Over-the-Counter Analgesics: What Nurse Practitioners Need to Know

Theresa Mallick-Searle, MS, ANP-BC


Journal for Nurse Practitioners. 2016;12(3):174-180. 

In This Article

Abstract and Introduction


Many patients and health care practitioners are unaware that over-the-counter (OTC) analgesics can cause potentially serious adverse effects when used in combination with other common medications and in certain patient populations. Recently, there has been a call from the United States Food and Drug Administration, consumer groups, and specialty medical groups for safer use of OTC analgesics. This article reviews the more common OTC analgesics, mechanisms of action, potential drug interactions, and approach to patient management, with consideration of special patient groups.


A landmark survey of medication use patterns in the United States found that > 82% of adults used at least one over-the-counter (OTC) or prescription medication each week, and that 30% used up to five OTC medications.[1–3] Acetaminophen, ibuprofen, and aspirin are among the most frequently utilized OTC analgesics medications.[4]

Because of the widespread availability and perceived safety of OTC analgesics, self-medication with these agents has become commonplace. Practitioners do not always inquire in the medication history about the use of nonprescription drugs or supplements. Many patients and practitioners are unaware of the potential for toxicity and adverse drug interactions associated with the long-term and inappropriate use of OTC analgesics. OTC analgesics may be used in higher-than-recommended doses or in combinations that increase the risk of adverse interactions. Practitioners should be aware of potential drug interactions with OTC analgesics when prescribing new medications, and should review all medications taken (prescription and OTC) with each office visit.

The ready availability of OTC products provides both challenges and opportunities for practitioners. The challenge is to understand the current recommendations for dosing, evaluate drug interactions, and educate patients on the safe use of OTC products. The purpose of this investigation is to review the more common OTC analgesics, mechanisms of action, potential drug interactions, and approach to patient management, including special patient groups (Table).

Acetaminophen, or paracetamol, was first synthesized in 1878, and was introduced for medical use in 1883.[5] It is commonly used as an analgesic and antipyretic, available in many preparations both OTC (oral, rectal, topical) and in prescription formulations, generally combined with opioids and as a branded IV preparation (ie, Ofirmev; Cadence Pharmaceuticals).