There are multiple over-the-counter fever and pain-reducing medications, but they are not all equal and some can be dangerous for certain people. It is important to know the differences so you can keep you and your family safe.
Trying to choose a fever-reducing medication can be confusing. There are so many different drug names and brands, and they can come in liquid, tablets, extended release, or mixed with other medications.
Over-the-counter (OTC) medications you can purchase without a prescription for fever and pain fall into two major categories:
- Acetaminophen (Tylenol or Paracetamol)
- Nonsteroidal anti-inflammatory drugs (NSAIDs) include aspirin, ibuprofen (Advil, Motrin), and naproxen (Aleve)
These types of medications have three main effects:
- Reduce pain (analgesic)
- Reduce fever (antipyretic)
- Reduce inflammation (anti-inflammatory)
* Aspirin can also act as a “blood thinner” by reducing blood clotting (anti-thrombotic). *
➕➖All medications have benefits and side effects, and times when they shouldn’t be used for certain people or to treat certain conditions. It is always best to talk with your trusted clinician to determine which medication is best for you or your child. They will know your medical history and risks, as well as any other medications you are taking that might lead to dangerous interactions.
📣Always tell your trusted clinician about any supplements you are taking because they also can have interactions with prescription and over-the-counter medications.
⚠️Because you can buy and take these medications without talking to a clinician, sometimes people end up taking too much. All medications can be dangerous in high doses so be sure to take any medication as described on the label unless your trusted clinician tells you differently.
So what are these medications and when should you use them (or not)?
Acetaminophen, also known as Tylenol or Paracetamol
👍🏿Uses
- For temporary relief from fever, aches, and pains.
- Generally safe and does not cause many side effects.
👉Side effects
- Liver damage can occur with large doses.
- Rare allergic skin rashes can occur.
- Taking too much acetaminophen can cause permanent liver damage so don’t take more than recommended on the label.
- Acetaminophen is in many prescription pain medications and also combined in other OTC medications, for example Nyquil. It is very important to check all labels carefully to make sure you are not doubling up and taking too much!
- Drinking alcohol while taking acetaminophen can cause, or worsen, liver damage.
- Acetaminophen can interact with other prescribed medications like certain types of blood thinners and seizure medications–talk to your trusted clinician before using acetaminophen or any over-the-counter medication.
🤔Fun fact: doctors and scientists don’t know exactly how this medication works yet. It will reduce fevers and lessen pain, but unlike the other medications discussed below, it is not specifically used to treat general inflammation.
Nonsteroidal anti-inflammatory drugs (NSAIDs)
There are several different NSAIDs, including aspirin, ibuprofen, and naproxen. Because they work in similar ways, multiple different NSAIDs should not be used at the same time unless recommended by your trusted clinician.
🤓Nerd alert: NSAIDs, like aspirin, work by blocking the action of an enzyme called COX1 and reducing the activity of its cousin COX2. These enzymes promote a chemical reaction leading to the production of inflammatory molecules called thromboxane and prostaglandin. Prostaglandins have various effects on the body, including inducing fever and increasing pain. Thromboxanes activate blood clotting. That is why inhibition of COX with NSAIDs reduces fever and pain. However, only aspirin helps prevent blood clots because its effect on platelets lasts longer than other NSAIDs.
➡️Aspirin
Actually known by the complicated chemical name acetylsalicylic acid, Bayer pharmaceutical coined the brand name aspirin, but the company no longer holds the trademark, and most people use aspirin as the generic name.
👍🏿Uses
- Temporarily relieves fever and pain.
- Reduces general inflammation.
- Some clinicians may recommend low dose aspirin for some adults to reduce chances of heart attack and stroke by preventing blood clotting.
👉Side effects
- Upset stomach
- Ringing in the ears at high doses
- Stomach ulcers
- Bleeding risk
- Delayed release formulations don’t work right away so they shouldn’t be used for fever or pain.
- May worsen asthma symptoms in some people.
