Q: My 88-year old mother often complains of various aches and pains. What is the safest over-the-counter painkiller for her to take? Aren’t some of them bad for your liver and kidneys?
A:Frequent aches and pains are a common problem for older adults.
If your mother has been complaining, you’ll want to make sure she gets a careful evaluation from her doctor. After all, frequent pain can be the sign of an important underlying health problem that needs attention. You’re also more likely to help your mom reduce her pains if you can help her doctors identify the underlying causes of her pain.
That said, it’s a good idea to ask what over-the-counter analgesics are safest for older people.
That’s because improper use of OTC painkillers is actually amajor cause of harm to older adults.
So let me tell you what OTC painkiller geriatricians usually consider the safest, and which very common group of painkillers you should look out for.
What’s the safest OTC painkiller for an older parent?
For most older adults, the safest oral OTC painkiller for daily or frequent use is acetaminophen (brand name Tylenol), provided you are careful to not exceed a total dose of 3,000mg per day.
Acetaminophen is usually called paracetamol outside the U.S.
It is processed by the liver and in high doses can cause serious — sometimes even life-threatening — liver injury. So if an older person has a history of alcohol abuse or chronic liver disease, then an even lower daily limit will be needed, and I would strongly advise you totalk to a doctor about what daily limit might be suitable.
The tricky thing with acetaminophen is that it’s actually included in lots of different over-the-counter medications (e.g. Nyquil, Theraflu) and prescription medications (e.g. Percocet). So people can easily end up taking more daily acetaminophen than they realize. This can indeed be dangerous; research suggests that 40% of acetaminophen overdoses cases are accidental.
But when taken at recommended doses, acetaminophen has surprisingly few side-effects and rarely harms older adults. Unlike non-steroidal anti-inflammatory drugs (NSAIDs, see below), it does not put older adults at risk of internal bleeding, and it seems to have minimal impacts on kidney function and cardiovascular risk.
Be careful or avoid this common class of painkillers
At the drugstore, the most common alternatives to acetaminophen are ibuprofen (brand names Advil and Motrin) and naproxen (brand names Aleve, Naprosyn, and Anaprox).
Both of these are part of a class of drugs known as non-steroidal anti-inflammatory drugs (NSAIDs). Many people are familiar with these medications. But in fact, older adults should be very careful before using NSAIDs often or regularly.
Unlike acetaminophen, which usually doesn’t become much riskier as people get older, NSAIDs have side-effects that are especially likely to cause harm as people get older. These include:
- Increased risk of bleeding in the stomach, small bowel, or colon. Seniors who take daily aspirin or a blood-thinner are at especially high risk.
- Problems with the stomach lining, which can cause stomach pain or even peptic ulcer disease.
- Decreased kidney function. This can be especially problematic for those many older adults who have already experienced a chronic decline in kidney function.
- Interference with high blood pressure medications.
- Fluid retention and increased risk of heart failure.
Experts have estimated that NSAIDs cause 41,00 hospitalizations and3,300 deaths among older adults every year.
Recent research has also suggested that NSAIDs cause a small but real increase in the risk of cardiovascular events (e.g. heart attacks and strokes).
Because of these well-known side-effects of NSAIDs in older adults, in 2009 the American Geriatrics Society recommended that older adults avoid using NSAIDS for the treatment of chronic persistent pain. Today, oral NSAIDs remain on the Beer’s List of medications that older adults should avoid or use with caution.
(NSAIDs can also be prescribed as creams or gels. These topical forms are much safer, and can be effective for pain.)
Despite this fact, NSAIDs are often bought by seniors at the drugstore. Perhaps even worse, NSAIDs are often prescribed to older adults by physicians, because the anti-inflammatory effect can provide relief from arthritis pain, gout, and other common health ailments.
(Commonly prescribed NSAIDs includeindomethacin, diclofenac, sulindac, meloxicam, and celecoxib. These tend to be stronger than the NSAIDs available without a prescription. However, stronger NSAIDs are associated with higher risks of problems, unless they are used as a cream or gel, in which case the risks are much less.)
