What are the top 5 pain relievers?

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Over-the-counter painkillers

Madeeha Waheed, pharmmeds.store at Bupa, Clinical and Operational Improvement

Over-the-counter (OTC) painkillers are medicines to relieve pain that you can buy without a prescription. You can buy them from a pharmacy or a shop. OTC painkillers include paracetamol, ibuprofen, low-dose codeine, dihydrocodeine, and aspirin.

Uses of over-the-counter painkillers

You can use over-the-counter painkillers for short-term relief of minor pain. They can also help to reduce a fever. Examples of when you might want to use painkillers include if you have:

You can also take them if you’re recovering from minor medical procedures.

If you need painkillers to treat long-term (chronic) pain – for example, pain from arthritis – you should see a GP. They may be able to prescribe stronger painkillers or for a longer duration than what you can buy over the counter.

Types of over-the-counter painkiller

The main over-the-counter painkillers are:

  • paracetamol (for example, Panadol and Calpol®)
  • non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (for example, Nurofen and Calprofen®) and aspirin (for example, Anadin)
  • weak opioid painkillers such as codeine and dihydrocodeine – these are usually added to another painkiller such as paracetamol (for example, co-codamol, Solpadol and Paramol)

If you have mild-to-moderate pain, paracetamol is often the best painkiller to try first. But NSAIDs such as ibuprofen can be better for pain associated with inflammation. You can switch to a different painkiller if the first one you try doesn’t ease your pain. You can also take different types together – for example, paracetamol and ibuprofen. You might also choose to try a product that contains codeine if paracetamol or ibuprofen alone are not enough.

Which painkiller suits you will depend on exactly what you’re taking it for. It will also depend on whether or not you have any medical conditions or are taking any other medications. For more information, see our sections on Interactions and special considerations.

How over-the-counter painkillers work

Different painkillers work in different ways.

  • Anti-inflammatory painkillers, such as ibuprofen and aspirin, stop your body making chemicals called prostaglandins. Prostaglandins are partly responsible for causing pain and inflammation in your body. So, reduced prostaglandins can reduce pain and inflammation.
  • It’s unclear exactly how paracetamol works. But it’s known to reduce production of prostaglandins and also reduce pain signals in your brain and spinal cord. Paracetamol doesn’t reduce inflammation. But it can relieve pain and reduce a high temperature.
  • Opiate painkillers, such as codeine, work by blocking pain messages in your brain and spinal cord.

Because painkillers work in different ways, there are some products available that contain more than one type of painkiller. For example, aspirin, paracetamol, or ibuprofen can be combined with codeine. If you’re taking several painkillers, read the patient information leaflets that come with your medicines to make sure you don’t accidentally take too much. Ask a pharmacist for advice if you’re unsure.

Taking over-the-counter painkillers

You can buy over-the-counter (OTC) painkillers in several different forms, including:

  • tablets, caplets (coated and rounded tablets), or capsules that you swallow
  • a powder or tablet to dissolve in water
  • a liquid or syrup
  • suppositories – soft, shaped tablets that you put into your back passage
  • gels or creams that you rub into your skin
  • patches that you put on your skin

You can buy OTC painkillers from a pharmacy, supermarket, or other shops without a prescription from a doctor. You can buy two packs of 16 tablets of paracetamol or ibuprofen from a pharmacy, shop or supermarket (a maximum of 32 doses) but only one pack of codeine/dihydrocodeine. Shops and pharmacies legally aren’t allowed to sell you more than this at a time. This is to prevent people accidentally or intentionally taking too many.

How much to take

Read the patient information leaflet that comes with your OTC painkillers carefully. This will give you information about the dose – including exactly how much to take and how often you can take it. This may also be displayed on the product packaging. You can usually take most over-the-counter painkillers every four to six hours.

