The over-the-counter pain reliever acetaminophen (Tylenol) has been in the news lately, since the FDA sent a letter to doctors warning of its possible link to autism, attention deficit hyperactivity disorder (ADHD), and other neurological conditions when taken during pregnancy. There is no established evidence to confirm such a link, and for older adults with sore joints, headaches, and other everyday aches and pains, Tylenol remains a go-to over-the-counter (OTC) pain relief option. A 2022 University of Michigan poll of people ages 50 to 80 with joint pain found that 66 percent had used OTC pain relievers during the past year.
While OTC pain relievers can be safe and effective for people of any age, they’re not appropriate for everyone. As you get older, you’re more likely to have health issues that these drugs could worsen, such as high blood pressure, cardiovascular disease, and loss of kidney function. And other drugs you take to manage health conditions—such as blood thinners—could interact with a pain reliever and amplify its side effects.
Because you can buy pain relievers like acetaminophen (Tylenol) and ibuprofen (Advil, Motrin) without a doctor’s prescription, you might assume that they’re safer than prescription medicines—but that’s not necessarily true. There is always a possibility that you might use either type of medicine incorrectly—for example, by taking the wrong dose or combining it with incompatible medicines.
You might not require a pain reliever at all. For some types of pain, interventions like physical therapy, massage therapy, or acupuncture may work just as well, without as many side effects. If your doctor determines that your pain does warrant an OTC pain reliever, choosing the right one depends on the cause of your pain, which health conditions you have, and what other medicines you take to manage those conditions. The decision starts with an understanding of your options and a thoughtful discussion with your doctors and pharmacist.
Here’s a breakdown of the OTC options.
Acetaminophen
Known as paracetamol in other countries, acetaminophen (Tylenol) relieves minor aches and pains and reduces fever. It’s one of the most popular pain relievers, and one of the oldest (Tylenol has been on the market since 1955).
How it works
Researchers have been studying acetaminophen for 150 years, and they still aren’t sure how it relieves pain. One likely mechanism is its ability to block cyclooxygenase (COX) enzymes—particularly the COX-2 enzyme that’s involved with triggering pain in the central nervous system. It also may reduce sensitivity to pain.
Acetaminophen relieves mild to moderate pain, such as from headaches, menstrual cramps, backaches, muscle aches, sore throat, toothaches, and osteoarthritis. It’s a good go-to for minor ailments because it’s less likely to cause stomach irritation than NSAIDs (see below).
Forms
Acetaminophen comes in a tablet, extended-release tablet, chewable tablet, capsule, and liquid. Brand names other than Tylenol include Panadol and FeverAll. Acetaminophen is also an ingredient in multi-symptom cold and flu remedies like NyQuil Cold/Flu Relief and Dayquil. Products like Excedrin Migraine combine acetaminophen with caffeine. Because caffeine acts on the central nervous system, its addition contributes to a small but noticeable improvement in pain relief.
Side effects
This pain reliever is safe to take from time to time, but using it for long periods or taking more than the recommended daily limit (4,000 milligrams) could cause serious side effects. Signs of acetaminophen overdose include nausea, vomiting, abdominal pain, jaundice (yellow color to the skin and eyes), and confusion.
Consuming excess acetaminophen can damage the liver. Your liver breaks down this drug and removes the byproducts into your urine, but it converts a small amount into a toxic byproduct. If you take too much acetaminophen, that toxin could build in your liver. Avoid acetaminophen if you have liver disease or severe liver impairment. Because the combination of acetaminophen and alcohol also contributes to liver damage, it isn’t the right pain relief choice for a hangover.
While concerns have recently been raised about acetaminophen use in pregnancy, the American College of Obstetricians & Gynecologists considers this pain reliever safe during pregnancy. Major studies, including one in BMJ in 2025, have found no link between its use in pregnancy and the risk of autism or ADHD in the child. The dangers of having an untreated fever in pregnancy, including a possible increased risk for ADHD or autism and birth defects in the child, could make it more dangerous to “tough it out” than to treat the fever with acetaminophen.
Acetaminophen precautions
Check the ingredients list of your OTC and prescription medicines, including cold and flu remedies and other pain relievers, so that you don’t inadvertently take too much acetaminophen. Limit alcohol, or better yet, avoid it entirely, because it can increase the amount of toxic byproduct the liver makes as it breaks down acetaminophen. And if you do drink, do it several hours before or after taking acetaminophen.
Ask your doctor before using acetaminophen if you have high blood pressure. Research suggests that regular use of this pain reliever (4,000 mg daily) can raise blood pressure in people with hypertension, increasing the risk for heart disease and stroke. Some brands of chewable acetaminophen contain the sweetener aspartame, which is dangerous for people with the inherited disease phenylketonuria (PKU).