Now let me share a true story. Many years ago, a man in his 70s transferred to my patient panel. He had been taking a daily NSAID for several months, prescribed by the previous doctor, to treat his chronic shoulder arthritis.
I cautioned him about continuing this medication, explaining that it could cause serious internal bleeding. He seemed dubious, and said his previous doctor had never mentioned bleeding. He wanted to continue it. I decided to let it slide for the time being.
A few weeks later, he was hospitalized for internal bleeding from his stomach. Naturally, I felt terrible about it.
This is not to say that older adults should never use NSAIDs. Even in geriatrics, we sometimes conclude that the likely benefits seem to outweigh the likely risks.
But this conclusion really shouldbe reached in partnership with the patient and family; only they can tell us how much that pain relief means to them, and how concerned they are about the risk of bleeding and other side-effects. (It’s also possible to reduce the risk of bleeding by having a patient take a medication to reduce stomach acid.)
Unfortunately, far too many older adults are never informed of the risks associated with NSAIDs. And in the drugstore, they sometimes choose ibuprofen over acetaminophen, because they’ve heard that Tylenol can cause liver failure.
Yes, acetaminophen has risks as well. But every year, NSAIDs cause far more hospitalizations among older adults than acetaminophen does.
Aspirin: a special NSAID we no longer use for pain
Aspirin is another analgesic available over-the-counter.
It’s technically also a NSAID, but its chemical structure is a bit different from the other NSAIDs. This is what allows it to be effective in reducing strokes and heart attacks. It is also less likely to affect the kidneys than other NSAIDs are.
(For more on the risks and benefits of aspirin, see this MayoClinic.com article.)
Aspirin is no longer used as an analgesic by the medical community. But many older adults still reach for aspirin to treat their aches and pains, because they are used to thinking of it as a painkiller. Aspirin is also included in certain over-the-counter medications, such as Excedrin.
Taking a very occasional aspirin for a headache or other pain is not terribly risky for most aging adults. But using aspirin more often increases the risk of internal bleeding. So, I discourage my older patients from using aspirin for pain.
Tips on safer use of OTC painkillers
In short, the safest oral OTC painkiller for older adults is usually acetaminophen, provided you don’t exceed 3,000 mg per day.
If you have any concerns about liver function or alcohol use, plan to use the medication daily on an ongoing basis, or otherwise want to err on the safer side, try to not exceed 2,000 mg per day, and seek medical input as soon as possible.
You should also be sure to bring up any chronic pain with your parent’s doctor. It’s important to get help identifying the underlying causes of the pain. The doctor can then help you develop a plan to manage the pain.
And don’t forget to ask about non-drug treatments for pain; they are often safer for older adults, but busy doctors may not bring them up unless you ask. For example, chronic pain self-management programs can be very helpful to some people.
Now if your older parent is taking acetaminophen often or every day, you’ll want to be sure you’ve accounted for all acetaminophen she might be taking. Remember, acetaminophen is often included in medications for cough and cold, and in prescription painkillers. So you need to look at the ingredients list for all medication of this type. Experts believe that half of acetaminophen overdoses are unintentional, and result from people either making mistakes with their doses or not realizing they are taking other medications containing acetaminophen.
Last but not least: be sure to avoid the “PM” version of any OTC painkiller. The “PM” part means a mild sedative has been included, and such drugs — usually diphenhydramine, which is the main ingredient in Benadryl — are anticholinergic and known to be bad for brain function. (See 7 Common Brain-Toxic Drugs Older Adults Should Use With Cautionfor more about the risks of anticholinergic drugs.)
My own approach, when I do house calls, is to check the older person’s medicine cabinet. If I find any NSAIDs or over-the-counter anticholinergic medications (e.g. antihistamines, sleep aids, etc), I discuss them with my older patient and usually remove them from the house unless there’s a good reason to leave them.
