The most common over-the-counter pain relievers available in the U.S. are aspirin, Tylenol and ibuprophen. But even though they all relieve pain and reduce fever, they are three different drugs. Each has its own strengths and weaknesses.
Ibuprofen, sold under brand names such as Motrin and Advil, is commonly used for injuries and illnesses in which inflammation is present. Aspirin is acetylsalicylic acid and is sold under many brand names, including Bayer and St. Joseph's. Both aspirin and ibuprophen are nonsteroidal anti-inflammatory drugs (NSAIDs). Tylenol, on the other hand, is a brand name of acetaminophen, which has no anti-inflammatory properties.
Ibuprofen is sold over-the-counter in strengths ranging from 50 to 400 milligrams, though it is available in stronger doses with a prescription. Aspirin typically is available in strengths from 81 to 500 milligrams. Tylenol is available in a wide range of strengths, from a 160-milligram children’s dose to the 650-milligram extended relief version in Tylenol Arthritis. There are no prescription versions of aspirin or Tylenol available without added ingredients (such as codeine or propoxyphene), which make them narcotic painkillers.
Aspirin and ibuprophen can both cause symptoms such as heartburn, nausea, vomiting and even gastrointestinal bleeding. Tylenol is considered the safest of the over-the-counter pain relievers, but it can cause severe liver damage if taken in excess. To avoid this, take no more than 4,000 milligrams in any 24-hour period, and preferably in doses of 1,000 milligrams or less. Also, limit alcohol consumption when taking Tylenol.
Aspirin use by children who have a cold or flu-like illness has been linked to Reye's syndrome, a deadly disease that usually strikes those under the age of 19. Conversely, there has no known correlation between taking Tylenol or ibuprofen and Reye's syndrome. Accordingly, the U.S. Food and Drug Administration and American Academy of Pediatrics recommend that those under the age of 19 should avoid taking aspirin if they have an illness accompanied by a fever.
For treating inflammation, aspirin or ibuprofen are better choices, though they both pose short- and long-term risks. For a chronic illness with inflammation, ask your doctor about getting a prescription COX-2 inhibitor such as Celebrex, which has fewer gastrointestinal risks. If inflammation is not the issue, Tylenol is probably the safest choice for over-the-counter pain relief.