Not all painkillers are created equal – some are better than others at treating different types of pain. Some painkillers also go together safely to make a stronger mix; and how often should you take painkillers?
In this article we’re going to look at these questions, whether you have occasional headaches, period pain, strained muscles or toothache.
The information is mainly for people over 18 years of age, who are not pregnant or breast feeding.
We won’t be looking at prescription opiate drugs, cancer pain etc.
Note: All medications have a drug (chemical) name and a Brand Name. We’ve used mostly drug names here because the brand name for the same drug will vary from country to country. Check the drug packet or ask the pharmacist for the drug information.
Painkillers – where do you start?
You’ve probably heard the phrase ‘don’t take a sledgehammer to crack a nut.’ Probably with that in mind, the World Health Organization (WHO) recommends that if you’re in pain, you start with basic painkillers and build on their strength as you need to.
In practice that means starting with taking 2 paracetamol (2 paracetamol = 1gram and is the full recommended dose) and 4 hours later, taking 2 more.
If you find that you’re still in pain, then you can add another painkiller. An example would be ibuprofen, which is a non-steroidal anti-inflammatory drug (NSAID).
If pain is ongoing you can alternate each of these painkillers every 2 hours so that you’re spacing each drug 4 hourly. For example: take paracetamol at 8am, ibuprofen at 10am, paracetamol at midday, ibuprofen at 2pm etc.
Taking painkillers regularly – every 4-6 hours – when you have ongoing pain is important. It means that the drugs are topped up in your blood stream and always working for you. It’s one of the most common mistake people make when treating pain. We’ll remind you of this further down the page.
If you’re in any doubt about what painkillers you should take, or if you have a pre-existing medical condition, then you should talk to your doctor or to a pharmacist. Do this before you take any painkillers.
Paracetamol and paracetamol-based painkillers.
Paracetamol is a drug that’s been on the market for many years. That means it’s tried and tested by millions of people and is a good basic painkiller.
It is also contained in some cold and flu remedies so check the packaging before taking paracetamol as well as these remedies.
Dose: 2 tablets as a one-off dose or every 4 hours for ongoing pain. Don’t take more than 8 in 24 hours.
Best for: headache, flu symptoms, fever, back ache, after operation.
Don’t take if you have: liver or kidney problems, allergy to paracetamol.
Examples of paracetamol-based painkillers: Co-codamol (a brand name; contains paracetamol and codeine); Anadin Extra (brand name; contains paracetamol, anadin and caffeine).
NSAIDs – non-steroidal anti-inflammatory drugs.
These have also been around for many years. This is a large family of drugs, with over 20 different types so it’s easy to get confused if you have a cabinet full of prescription drugs and bought painkillers.
Ibuprofen, diclofenac, naproxen and aspirin are the most common over-the-counter painkillers in this group.
They work by stopping the body from making chemicals that cause inflammation and pain.
Examples of both prescription and over-the-counter NSAIDs are: ibuprofen (eg brand name Nurofen), aspirin, aceclofenac, acemetacin, celecoxib, dexibuprofen, dexketoprofen, diclofenac, (eg brand Voltarol) etodolac, etoricoxib, fenbufen, fenoprofen, flurbiprofen, indometacin, ketoprofen, mefenamic acid, meloxicam, nabumetone, naproxen, piroxicam, sulindac, tenoxicam, and tiaprofenic acid. Each of these also has one or more brand names.
Dose: read the packaging and leaflet carefully as dosing varies between drugs. For Ibuprofen the over-the-counter dose is usually 200mg in each tablet and you take 2 tablets every 4-6 hours; no more than 3,200mg in 24 hours. This may vary between countries so check the label.
For aspirin the dose is 300mg per tablet and you take 2 every 4-6 hours; no more than 8 tablets in 24 hours.
For diclofenac the over-the-counter dose will vary between countries. Maximum dose in 24 hours is 150mg.
For naproxen 1000mg. for each drug, check the dose in each tablet and work out how many tablets this max dose will be.
Take with: paracetamol (see above), codeine. Be careful not to mix one type of NSAID with any other.
Don’t take if you have: asthma, heart problems, liver problems, kidney problems, peptic ulcers or frequent heart burn problems, allergy to NSAIDs, are taking blood thinning meds such as warfarin.
Codeine and codeine-based painkillers.
Codeine is from the morphine family of drugs, called ‘opioids’. It is a weak opioid and taken as a painkiller (ie not as a recreational drug) it is not addictive and safe to use.
They work by blocking certain chemical receptors in the body changing the way you feel and react to pain.
Dose: the dose of codeine and codeine-based painkillers you can buy from the pharmacy varies between countries. For example in the UK codeine can only be bought when it’s combined with paracetamol (eg brands Co-Codamol or Tylex) or ibuprofen (eg brand names Nurofen Plus, Solpadeine). Check with your pharmacist or the drug leaflet in the box.
They can cause nausea, constipation and/or dry mouth.
Best for: back pain, toothache, after operation, migraine.
Don’t take if you have: problems with drug abuse, problems with constipation, heart, liver or kidney problems, have epilepsy, recent head injury or low blood pressure.
Take with: paracetamol, NSAIDs.
Tylenol is currently available over the counter in the US but not the UK. Its active ingredient is acetaminophen.
It reduces fever but doesn’t reduce inflammation.
Best for: headache, joint pain, cold and flu symptoms.
Dose: 325 mg to 650 mg every 4 to 6 hours to a maximum of 4,000 mg in 24 hours.
Don’t take if you have: diabetes, PKU or need to avoid other substances in your diet, epilepsy, take blood thinners such as warfarin, have liver problems, are allergic to acetaminophen.
Dos and don’ts for painkillers.
- Do take them seriously. Just because they can be bought from the pharmacy doesn’t mean they aren’t powerful.
- Do read the packet information.
- Do take them with food (especially NSAID painkillers).
- Do take them with a cup of coffee or caffeinated drink unless the painkiller already has caffeine in the combination, or it’s near bedtime. Caffeine can make the painkillers work faster.
- Do get the timing right between doses.
- Do see your healthcare professional if your symptoms persist or if you need stronger pain relief.
- Don’t take more than the stated dose in 24 hours.
- Don’t forget to ask your pharmacist if you have any doubts about taking certain painkillers with your current meds.