If acetaminophen isn’t providing enough pain relief
If acetaminophen doesn’t provide enough relief for your mom’s pains, then it may be reasonable to consider over-the-counter (or sometimes prescription) NSAIDs, preferably for a limited period of time. But be sure to discuss the risks and alternatives with the doctor first, and be sure to discuss possible non-drug approaches to lessen pain.
You may also want to ask about topical painkillers, such as gels, creams, and patches. These are generally safer than oral medications, because less of the body is exposed to side effects.
By being informed and proactive, your family can help your mom get better care for her pain, while minimizing the risk of harm from medications.
Questions? Please post them below.
This article was reviewed & updated in April 2021.
FAQs
What is the best pain killer for the elderly? ›
Acetaminophen: American Geriatrics Society (AGS) recommends acetaminophen as the first-line agent for mild to moderate chronic pain in the elderly [1] due to its favorable safety profile.
What is the safest pain reliever to take on a daily basis? ›Acetaminophen is generally considered safer than other pain relievers. It doesn't cause side effects such as stomach pain and bleeding.
What is the safest Nsaid for elderly? ›confirmed these findings when they studied elderly patients on low-dose aspirin. They found that celecoxib has superior GI safety profile, compared with non-selective NSAIDs [26].
Should seniors take ibuprofen or acetaminophen? ›NSAIDs, like ibuprofen and naproxen (Motrin, Aleve), are more effective than acetaminophen (Tylenol), Perloff said. But acetaminophen may be the safer choice for some seniors, including those who are at increased risk of stomach bleeding, or who have kidney or heart disease.
What medication should be avoided in the elderly? ›- NSAIDs. (non-steroidal inflammatory drugs) such as ibuprofen (Advil, Motrin), naproxen (Aleve) and aspirin can increase risk of stomach ulcers, blood pressure, heart failure and affect kidneys.
- Antihistamines. ...
- Sleeping aids. ...
- Benzodiazepines. ...
- Opioids.
For most older adults, the safest oral OTC painkiller for daily or frequent use is acetaminophen (brand name Tylenol), provided you are careful to not exceed a total dose of 3,000mg per day. Acetaminophen is usually called paracetamol outside the U.S.
Why is ibuprofen not recommended for over 65? ›If you're over 65, ibuprofen can make you more likely to get stomach ulcers. Your doctor will prescribe you a medicine to protect your stomach if you're taking ibuprofen for a long-term condition.
Can I take Tylenol every day for chronic pain? ›Is it harmful to take Tylenol every day? In short, no — most people can safely take Tylenol within recommended doses every day.
What is the least harmful NSAID? ›Among traditional nonselective NSAIDs, diclofenac represents the greatest cardiovascular risk. In contrast, naproxen seems to have the safest cardiovascular profile and is the best treatment option in patients with high cardiovascular risk.
What is the best anti-inflammatory that is not an NSAID? ›Acetaminophen is a safe alternative to NSAIDs for people who are allergic or hypersensitive to ibuprofen or other NSAIDs. In addition, certain supplements can help provide relief from inflammation and pain. Common alternatives to NSAIDs include arnica, curcumin, and bromelain.
What can I take for arthritis pain that is not an NSAID? ›
Acetaminophen is as effective as NSAIDs for the management of mild-to-moderate OA pain and is the recommended first-line therapy by the American College of Rheumatology (ACR).
Why do hospitals prefer Tylenol over ibuprofen? ›Hospitals tend to prefer acetaminophen (Tylenol) as a fever reducer and pain reliever because it has fewer side effects than ibuprofen (Advil).
Why do doctors recommend Tylenol instead of ibuprofen? ›Ibuprofen can also damage the kidneys and cause high blood pressure, especially when large doses are taken over a prolonged period. The biggest risk with acetaminophen is liver damage when very high doses are taken. This can lead to liver failure and death if prompt medical attention is not sought after an overdose.
