I keep forgetting what the differences are in the over the counter pain relievers, so I made a handy chart.
i like the idea of a chart to differentiate the most common over the counter pain medications — a lot of people aren’t sure about the differences between them, and aren’t sure how to take them or what to expect. however, i think there are a lot of problems with this particular chart, which i will address:
1. ibuprofen is absolutely not mild on the stomach, and should never be taken by someone with ulcers or acid reflux (unless under direct supervision by a doctor) at the risk of gastric bleeding. ibuprofen is very hard on the digestive system and is associated with greatly increased risk for GI ulceration and bleeding.
in fact, all of the NSAID drugs have negative GI effects. tylenol is the only drug on this chart that can truly be said to have mild digestive effects.
2. aspirin and acetaminophen are in fact very effective for relieving migraine pain in many people! excedrin migraine, a common over the counter migraine pain reliever, contains aspirin, acetaminophen, and caffeine.
3. i disagree with ranking the medications according to how effective they are at alleviating menstrual cramps, and really the category of “best uses”. everyone’s pain is different, and everyone responds to drugs differently. while acetaminophen might be a god-send for one person with menstrual cramps, another person might swear by naproxen and only naproxen. maybe i’m misunderstanding this chart, maybe whoever made it just made it for themselves to remember which ones work best for them, and that’s fine, but the uses should not be taken as gospel.
4. all of these drugs are broken down in the liver (though a small portion of aspirin is also metabolized at the gut wall itself), and nothing is ever broken down in the kidneys. the kidneys are involved in the excretion of all of these drugs, which is different. “break down” or metabolism is how they go from being active (and toxic!) substances to harmless (mostly) waste products, excretion is how they get out of your body. its worth noting that other forms of excretion are through sweat, saliva, and feces.
the reason acetaminophen is more commonly associated with the liver is because it is acutely toxic to the liver itself — that is, it is comparatively easy to fatally damage your liver through an overdose of acetaminophen. this is not true of the other drugs listed, as overdose would manifest in other ways before liver damage occurred.
5. aspirin is an anti-platelet, not an anti-coagulant. aspirin doesn’t affect clotting factors, it just makes platelets, or the blood cell components involved in clot formation, more “slippery” so to speak, so that they don’t get stuck together. anti-coagulants affect the production of clotting factors themselves. this is sort of esoteric, but i think it’s important terminology to know about.
6. i think this was just a mix-up with formatting the table, but there should be two asterisks next to aspirin, ibuprofen, and naproxen, and one asterisk next to acetaminophen.
aspirin, ibuprofen, and naproxen are all non-steroidal anti-inflammatory drugs (NSAIDs), which means that they help alleviate pain by reducing inflammation.
acetaminophen, on the other hand, is not an NSAID, but is (most likely) a cyclooxygenase inhibitor, which means that it blocks the cyclooxygenase enzyme and prevents it from producing prostaglandins, which are molecules associated with pain. it’s worth noting that acetaminophen’s mechanism of action is not well understood, but since it appears to work clinically and we understand enough about it to keep it relatively safe, it’s good enough to use!