The number of pain relief medications available without a prescription can be very confusing for consumers. With all the different brand names out there - each claiming superiority over the other - no wonder it is difficult to sort out which product might be best for your needs.

There are four basic groups of non-prescription pain relievers available in Canada: Acetylsalicylic Acid (A.S.A.), Acetaminophen, Ibuprofen, and Codeine. The following descriptions should give you an idea of their different uses.

Acetylsalicylic Acid

Dating back to the middle of the 18th century, A.S.A. is one of the oldest pain relievers available. It works to alleviate pain, fever, and reduce inflammation (redness, swelling or heat radiating from the painful site) due to injury or certain types of arthritis.

A.S.A. comes in various forms, including:

• Regular A.S.A. Usually the least expensive available.
• Coated A.S.A. With a special coating to help protect the stomach. Useful for people who need to take A.S.A. on a regular basis.
• Buffered A.S.A. Also meant to protect the stomach, but is not nearly as effective as Coated A.S.A.

For the most part, A.S.A. is a safe pain reliever, but some people should check with their doctor or pharmacist first before trying it. These people include:

• People with ulcers
• People on certain types of medication and/or pain relief rubs
• Children with viral infections,
• People who may be sensitive or allergic to A.S.A. (e.g., some asthmatics)

Acetaminophen

Best known by its brand name, Tylenol, acetaminophen works best on pain and fever and doesn't have anti-inflammatory effects. It is not hard on the stomach and doesn't require a protective coating like A.S.A. Acetaminophen is relatively safe, as long as it is not used above the maximum recommended dose (found on the package, the dose varies according to the strength of the tablet), and should not be taken with alcohol. People who regularly consume alcohol or who have liver problems should avoid this medication. Acetaminophen is safe for children to take.

Ibuprofen

As part of a class of medications called Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), ibuprofen is the only type available without a prescription in Canada (in the U.S., there are a number of NSAIDs available without a prescription, including Aleve and Orudis). Ibuprofen works well on pain, fever and inflammation. It can also be very effective for relieving menstrual cramps (works best when taken as soon as you begin to feel discomfort).

Ibuprofen is not as hard on the stomach as A.S.A. and therefore doesn't come with a protective coating. It is generally a safe medication but should be avoided by people with ulcers, who are sensitive to NSAIDs (e.g., some asthmatics), and by children under 12 years of age unless recommended by a physician. As with any other pain reliever, alcohol consumption should be kept to a minimum while taking ibuprofen.

Consult your doctor or pharmacist for more information on the use of this medication for menstrual cramps and other types of pain.

Codeine

Classified as a narcotic pain reliever, codeine is only available without a prescription in small amounts mixed with caffeine and acetaminophen or A.S.A. It can be very effective for some types of pain, but tends to have more side effects than other pain relievers. Some of these side effects include constipation, nausea and drowsiness (people who need to stay alert should avoid codeine). Codeine is potentially addictive and therefore should be used only for a short period of time unless otherwise directed by a physician. Avoid alcohol while taking codeine.

Brand Names for Pain Relievers

If you have more questions, or are still uncertain about which pain reliever may be the safest and most effective for you, contact your doctor or pharmacist for some help.

Compiled by Carlene Kusch
Chemainus Pharmacy, Chemainus, B.C.
Edited by Megan Stiles
Last Reviewed: September 2001