Key takeaways:
Ibuprofen (Advil, Motrin), naproxen (Aleve), and aspirin are three common over-the-counter (OTC) pain relievers. Other OTC pain relief medications include acetaminophen (Tylenol), Alka-Seltzer (aspirin / citric acid / sodium bicarbonate), and diclofenac 1% gel (Voltaren Arthritis Pain).
The best pain reliever for you depends on what type of pain you’re treating. For example, nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen may be best for swelling and inflammation. But acetaminophen tends to have fewer risks, so it may be a better choice for pain if you have existing kidney or heart problems.
Like all medications, these OTC pain medications can have side effects. Always check with your healthcare team before starting a new medication.
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Have a headache, a pulled muscle, or body aches? Over-the-counter (OTC) pain relievers such as ibuprofen (Advil, Motrin), aspirin, or acetaminophen (Tylenol) may help. Unlike prescription opioid pain relievers, OTC pain relief medications aren’t habit-forming. And they’re less likely to cause drowsiness and dizziness. They also tend to be affordable and easy to access.
Most OTC pain relievers come in generic versions, which are generally more affordable than their brand-name counterparts and work just as well. Here, we’ll cover the six of the best pain relievers you can find OTC and how they compare.
Good to know: These OTC pain medications aren’t meant to treat nerve pain. If you think you may have nerve pain, talk with your healthcare team about the best treatment option for you.
1. Ibuprofen (Advil, Motrin)
Ibuprofen is part of a group of medications called nonsteroidal anti-inflammatory drugs (NSAIDs). These medications treat pain, fever, and swelling. Many people consider OTC NSAIDs to be the best pain relief medications that you can access without a prescription.
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OTC NSAIDs like ibuprofen are anti-inflammatory. So work especially well for pain that involves inflammation, such as arthritis, joint pain, and muscle pain. The maximum daily OTC ibuprofen dose is typically 1,200 mg. But if you’re working with a healthcare professional, they may recommend a higher dose with their supervision. Alternatively, they may recommend a lower dose if you’re more at risk of ibuprofen side effects.
Ibuprofen starts working quickly — within 30 minutes after taking it. But maximum pain relief can take 1 to 2 hours. However, the exact amount of time ibuprofen takes to work can depend on individual factors, as well.
Ibuprofen side effects are like those of most NSAIDs, including:
More seriously, NSAIDs can cause kidney damage, bleeding, and heart problems. These risks are rare with recommended ibuprofen doses taken for short periods of time. However, your risk may be higher if you have a history of kidney or heart problems, or if you take medications that increase the risk of bleeding, such as blood thinners. So talk to your prescriber or pharmacist before taking an NSAID like ibuprofen. They can help you determine whether you’re at increased risk of side effects.
2. Naproxen (Aleve)
Naproxen (Aleve) is another OTC NSAID. Like ibuprofen, it treats body aches, swelling, and fever. The maximum daily dose of OTC naproxen is 660 mg per day. Though, if you’re working with a healthcare professional, they may recommend a higher (or lower) dose in some cases.
Although naproxen and ibuprofen are both NSAIDs and have similar side effects, they have some differences:
Naproxen lasts longer, so it usually isn’t taken as often as ibuprofen. For treating pain, OTC ibuprofen is usually taken every 4 to 6 hours, while OTC naproxen is usually taken every 8 to 12 hours. Extended-release naproxen is also available by prescription, and is taken once daily.
It may take longer to feel maximum pain relief with naproxen. Similar to ibuprofen, naproxen starts working in as little as 30 minutes. But it can take up to 4 hours to feel the full effects, which is longer than ibuprofen.
Ibuprofen can be used in children as young as 6 months old (with a healthcare professional’s approval). OTC naproxen is only approved for adults and children ages 12 and older.
Ibuprofen may be less likely to cause bleeding and ulcers. But naproxen may be safer for long-term use if you have heart disease. Although all NSAIDs have risks for bleeding, ulcers, and heart problems, just how risky they are may vary slightly.
