Pain relievers: what the label warns

Acetaminophen (Tylenol, paracetamol)

1. It hides in many products. More than 600 prescription and over-the-counter medicines contain it, including many cold, flu and sleep medicines. Source: FDA
2. Take only one product with acetaminophen at a time. Two products at once is how people take too much by accident. Source: FDA
3. Prescription labels may not spell it out. Look for APAP, Acetaminoph, Acetaminop, Acetamin or Acetam. Source: FDA
4. Never take more than the label says, even if the pain is still there. Too much can cause liver failure and death. Source: FDA
5. The label's liver warning: severe liver damage may occur if you take more than the most the label allows in 24 hours, take it with other drugs containing acetaminophen, or have 3 or more alcoholic drinks every day while using it. Source: FDA label rule
6. Liver disease? Ask a health care professional before using it. Source: FDA

NSAIDs (ibuprofen, naproxen, aspirin and others)

1. They can cause severe stomach bleeding. The label says the chance is higher if you are age 60 or older, have had stomach ulcers or bleeding problems, take a blood thinner or a steroid, take another NSAID, have 3 or more alcoholic drinks every day, or take more or for longer than directed. Source: FDA label rule
2. Non-aspirin NSAIDs such as ibuprofen can raise the risk of heart attack or stroke. The risk may be higher with long use or higher doses. Source: MedlinePlus
3. Ask a doctor before use if the stomach bleeding warning applies to you, you have had stomach problems such as heartburn, you have high blood pressure, heart disease, liver cirrhosis or kidney disease, or you take a diuretic (a water pill). Source: FDA label rule
4. Do not stack them. Taking two NSAIDs together, such as ibuprofen with naproxen, is one of the label's bleeding risks. Source: FDA label rule

After 75, or on a blood thinner or steroid

1. Geriatric experts advise against NSAIDs every day for a long time unless other options have not worked and a stomach-protecting medicine can be taken with them. The bleeding risk is higher over age 75 and with steroids, blood thinners or antiplatelet medicines. Source: AGS Beers Criteria 2023
2. They can also raise blood pressure and injure the kidneys, and the risks grow with the dose. Source: AGS Beers Criteria 2023
3. Show the pharmacist everything you take, prescriptions and supplements too, and ask whether adding a pain reliever is safe. Source: FDA

What I take for pain: a list for the pharmacist

Write each pain medicine, the active ingredient from its label, and how often you take it. Then print it, or show the screen. Nothing is saved or sent.