Is Tylenol risky for elderly? ›For most seniors, the safest over-the-counter painkiller is acetaminophen (like Tylenol). However, older adults must NOT take more than 3000 mg of acetaminophen in one day. In high doses, acetaminophen can cause serious or fatal liver damage.
What is the most common medication problem in the elderly? ›Warfarin is one of the most common causes of medication-related hospitalizations in older adults. To reduce the risk of serious problems, one may need to apply extra care in monitoring warfarin effect (via the prothrombin blood test) and extra care in checking for interactions when a new drug is prescribed.
What are three drugs commonly associated with adverse drug reactions in the elderly? ›Hospitalization rates due to adverse drug effects are 4 times higher in older patients (about 17%) than in younger patients (4%). And 66% of these hospitalizations in older patients are due to 4 drugs or drug classes—warfarin, insulin, oral antiplatelet drugs, and oral hypoglycemic drugs.
What are high risk medications for the elderly? ›- Phenobarbital (Luminal) - Mephobarbital (Mebaral) - Secobarbital (Seconal) - Butabarbital (Butisol) - Pentobarbital (Nembutal) - Butalbital and Butalbital combinations (Fioricet/Codeine) These medications are highly addictive and cause more adverse effects than most other sedatives in the elderly, greatly increasing ...
What lists drugs that should not be prescribed to patients over the age of 65? ›The AGS Beers Criteria® identify medications with risks that may be greater than their benefits for people age 65 and older.
What are the safest most effective medications for spine related pain in older adults? ›Acetaminophen (paracetamol) is safe in older adults, but non-steroidal anti-inflammatories (e.g. ibuprofen) may be more effective for spine-related pain. Non-steroidal anti-inflammatories should be used in short-term lower dose courses with gastrointestinal precaution.
Which are the three most common drugs are prescribed to elderly? ›- Opioids.
- NSAIDs.
- Benzodiazepines.
- Ambien.
- Medical Marijuana.
What is the new treatment for chronic pain? ›
Deep-brain stimulation, or DBS, may offer an alternative to existing treatments. It is already used to treat epilepsy and movement disorders, and there is emerging evidence that it may be effective for chronic pain.
What is the most common treatment for chronic pain? ›Medical management of chronic pain, including medicine management: Over-the-counter (OTC) medicines may include nonsteroidal anti-inflammatory drugs (NSAIDs), aspirin, or acetaminophen. Prescription pain medicines, including opioids, may be needed to provide stronger pain relief than aspirin.
What's the strongest OTC pain reliever? ›Naproxen. Naproxen (Aleve) is the most powerful anti-inflammatory pain reliever available without a prescription. It is especially effective for sprains, sunburns and arthritis and other conditions. Similar doses of Naproxen tend to last longer than other non-prescription pain relievers.
What helps arthritis pain in the elderly? ›“In the elderly, treatment options like exercise, weight loss, physical therapy, bracing, and the use of assistive devices, such as canes and walkers, should be considered first to minimize the adverse effects of medication,” she says.
Which antiinflammatory is safest? ›...
This class of medications includes:
- Aspirin (full dose)
- Celecoxib (used in Celebrex)
- Diclofenac (used in Votaren)
- Ibuprofen (used in Advil or Motrin)
- Naproxen (used in Aleve)
NSAIDs can cause ulcers or holes in the gastrointestinal tract and these problems can develop without warning and at any time during treatment. “Older adults are at greater risk of bleeding because the integrity of the stomach linings is not as substantial,” Watanabe said.
What happens if you take Tylenol everyday for a year? ›Heavy use of acetaminophen is associated with kidney disease and bleeding in the digestive tract, the paper reports. The medication also has been linked to increased risk of heart attack, stroke and high blood pressure, the study authors noted.
How much Tylenol can you take in a day long term? ›The maximum daily dose for a healthy adult who weighs at least 150 pounds is 4,000 milligrams (mg). However, in some people, taking the maximum daily dose for extended periods can seriously damage the liver. It's best to take the lowest dose necessary and stay closer to 3,000 mg per day as your maximum dose.