- Should not be used in children under 12
- Reye Syndrome: In the decades before 1980, doctors began to notice that treating viral infection-associated fevers in children was highly associated with a severe and often fatal disease called Reye Syndrome. This is a rapidly developing brain and liver disease and 20-40% of children who develop Reye Syndrome die from it. The good news is that strict warnings against use of aspirin in children that began around 1980 led to a dramatic reduction in Reye Syndrome, from over 400 cases per year in the US in the 1970’s to fewer than 2 cases per year since 1994. Because your child could have a viral illness without you knowing, aspirin is no longer recommended for use in anyone under 12, and it is best not to use it until someone reaches adult age.
- You may have heard to take an aspirin if you think you are having a heart attack, but the American Heart Association no longer recommends this because if you are not actually having a heart attack, you can make things worse.
- Use of aspirin during pregnancy is complicated. Aspirin generally should not be used in pregnancy, especially in the later part of pregnancy. However, it is sometimes used in women with a higher risk for preeclampsia under the direction of a clinician. Pregnant people should always consult with their clinician before taking any over-the-counter medications.
➡️Ibuprofen (Advil and Motrin) and Naproxen (Aleve)
👍🏿Uses for ibuprofen and Naproxen
- Temporarily relieves fever, aches, and pain
- Temporarily reduces general inflammation to manage short-term or chronic inflammatory conditions, such as arthritis or gout
👉Side effects
- Upset stomach
- Heartburn
- Indigestion
- Stomach ulcers
- Bleeding risk
- Fluid buildup
- Higher blood pressure
⚠️Important information for ibuprofen and Naproxen
- Long-term use can lead to kidney damage.
- Can increase risk of heart attacks and stroke, especially in those with existing heart conditions.
- Can worsen disease in people with high blood pressure or kidney disease.
- May worsen asthma symptoms in some people.
- Rare severe allergic reactions can occur.
- Not recommended for use during pregnancy.
- Naproxen is longer lasting than ibuprofen (up to 12 hours).
- Only ibuprofen (not naproxen) is generally recommended for use in children (more on this below).
Age and other considerations for use of any pain and fever reducing medication
🧑🦱Adults 18 and older (age 19 for aspirin)
✅It is generally safe to use acetaminophen, or any of the NSAIDs, for temporary pain or fever relief.
💬Always check with your trusted clinician if you have questions or concerns about your specific situation or if you have other medical conditions or are taking other medications, including supplements.
🤰🏾Pregnant people
⚠️According to the American College of Obstetricians and Gynecologists (ACOG), acetaminophen is considered the safest option for fever reduction and pain relief during pregnancy, but always check with your trusted clinician before taking any medication during pregnancy.
⛔Use of NSAIDs during pregnancy is generally not recommended.
🚨Fever is a known risk factor for preterm birth, birth defects, and developmental problems.
👩🏼⚕️Talk to your trusted clinician if you have a fever, *do not tough it out*.
Breast/chestfeeding people
⚠️Medications can transfer to breast milk. Always consult your trusted clinician or your baby’s pediatric clinician before taking any medications while breastfeeding.
👦🏻Children
✅American Academy of Pediatrics posted a fact checked statement reconfirming that it is safe to use acetaminophen in most children and they continue to recommend either acetaminophen or ibuprofen for temporary pain or fever relief. If your child is under 3 you should check with their pediatric clinician first, and if they are under 6 months, your pediatric clinician will likely recommend acetaminophen rather than ibuprofen due to a rare risk of kidney injury with ibuprofen.
⚠️Naproxen is generally considered safe for children 12 and over, but it is best to consult with their pediatric clinician first.
⚠️Always be sure to check the label of any OTC medication carefully to prevent giving too much to a child because there are different dosages for children of different ages.
🚫Aspirin should not be given to people under 19 unless specifically directed by their pediatric clinician.
Remember, over-the-counter pain and fever reducers are extremely helpful for short-term relief. As with all medications, they should only be used as necessary, according to the label directions, and only for a few days unless your trusted clinician recommends otherwise.
Stay healthy and wise,
Those Nerdy Girls
