Painkillers not always risk-free

It seems so easy: Take two aspirin (or Excedrin or Tylenol or Motrin) and call your doctor in the morning. Better yet, hope for the best so you can skip that last part.

Painkillers are available over the counter. So what could go wrong? In many cases, they are harmless -- and helpful. But painkillers also can be dangerous.

"Just because these medications are available without a prescription doesn't mean they are without risks," said Dr. Brian Durkin, director of the Center for Chronic Pain Management at Stony Brook University Medical Center. "Many of these medications were only available by prescription in the past and approved for over-the-counter availability at a time when the bad things that these drugs can lead to were not known."

Medical experts offer suggestions:

1. Try more than one brand to find what works best for you. The two main types are NSAIDs (nonsteroidal anti-inflammatory drugs, including aspirin and ibuprofen) and acetaminophen (like Tylenol).

"Most of the OTC anti-inflammatories are equally effective," said Dr. Robert Duarte, director of the Pain and Headache Treatment Center at the North Shore-LIJ Health System. "There's not one that's stronger than another, but some people respond better to one of them."

2. Be careful about overuse if you have a headache. Painkillers can be good for an occasional mild headache, but they can worsen headaches if taken repeatedly, Duarte said. He said to see a doctor about moderate or severe headaches.

3. Carefully monitor how many pills you take. "Acetaminophen toxicity is well known and can lead to liver failure and death," Durkin said. "The previous recommended maximum dose of 4,000 milligrams per day has been lowered to 3,250 milligrams, and for those who drink more than three alcoholic beverages per day it is even lower." People may end up taking too much without realizing it, Durkin said. That's because other drugs often contain acetaminophen, pushing them over the maximum daily dose.

4. Be cautious about aspirin, especially if you're older. Aspirin can cause internal bleeding, and doctors may recommend another painkiller in seniors because of their higher risk.

5. Consult a doctor before taking any OTC painkiller if you have a chronic medical condition. Research has found that NSAIDs can boost the risk for heart problems, Durkin said, "so patients who are at risk for cardiovascular events, including hypertension, should be monitored closely for increases in blood pressure after starting to take these drugs."