What is the safest medicine for arthritis? ›Methotrexate is widely regarded as one of the safest of all arthritis drugs, though it carries some potential downsides. Gastrointestinal symptoms such as nausea and vomiting are its most frequent side effects.
Which pain reliever is least harmful to the kidneys? ›Acetaminophen remains the drug of choice for occasional use in patients with kidney disease because of bleeding complications that may occur when these patients use aspirin.
What is safer NSAIDs or acetaminophen? ›
Experts still consider acetaminophen a safer option than NSAIDs for older or frail adults, as long as dosages given are at the lower end of the recommended dosage range.
Which is worse NSAID or acetaminophen? ›While acetaminophen is less effective for inflammatory pain than NSAIDs, it does carry fewer side effects. Consider taking acetaminophen if your pain is mild.
What are the strongest natural anti inflammatories? ›Omega-3 fatty acids , which are abundant in fatty fish such as salmon or tuna, are among the most potent anti-inflammatory supplements. These supplements may help fight several types of inflammation, including vascular inflammation. Vascular inflammation is a significant risk factor for heart disease and heart attack.
What antiinflammatory can I take instead of ibuprofen? ›The main alternative for pain relief is paracetamol, which is available over the counter and is safe for most people to take.
What is the best anti-inflammatory on the market? ›Research shows diclofenac is the strongest and most effective non-steroidal anti-inflammatory medicine available.10 Diclofenec is sold under the prescription brand names Cambia, Cataflam, Zipsor, and Zorvolex. It is also available as a topical gel, Voltaren, which is available over the counter.
What over-the-counter painkillers are good for arthritis? ›Over-the-counter pain medications, such as acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve) can help relieve occasional pain triggered by activity your muscles and joints aren't used to — such as gardening after a winter indoors.
What's the best painkiller for arthritis? ›- Paracetamol. If you have pain caused by osteoarthritis, a GP may suggest taking paracetamol to begin with. ...
- Non-steroidal anti-inflammatory drugs (NSAIDs) ...
- Opioids. ...
- Capsaicin cream. ...
- Steroid injections.
- NSAIDs . Nonsteroidal anti-inflammatory drugs (NSAIDs) can relieve pain and reduce inflammation. ...
- Counterirritants. ...
- Steroids. ...
- Disease-modifying antirheumatic drugs (DMARDs).
In high doses, acetaminophen is known to be hepatotoxic or damaging to the liver. Ibuprofen is less likely than acetaminophen to cause liver damage. On the other hand, ibuprofen is more likely to cause gastrointestinal and cardiovascular adverse effects than acetaminophen.
Which is worse for your liver acetaminophen or ibuprofen? ›Acetaminophen is harder on the liver than ibuprofen. The liver is the main organ responsible for breaking down acetaminophen. When taken occasionally, and at recommended doses (no more than 4,000 mg per day), it shouldn't cause any liver damage.
What can I take to replace ibuprofen? ›
Naproxen and aspirin are two other common over-the-counter pain relievers. Reeder describes the uses, benefits and potential problems with these as well: Naproxen. Another anti-inflammatory drug, which works much like ibuprofen.
Is Tylenol OK for elderly? ›For most seniors, the safest over-the-counter painkiller is acetaminophen (like Tylenol). However, older adults must NOT take more than 3000 mg of acetaminophen in one day. In high doses, acetaminophen can cause serious or fatal liver damage.
What is prescribed to control extreme pain? ›Narcotics (also called opioids) are used for moderate to severe pain and require a doctor's prescription. They may be habit-forming. They can also be dangerous when taken with alcohol or certain other drugs. Examples of narcotics are codeine, morphine, and oxycodone.
How do you stop the pain when you get older? ›Stretching and exercises like yoga and Pilates can help keep your muscles long and limber, and can help when you're feeling sore, too. If your muscles are hurting, try RICE therapy and over-the-counter pain medicine. See your doctor if you're in a lot of pain.