December 01, 2020

How safe are Tylenol and Advil compared to other pain drugs?

Q: I was able to stop taking opioids to manage my pain. Now I'm reading that Advil and Tylenol have risks, too. Is anything safe?

A: No drug is completely without risk, but nonprescription pain drugs have no risk of addiction and generally carry less severe side effects than do prescription pain drugs. Still, it's very important to know the full story and talk with your doctor and pharmacist about the right drugs and dosage for you.

Acetaminophen (Tylenol, others) can damage the liver or cause liver failure, particularly at high dosages. The risk of liver damage increases if you drink alcohol. Older adults are more susceptible to side effects due to natural declines in organ function and resiliency, and due to higher likelihood of having underlying disease.

Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve) are commonly taken. However, regular use and overuse can cause stomach ulcers, kidney damage and internal bleeding, with bleeding risk being increased if you take a clot-preventing drug such as aspirin or clopidogrel (Plavix). NSAIDs can also increase your risk of heart attack and stroke, even early in treatment.

Generally, it's best to limit your use of nonprescription pain relievers. The dose of acetaminophen should be no more than 3,000 milligrams (mg) — no more than nine regular-strength or six extra-strength tablets — in a 24-hour period and less if you drink alcohol. Be alert to hidden sources of alcohol, such as in certain cough and cold formulas.

For ibuprofen, limit your use to no more than 1,200 mg a day, broken into doses of 200 to 400 mg every four to six hours. For naproxen sodium,...