also contain acetaminophen.
If you must combine products that contain acetaminophen, be aware of the maximum recommended daily dose.
- Adults and children aged 12 years and older should not exceed 4,000 mg of acetaminophen from all products.
- Children less than 12 years old should receive dosing by weight. Check with your doctor or pharmacist for help in choosing the right dose for your child.
- Be extra cautious of liquid preparations, as different formulations contain varying concentrations of acetaminophen. Always use the dosing device specific to the product you have purchased.

Many medications contain acetaminophen. Talk to your pharmacist or other health care provider if:

you're unsure about whether a product contains acetaminophen
you do not know how much you're taking
you have questions about risk factors associated with this medication.

If you have liver disease, are pregnant or take prescription drugs, check with your pharmacist or doctor before choosing acetaminophen.

Ibuprofen

Ibuprofen became an OTC medication in the late 1980s. Today it is available as Advil, Motrin, and in generic form. Ibuprofen is effective for easing pain and inflammation, and is also available as a liquid to treat a child’s pain and fever. Many dentists recommend this drug because it works well for dental pain.

Ibuprofen is similar to ASA, so many of the same guidelines (see above) apply. Always take ibuprofen with food.

Check with your pharmacist or doctor before you take this medication, especially if you have certain medical conditions, are pregnant or take other medications.

Naproxen sodium

In 2009, naproxen sodium became available in Canada without a prescription. It is available as Aleve and in generic brands. This medication also relieves pain and inflammation. It lasts longer in the body than ibuprofen.

Talk to your doctor or pharmacist before you take naproxen sodium, especially if you have other medical conditions, are pregnant or are taking other medications. Use it no more than twice a day, as higher doses are more likely to cause stomach pain or ulcers.

Combination products

Codeine is available in eight-milligram strength without a prescription in most provinces, as long as the tablet contains two non-narcotic ingredients. It is available as Tylenol #1 and in generic brands. Caffeine is often one of the two ingredients. The other will be either ASA or acetaminophen. Pain relievers containing codeine are only available directly from your pharmacist. Codeine can be abused, and large doses will damage the liver and kidneys. Codeine can also cause drowsiness and constipation (trouble moving the bowels). For these reasons, your pharmacist must document the sale of these products to ensure the health and safety of those with pain.

Non-prescription codeine should not be given to children. (Since 2013, Health Canada has also recommended that children under age 12 should not use prescription codeine-containing products. Very recently, another recommendation was added – this medication should not be used after surgery to remove tonsils or adenoids in those under 18 years of age.)

Muscle relaxants are also combined with pain relievers to treat aches, strains and stiff muscles. Methocarbamol and chlorzoxazone are the two most commonly used in Canada. These products should be taken with food and can cause drowsiness. Robaxacet, Robaxisal, Robax Platinum and Tylenol Muscle Aches and Body Pain are all muscle relaxants.

Advil Nighttime is another combination product now being sold. It contains ibuprofen for pain and diphenhydramine (Benadryl) as a sleep aid. If pain makes it difficult for you to sleep, this medication can be used on a short-term basis.

However, do not use this product if you have glaucoma, chronic lung disease or difficulty urinating due to an enlarged prostate. Always check with your pharmacist to ensure this is safe for you before using.

Rubs

Rubs can be an effective way to treat sore muscles or arthritis. The ingredients in most rubs mildly irritate the skin, so the body notices that sensation instead of pain. You can choose a rub with a warming or cooling effect, depending on your preference. Most rubs work quickly, except for those containing capsaicin. The effects of capsaicin build over time, so this type of rub must be used regularly. Do not wrap the affected area or apply heat (including baths or heating pads) while using a rub. This can burn you.

There is also a rub available that contains diclofenac, a non-steroidal anti-inflammatory medication in topical format for rubbing into the affected area. The regular strength rub can be used in people 16 years of age and older and the extra strength rub can be used in people 18 years of age and older. Do not use this rub if you are already taking an NSAID by mouth or if you have had a reaction to NSAIDs in the past. Talk to your doctor or pharmacist before using this rub if you take other medications, are pregnant or breastfeeding or have other medical conditions. Diclofenac rub can be used for relief of aches and pain associated with acute, localized muscle or joint injuries such as sprains, strains or sports injuries (including sprained ankles and strained shoulder or back muscles). Talk to your doctor if your condition does not improve within seven days of use or if it gets worse.

The next time you are looking for pain relief, talk to your pharmacist. The array of brands and dosages on pharmacy shelves can be confusing. However, only a few ingredients are available over the counter to relieve pain. Armed with your pharmacist’s help and some knowledge, you can choose the one that is right for you.

Over-the-Counter Pain Relievers Choosing the right one

At the pharmacy, all the choices staring at you from the shelves may seem baffling. Relax. You are choosing between four main types of OTC pain relief medication:

ASA

Acetaminophen

Ibuprofen

Naproxen sodium

Combination products

Rubs

Over-the-Counter Pain Relievers
Choosing the right one