Is There Any Difference Between OTC Pain Relievers?

Table of Contents
View All
Table of Contents

Ads frequently promote the pain-relieving properties of Motrin, Aleve, Tylenol, Bufferin, and similar over-the-counter (OTC) products found on drugstore shelves. By and large, most people tend to stick with the brand that we recognize or believe is "better" than others.

But the question is this—are they better, and is there really any difference between one pain reliever and the next? The simple answer is yes, they are different and some of them have side effects or drug interactions to be aware of. Before you pick up a bottle, you'll want to make an informed decision about which to buy.

Tetra Images/Getty Images

Properties of Pain Relievers

Each of these popular pain relievers has both benefits and risks. While their general function is more or less that same—to alleviate pain—their mechanism of action and indications for use do vary.

The reasons for using them can include some or all of the following:

  • To relieve a headache
  • To treat fever
  • To alleviate pain, swelling, and stiffness in joints or muscles
  • To relieve pain from injury
  • To lessen some of the symptoms of allergies, colds, or the flu

The choice of drugs depends largely on the condition(s) you need to treat and the potential problems that may prevent you from using a particular product.

The products themselves can be divided into four drug classes:

Ibuprofen, naproxen sodium, and aspirin are all non-steroidal anti-inflammatory drugs (NSAIDs) with a similar mechanism of action. You shouldn't combine NSAIDs as that can increase the likelihood of side effects. Serious risks of NSAIDs (with the exception of aspirin) include an increased risk of heart attack or stroke.

NSAIDs work by blocking certain proteins, called COX-1 and -2 enzymes, outside of the central nervous system (CNS) and at the site of damaged tissues. COX enzymes are involved in the inflammatory process, so blocking them counters inflammation and the pain it can cause.

Meanwhile, acetaminophen has a mechanism of action that is not fully understood. It's suspected of targeting a protein that sometimes called COX-3 but is actually a variant of COX-1.

However, it blocks the protein inside the CNS, not outside of it like NSAIDs. This crucial difference means that acetaminophen isn't effective for inflammation-related problems, such as sprains.

Motrin and Advil (Ibuprofen)

Motrin and Advil are two of the best-known brand names of ibuprofen, which is also marketed under other names. It is used to treat pain, fever, and inflammation, and is commonly used to alleviate the symptoms of a migraine, menstrual cramps, or rheumatoid arthritis

Ibuprofen has fewer side effects than other NSAIDs but can cause heartburn and a rash. It should be avoided in people with kidney or liver problems and may increase the risk of hypertension (high blood pressure) and heart attack if taken excessively.

Aleve (Naproxen Sodium)

Aleve is the brand name of naproxen sodium and is also marketed under other names such as Midol. It treats the same symptoms as ibuprofen, although Midol (which is marketed as a treatment for menstrual cramps) also contains caffeine and a mild antihistamine. The advantage of naproxen is that it remains in the system far longer than other NSAIDs.

Compared to ibuprofen, naproxen has a far higher risk of stomach ulcers. As such, it should be taken with food or avoided if you have a history of ulcers or inflammatory bowel disorders (IBD).

Tylenol (Acetaminophen)

Tylenol is the best-known brand name of acetaminophen. It is also marketed under other names such as Anacin and Panadol. It's used to treat pain and fever, but it doesn't help with inflammation.

Acetaminophen is often combined with opioid pain medication to treat serious pain following surgery. It is generally safe at the recommended dose although a serious skin rash has been known to occur in some individuals.

An overdose of acetaminophen can cause serious, sometimes fatal, damage to your liver. It's important that you stay within the recommended dose. Acetaminophen is in a lot of combination products, so be sure to check everything you're taking.

Unlike NSAIDs, however, the use of acetaminophen is not associated with heart attack or stroke risk.

Excessive use of acetaminophen can lead to liver failure, particularly if accompanied by alcohol.

Aspirin (Acetylsalicylic Acid)

Aspirin, also known as acetylsalicylic acid (ASA), is marketed under the names Bayer, Bufferin, Ecotrin, and an assortment of generic versions. Aspirin is used to treat pain, fever, and inflammation.

Upset stomach is a common side effect of aspirin. Stomach ulcers and gastrointestinal bleeding can occur. This happens most often in older people, those who drink alcohol, take other NSAIDs, or are on blood thinners.

Aspirin should be avoided in children with fever due to the risk of Reye's syndrome (a form of encephalopathy).

Unlike other NSAIDs, aspirin is not associated with heart attack risk. In fact, it is often taken on a daily basis to reduce the risk of heart attack and stroke, particularly in people considered to be at high risk.

If taken during a heart attack, aspirin can significantly reduce the chance of death. On the other hand, it should not be taken if you are having a stroke as strokes are often caused by the rupture of a vein (rather than by blockage). As such, aspirin can make a stroke worse by promoting bleeding.

A Word From Verywell

When choosing the right pain reliever, it's important to look at the side effects and any potential drug interactions. Get advice from your doctor as to which may be the best for you.

If you are in the drug store and need some last-minute advice, particularly if you have medical conditions or take medications of any kind, you can also ask the pharmacist.

Was this page helpful?
Article Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Hospital for Special Surgery. Guidelines to help reduce the side effects of NSAIDs (nonsteroidal anti-inflammatory drugs).

  2. U.S. Food and Drug Administration (FDA). FDA strengthens warning of heart attack and stroke risk for non-steroidal anti-inflammatory drugs. June 9, 2015.

  3. Risser A, Donovan D, Heintzman J, Page T. NSAID prescribing precautions. Am Fam Physician. 2009;80(12):1371–1378. 

  4. Sharma CV, Mehta V. Paracetamol: mechanisms and updates, Continuing Education in Anaesthesia Critical Care & Pain, 2014:14(4);153–158. doi:10.1093/bjaceaccp/mkt049

  5. Angiolillo DJ, Weisman SM. Clinical pharmacology and cardiovascular safety of naproxen. Am J Cardiovasc Drugs. 2017;17(2):97–107. doi:10.1007/s40256-016-0200-5

  6. U.S. Food and Drug Administration (FDA). Questions and answers: FDA warns of rare but serious skin reactions with the pain reliever/fever reducer acetaminophen. Updated Jaunuary 7, 2015.

  7. Yoon E, Babar A, Choudhary M, Kutner M, Pyrsopoulos N. Acetaminophen-induced hepatotoxicity: A comprehensive update. J Clin Transl Hepatol. 2016;4(2):131–142. doi:10.14218/JCTH.2015.00052

  8. American Society of Health-System Pharmacists, SafeMedication. The benefits and risks of aspirin.

  9. American Heart Association. Aspirin and heart disease. Updated March 20, 2019.

Additional Reading