Sometimes life gets painful and we need to find relief. If you’re like me, you prefer using natural remedies when possible. However, sometimes a natural option isn’t available and you may be wondering if over-the-counter painkillers are safe.
In this article, I cover the pros and cons of the top over-the-counter painkillers (acetaminophen, ibuprofen, and Aspirin) plus all the extra things you need to keep in mind if you’re pregnant, breastfeeding, or treating little ones at home. I’ll also touch on natural pain relief alternatives.
*Always discuss painkiller use during pregnancy and lactation with your doctor. This is general information and may not be applicable to you.
**All of the following medications have drug interactions and medical conditions in which they should be avoided. These contraindications are not thoroughly covered in this article. Speak with a doctor for advice.
Ibuprofen (Advil, Motrin) & Naproxen (Aleve)
Pros of Ibuprofen & Naproxen
Ibuprofen and naproxen both belong to a class of drugs called NSAIDs. They reduce fever, pain, and inflammation. Ibuprofen is dosed every 4-6 hours and naproxen is dosed every 8-12 hours.
Cons of Ibuprofen & Naproxen
Ibuprofen and naproxen are hard on the stomach and aren’t a good choice for people who have heartburn, stomach pain, or ulcers. There are enteric coated preparations available, but they don’t necessarily reduce the risks of gastrointestinal injury. Ibuprofen and naproxen may increase the risk of cardiovascular events like heart attack and stroke. They may also increase the risk of serious bleeding events. People who are allergic to Aspirin and people with kidney problems should avoid ibuprofen and naproxen.
Considerations for Pregnancy
Ibuprofen is associated with birth defects, including problems with the ovaries and testes when taken during the first trimester. There is some evidence that ibuprofen use may be associated with an increased risk of miscarriage in the first trimester (this is not yet clear and may be due to its increased use for pain prior to miscarriage). Taken late in pregnancy, ibuprofen may interfere with the baby’s circulation and kidneys.
Considerations for Lactation
Ibuprofen is the preferred over-the-counter painkiller for use while breastfeeding because very low levels transfer to breast milk. Additionally, ibuprofen is safe for infants in doses higher than the amount they would receive from breast milk.
There is less information available about naproxen use during breastfeeding and it is generally not recommended.
Considerations for Kids
Ibuprofen is considered safe for children when dosing directions are followed. Ibuprofen is associated with higher risk of adverse events in infants under 6 months of age, therefore Acetaminophen is preferred for young infants. Naproxen is not recommended for children under 12.
Acetaminophen (Tylenol, Panadol)
Pros of Acetaminophen
Acetaminophen reduces fever and pain but doesn’t reduce inflammation. It doesn’t have any adverse effects on the stomach or bleeding so is considered safe for people on blood thinners and/or people with stomach concerns. It is also considered a good alternative for people who can’t take NSAIDs because of cardiovascular or kidney concerns.
Cons of Acetaminophen
Acetaminophen doesn’t reduce inflammation and so isn’t as helpful for injuries, PMS pain, and other cases when an anti-inflammatory is needed.
Acetaminophen use can be hard on the liver and can cause liver damage if taken in higher doses than recommended and/or if combined with alcohol. Acetaminophen overuse decreases glutathione.
Acetaminophen may cause allergic reactions.
Considerations for Pregnancy
Acetaminophen is the preferred over-the-counter painkiller for use during pregnancy and is considered safe in low doses and for short-term use. In my practice, I recommend pregnant mothers rely on natural painkillers and fever reducers (see below), bodywork, or acupuncture and limit acetaminophen use to 1-2 days maximum.
There is growing evidence that acetaminophen use during pregnancy increases the risk of autism and ADHD in children. Prenatal acetaminophen use might also be associated with asthma, reduced IQ, and other neurodevelopmental problems including gross motor development and communication. High, regular doses of acetaminophen are more likely to cause problems than low, infrequent doses.
Considerations for Lactation
Acetaminophen is an acceptable choice while breastfeeding. Amounts of the drug present in breast milk are much less than the recommended dose for infants.
Considerations for Kids
Acetaminophen is considered safe for kids if taken at the recommended dose. Acetaminophen is the preferred painkiller for infants under 6 months.