3. Aspirin
Aspirin is another NSAID that reduces fever and treats pain. But it’s unique compared to other NSAIDs. Low-dose aspirin can also protect the heart for certain people who’ve had a heart attack or stroke, or who are at increased risk of heart disease. In fact, it’s more commonly used for its heart benefits versus pain relief. NSAIDs such as ibuprofen and naproxen aren’t used to protect the heart.
And unlike other NSAIDs, aspirin is an antiplatelet medication (a type of blood thinner) and can prevent blood clots. But this can also increase your risk of bleeding. While other NSAIDs can also increase the risk of bleeding, aspirin may have a greater risk. Because of this, ibuprofen or naproxen may be safer NSAIDs for pain relief and reducing a fever.
The recommended and maximum daily dosage for aspirin varies, so it’s always best to talk with your healthcare team before starting this medication. Children and teens younger than age 19 shouldn’t take aspirin without a healthcare professional’s OK. Doing so has been linked to Reye’s syndrome — a condition that can damage the liver and brain.
4. Topical diclofenac
Diclofenac is another NSAID. It’s available in several forms, including oral pills and topical creams and gels. Diclofenac 1% gel (Voltaren Arthritis Pain gel) is the form of diclofenac that’s available OTC.
Diclofenac 1% gel is applied directly to the joints to help with joint pain related to osteoarthritis. So it’s a good option for pain associated with arthritis. Your body doesn’t absorb as much medication when diclofenac is applied to skin as it does with oral NSAIDs. So it’s less likely to cause side effects such as stomach problems. However, the risks associated with oral NSAIDs, such as kidney damage or heart problems, can still occur with diclofenac gel, although it’s rare. So it’s best to check with a healthcare professional before picking up this product OTC.
5. Acetaminophen (Tylenol)
Acetaminophen is an OTC pain reliever that’s gentler on the stomach compared to NSAIDs. It works well for relieving pain and reducing a fever. But it’s not as good at reducing inflammation and swelling as NSAIDs like ibuprofen and naproxen. Still, acetaminophen is one of the safest and best pain relievers available OTC.
Acetaminophen tablets start working within an hour after you take it. Side effects are rare, but taking too much acetaminophen can cause overdose or severe liver damage. So make sure to follow the dosing instructions on your acetaminophen bottle.
In general, the maximum acetaminophen dose is 4,000 mg per day for people ages 12 and older. However, the maximum dosage varies depending on what OTC acetaminophen product you use. And if you have certain health conditions, such as liver problems, the recommended dosage is even lower.
Multiple OTC medications contain acetaminophen. So make sure to read the labels of all the OTC products you take. Confirm what your maximum daily dosage should be with a healthcare professional, and ask them to make sure you’re not exceeding this amount.
6. Aspirin / citric acid / sodium bicarbonate
Alka-Seltzer contains aspirin, citric acid, and sodium bicarbonate. Aspirin works as a pain reliever, while sodium bicarbonate and citric acid are antacids. Antacids work to neutralize stomach acid. This relieves pain caused by heartburn. Antacids can also help manage aspirin’s digestive-related side effects.
By combining antacids with aspirin, Alka-Seltzer can treat heartburn along with other pain that may occur, such as headaches. Because it contains aspirin, this OTC pain relief medication has the same risks as taking aspirin on its own, including blood-thinning effects. Additionally, people with heart failure or kidney problems may need to avoid Alka-Seltzer due to the sodium content from sodium bicarbonate.
The maximum recommended dose of Alka-Seltzer depends on the specific product you’re taking. For example, don’t take more than 8 tablets of Alka-Seltzer Original per day if you’re between the ages of 12 and 59. And don’t take more than 4 tablets per day if you’re 60 or older.