Nonsteroidal anti-inflammatory drugs (NSAIDs)
Over-the-counter NSAIDs include aspirin (Bayer, Bufferin), ibuprofen (Advil, Motrin), and naproxen (Aleve). All are also available generically. NSAIDs relieve pain and lower fever, and, unlike acetaminophen, they also bring down inflammation in the body. (See box for more specific uses.)
How they work
The main mechanism of NSAIDs is to block both COX-1 and COX-2 enzymes in the brain and body. These enzymes are involved in the production of chemicals like prostaglandins, which contribute to pain, inflammation, and fever. Because NSAIDs act on both types of COX enzymes, they have different effects in the body, and different side effects, than acetaminophen. For example, since they block these enzymes less selectively than acetaminophen, they also lower inflammation.
Forms
Most NSAIDs come as tablets or capsules, but topical gels/creams are also available to treat osteoarthritis and soft-tissue injuries like sprains. These pain relievers may also be ingredients in combination products like Aleve PM and Advil PM, and they are combined with caffeine in OTC medicines like Advil Dual Action.
Side effects
All NSAIDs carry a boxed warning about their risks, which include an increased chance of a potentially life-threatening heart attack or stroke, even in people who don’t have heart disease. Those risks are primarily seen among people who take higher doses or who use NSAIDs for a long period of time.
Gastrointestinal risks like ulcers, bleeding, or holes in the esophagus can occur, because these medicines block the production of certain prostaglandins that normally protect the intestinal lining. The GI risks are higher in people who are older, have a history of peptic ulcers, or take NSAIDs long term.
Aspirin, as well as all other NSAIDs, can cause side effects like nausea, vomiting, heartburn, and stomach pain.
NSAID precautions
Tell your doctor before starting NSAIDs long-term (more than three times a week for over three months) if you or a family member has a history of heart disease, you’ve had a heart attack or stroke, you smoke, or you’ve ever had high blood pressure, high cholesterol, or diabetes. Your doctor should also know whether you have ulcers or other gastrointestinal conditions (including liver disease) or kidney disease. Inform them about all other medicines you take (especially blood thinners).
NSAIDs are not the best choice for treating injuries with bruising because they can reduce the body’s ability to clot, which could increase the bruising (take acetaminophen instead). Some ibuprofen products contain aspartame. Read the label and avoid these versions if you have PKU.
Get medical help right away if you have symptoms like these while taking NSAIDs: chest pain, shortness of breath, weakness on one side of the body, or slurred speech. Stop taking the pain reliever and call a doctor if you develop heartburn, stomach pain, blood in the stool, or vomit that is bloody or that looks like coffee grounds.
Although all NSAIDs reduce pain, fever, and inflammation—and have stronger anti-inflammatory effects than acetaminophen—each has slightly different clinical properties. But ultimately, the choice of which to use should be individualized, based on your cardiovascular, gastrointestinal, and renal risk factors.
Aspirin. Aspirin is used for mild to moderate pain from conditions like osteoarthritis, toothaches, muscle aches, and backaches. Aspirin also inhibits platelets in the blood from clumping together and forming clots. It once was common to take low-dose daily aspirin to help prevent heart attacks and strokes from cardiovascular disease (CVD), but the U.S. Preventive Services Task Force (USPSTF) revised its guidance for the primary prevention of CVD (stopping the disease from developing in the first place) in 2022. Adults ages 60 and older shouldn’t take low-dose daily aspirin to prevent CVD unless their doctor advises it, and people ages 40 to 59 who have a 10 percent or higher 10-year risk for CVD should talk to their doctor about whether the benefit outweighs the bleeding risk from aspirin.
Ibuprofen. This NSAID helps with mild to moderate pain, such as from a toothache or menstrual cramps. Its anti-inflammatory effects make it useful for conditions such as muscle strains, osteoarthritis, and rheumatoid arthritis. It typically lasts about four to eight hours and is less likely to irritate the stomach or affect blood clotting.
Naproxen. Like other NSAIDs, naproxen is used for pain and inflammation from conditions such as sprains and arthritis. A distinct advantage is that naproxen lasts longer than other NSAIDs—about eight to 12 hours—allowing for fewer doses throughout the day. And it has antiplatelet activity approaching that of aspirin.
BOTTOM LINE: OTC products like acetaminophen and NSAIDs (aspirin, ibuprofen, naproxen) can be a safe and effective way to manage everyday pain, but they’re often overused, so caution is warranted before you take them (particularly if you have risks like high blood pressure and kidney disease).
Be careful when using products that are marketed for a specific condition, such as back pain, along with an OTC pain reliever. Often, these products contain the same active ingredient, in the same dose, as the standalone pain reliever, and you might inadvertently take too much.
Ask your doctor to recommend a pain reliever based on your health profile, follow the directions on the label, and make sure not to exceed the recommended dosage. Your pharmacist can provide additional information and answer any further questions you may have.
