A Review of Over-The-Counter Analgesics: Efficacy and Safety Profile

Abstract

Mohamed A. Koronfel, Ankit D. Patel, Yiliam F. Rodriguez-Blanco and Keith A Candiotti

Chronic pain is a major health problem that affects more than 100 million adults in the US. A variety of overthe-counter (OTC) pain medications are available to patients, and they are typically broken down into two broad categories: acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs). Acetaminophen is one of the most consumed OTC since its introduction due to its cost effectiveness and safety when adhered to recommended doses and uses. However, in significantly larger doses, acetaminophen can cause serious adverse effects such as: upper GI hemorrhage, acute renal failure, and acute liver failure. NSAIDs exert their anti-inflammatory and analgesic properties via the inhibition of the enzyme cyclooxygenase (COX) isoforms. Hence, NSAIDs are classified into nonselective NSAIDs inhibiting both COX-1 and COX-2 such as ibuprofen, naproxen, diclofenac, and selective COX-2 inhibitors such as celecoxib. Despite their effectiveness, NSAIDs are associated with serious adverse events with chronic use including, gastrointestinal, cardiovascular and renal effects. The purpose of this article is to review the efficacy and the safety profile of most popular OTC analgesics, and to provide general recommendations and preventive strategies aiming to reduce the risks and help choosing the appropriate agent.

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