Salicylic Acid (Aspirin)
Pros of Aspirin
Aspirin reduces inflammation, pain, and fever. It also helps reduce the risk of blood clotting and many people take it in a low dose as prevention.
Cons of Aspirin
Aspirin may cause allergic reactions. In the case of an Aspirin allergy, all NSAIDs and salicylic acid-containing herbs (like willow bark) should be avoided.
Aspirin is hard on the stomach for many people and should be avoided if heartburn, ulcers, or stomach pain are present.
Aspirin’s ability to reduce blood clotting can be a pro, but it can also be a con. Aspirin usually shouldn’t be used by people with bleeding disorders or people taking blood thinning medication.
Considerations for Pregnancy
Salicylic acid preparations are not recommended for pain relief during pregnancy. However, low doses (also called baby aspirin) may be recommended to certain women during pregnancy. For more information on taking low-dose aspirin during pregnancy, see this article: Low-Dose Aspirin in Pregnancy: Potential Benefits & Risks.
Considerations for Lactation
Aspirin is not recommended as an over-the-counter painkiller during breastfeeding. When consuming the recommended dose for pain relief, potentially unsafe amounts of the drug transfer to the breast milk.
At low doses used for blood thinning effects (75- 325 mg per day), aspirin doesn’t enter breast milk and some doctors may recommend it. When taken this way, the infant should be monitored for signs of blood thinning, like bruising and bleeding.
Considerations for Kids
Aspirin generally isn’t recommended for children under 18 because it is associated with Reye’s syndrome when taken during a viral illness. Some doctors may prescribe Aspirin in special cases if the benefits outweigh the risks.
Natural Alternatives for Pain and Fever
Painkillers like Aspirin, Ibuprofen, Acetaminophen, and Naproxen are convenient and effective options for managing pain and fever. However, these options aren’t without side effects. Luckily there are natural alternatives for pain and fever management that are safer and have fewer side effects.
Magnesium is a favorite natural treatment for pain with very few side effects. It has been found effective for nerve pain, muscle pain, fibromyalgia, headaches, migraines, and more.
Ginger is another reliable natural treatment for pain, especially muscle and joint pain, chronic low back pain, and migraine. It is safe in pregnancy and breastfeeding.
Arnica is helpful for pain when taken either homeopathically or infused in an oil. It is best for muscle and joint pain that feels achy or sore.
Melatonin has been studied for the role it plays in reducing pain. In my practice, I haven’t found it to be particularly helpful for acute pain, but it seems to reduce chronic pain well. Research shows that melatonin is commonly taken during pregnancy and lactation and is safe for mom and baby.
Pain is one of the most important signals the body uses to alert you when something is wrong. It is always important to look into the root cause of pain and try to address it before taking a painkiller to mask it.
Fever is also an important and natural part of the body’s defense mechanism. It isn’t always necessary to treat unless a fever becomes too high or uncomfortable or it interferes with sleep. I recently wrote about herbal teas for fever management that also have the added benefits of improving the immune response and soothing other symptoms.
Summary
Aspirin, Acetaminophen, Ibuprofen, and Naproxen are all safe and effective painkillers when taken short term in the recommended doses. They each have adverse effects to consider.
- The most commonly recommended painkiller for women in pregnancy is acetaminophen (Tylenol), but taking too much prenatally may contribute to the development of ASD and ADHD in children.
- The most commonly recommended painkiller for women who are nursing is ibuprofen (Motrin, Advil).
- Children under 18 should avoid Aspirin because it is associated with Reye’s Syndrome.
- People with gastrointestinal tract issues, bleeding issues, cardiovascular issues, or kidney issues should choose acetaminophen (Tylenol) instead of an NSAID like ibuprofen or naproxen.
- People with liver concerns should avoid acetaminophen (Tylenol).
- If inflammation is playing a role in the pain (eg. sprain, strain, menstrual cramps), an NSAID like ibuprofen (Motrin, Advil) or naproxen (Aleve) is a better choice than acetaminophen (Tylenol).
- If an allergy to Aspirin is present, NSAIDs and salicylic acid-containing herbs like willow bark should be avoided.
Keeping these factors in mind can help in choosing the right painkiller to address pain while minimizing adverse effects.
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Aspirin. (2021). In Drugs and Lactation Database (LactMed). National Library of Medicine (US).
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