Take our quiz: OTC pain medications
Comparing OTC pain medications
Although the medications above are effective pain relievers, they still can cause side effects. If you’re considering taking one of them, it might be helpful to compare these risks side by side. You should also be aware of special precautions, which we’ve summed up below.
| Medication | What it treats | Risks and side effects |
|---|---|---|
| Ibuprofen (Advil, Motrin) |
|
Mild:
Severe:
Talk to a healthcare professional before taking if you have a history of:
|
| Naproxen (Aleve) |
|
Mild:
Severe:
Talk to a healthcare professional before taking if you have a history of:
|
| Aspirin |
|
Mild:
Severe:
Talk to a healthcare professional before taking if you have:
|
| Diclofenac 1% gel (Voltaren Arthritis pain) |
|
Mild:
Severe (less likely than with oral NSAIDs):
Talk to a healthcare professional before taking if you have a history of:
|
| Acetaminophen (Tylenol) |
|
Mild side effects are rare.
Severe:
Talk to a healthcare professional before taking if you:
|
| Alka-Seltzer (aspirin / citric acid / sodium bicarbonate) |
|
Mild:
Severe:
Talk to a healthcare professional before taking if you have a history of:
|
Frequently asked questions
The healthiest pain reliever for you depends on what you’re treating and your existing health conditions. Generally, acetaminophen tends to have fewer side effects than NSAIDs such as ibuprofen and naproxen. For example, acetaminophen may be safer if you have kidney problems, stomach bleeding, or stomach ulcers. But acetaminophen can be risky if you drink a large amount of alcohol or if you have existing liver problems.
NSAIDs may be a better option if you have inflammation or swelling.
If you’re over age 65, daily NSAID use isn’t recommended. So if you need a daily medication for pain relief, acetaminophen may be a better option. But talk to a healthcare professional before choosing a medication for pain relief. Your individual health history can help you and your healthcare team choose the best pain reliever option.
Typically, NSAIDs such as ibuprofen and naproxen are considered the strongest OTC anti-inflammatory medications. Acetaminophen isn’t considered anti-inflammatory.
One main difference between naproxen and ibuprofen is that naproxen lasts longer in the body. But both work similarly well for relieving pain and inflammation.
The healthiest pain reliever for you depends on what you’re treating and your existing health conditions. Generally, acetaminophen tends to have fewer side effects than NSAIDs such as ibuprofen and naproxen. For example, acetaminophen may be safer if you have kidney problems, stomach bleeding, or stomach ulcers. But acetaminophen can be risky if you drink a large amount of alcohol or if you have existing liver problems.
NSAIDs may be a better option if you have inflammation or swelling.
If you’re over age 65, daily NSAID use isn’t recommended. So if you need a daily medication for pain relief, acetaminophen may be a better option. But talk to a healthcare professional before choosing a medication for pain relief. Your individual health history can help you and your healthcare team choose the best pain reliever option.
Typically, NSAIDs such as ibuprofen and naproxen are considered the strongest OTC anti-inflammatory medications. Acetaminophen isn’t considered anti-inflammatory.
One main difference between naproxen and ibuprofen is that naproxen lasts longer in the body. But both work similarly well for relieving pain and inflammation.
The bottom line
Over-the-counter (OTC) pain relief medications work well for mild-to-moderate pain, and they’re readily available at local and online pharmacies. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin) and naproxen (Aleve), can treat pain and fever. So can acetaminophen (Tylenol). But NSAIDs are better for inflammation and swelling. Alka Seltzer (aspirin /citric acid / sodium bicarbonate) can treat heartburn along with other types of aches and pain. And diclofenac 1% gel (Voltaren Arthritis Pain) can treat joint pain related to osteoarthritis.
However, these pain relief medications have risks to be aware of. The option that’s best for you depends on what you’re treating, your health history, and your preferences. Work with a healthcare professional to choose the safest pain reliever for you.
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References
Bangash, A. A., et al. (2018). Effectiveness of acetaminophen in control of breakthrough pain: Randomized controlled trial. Journal of the Pakistan Medical Association.
Boakye, E., et al. (2021). Aspirin for cardiovascular disease prevention among adults in the United States: Trends, prevalence, and participant characteristics associated with use. American Journal of Preventative Cardiology.
Moon, R. Y. (2024). When a child has a fever, what is best? Acetaminophen, ibuprofen, or both? American Academy of Pediatrics.