Some other types of medicine – for example, cold and flu products – also contain painkillers such as paracetamol. So, if you need to take a painkiller, check the labels carefully on other medicines you’re taking. Ask your pharmacist for advice if you’re unsure.

Only take painkillers that contain codeine for a maximum of three days. If you still have pain after this time, see your GP.

Taking too much

Any medicine can be dangerous if you take too much of it.

  • If you take too much paracetamol, it can cause serious liver damage, which can be life-threatening. Sometimes, there are no symptoms until a few days or so afterwards.
  • If you take too many NSAIDs, it can make you feel or be sick and can also cause hearing problems, such as tinnitus.
  • If you take too much aspirin, it can make you hyperventilate (breathe faster than normal). It can also cause hearing problems and make you sweat a lot.

If you think you’ve taken too much of any medicine, get medical advice as soon as you can.

Interactions of over-the-counter painkillers

Non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen can interact with several other medicines. These include medicines to lower blood pressure, treat depression and reduce blood clotting (for example, warfarin). Check with your doctor or pharmacist before taking ibuprofen if you’re also taking steroids, lithium or methotrexate.

If you’re taking medicines with codeine in them, don’t drink alcohol or take sedatives. Together, they can make you very drowsy and affect your breathing.

Paracetamol is generally safe to take with other drugs. But check with your doctor or pharmacist if you’re unsure, especially if you have any liver function problems.

The patient information leaflet that comes with your medicine will give you more information about potential interactions with other medicines.

Children and over-the-counter painkillers

Paracetamol and ibuprofen can help to ease pain and discomfort or lower a fever in children and babies. You can give paracetamol from the age of two months and ibuprofen from the age of three months. If you try either of these and they don’t seem to be working, you can switch to the other medicine. You can also alternate between giving paracetamol and ibuprofen. But don’t give both medicines at the same time.

Always read the patient information leaflet that comes with the medicine. If you have any questions, or are unsure about how much to give, ask a pharmacist or your GP for advice.

You can buy paracetamol and ibuprofen as syrups and dissolvable powders, which are easier for children to take than tablets.

Don’t give aspirin to children under the age of 16 because it has been linked to a serious condition called Reye’s syndrome. This can be potentially life-threatening.

Special considerations

Some groups of people, such as the examples below, may need to avoid certain over-the-counter (OTC) painkillers or take special care with them.

  • You may not be able to take non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen, if you have a condition that causes bleeding. This includes haemophilia and peptic ulcers. You may need to take extra care if you have heart, liver or kidney problems or other long-term conditions, such as asthma or inflammatory bowel disease.
  • You need to be careful which medicines you take as you get older because they can affect you differently. You may also more likely to be taking lots of different medicines as you get older.
  • If you’re pregnant or breastfeeding, paracetamol is the safest painkiller to take. Don’t take ibuprofen unless your doctor advises you to.

Always read the patient information leaflet that comes with your medicine to check if you’re safe to take it. Ask your pharmacist or GP if you’re not sure.

Side-effects of over-the-counter painkillers

You’re unlikely to get side-effects from taking over-the-counter (OTC) painkillers if you follow instructions on how to take them.

Side-effects from paracetamol are rare when you take the recommended dose.

Non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen, can affect your stomach. You might get indigestion or heartburn, have diarrhoea or feel sick so it’s best to take NSAIDs with food, some yoghurt, or a glass of milk. NSAIDs can also make asthma worse, so check with your doctor or pharmacist if you have this condition.

Opioid painkillers, such as codeine, can cause constipation and may make you feel sick. They can also make you drowsy, so don’t take an opioid painkiller if you need to drive or operate machinery. Some people who take opioid painkillers become dependent on them. If you find that you need to keep taking them or they don’t work as well as they did, speak to your GP.

For more information about possible side-effects of OTC painkillers, read the patient information leaflet that comes with your medicine.

Medicines checklist

Bupa’s medicines checklist (PDF, 0.8MB), helps you understand what to check for before taking a medicine.

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