How to Choose the Safest Over-the-Counter Painkiller for Older Adults?
Dr. Martine Merez discussed the risks and benefits of the three main types of over-the-counter pain medications.
From migraines to more serious ailments such as severe burns, which pain medications should be used? Some of them are available over the counter in pharmacies, but this does not prevent them from having side effects. What are their risks and how to choose them? Martine Perez, general practitioner, made the point, Tuesday in the Grand direct de la santé on Europe 1.
Three types of them are available without prescription: paracetamol derivatives, acetylsalicylic acid derivatives, like aspirin, and non-steroidal anti-inflammatory drugs.
>> Paracetamol derivatives
In case of pain, the first analgesic to use is paracetamol, because it has the lowest benefit-risk ratio. You should not take more than 3 grams per day, which means a maximum dose of 1 gram of paracetamol every 8 hours. If you use several derivatives of paracetamol, for example Doliprane and Efferalgan, you should think that their doses of paracetamol add up: one gram of one and one gram of the other make two grams of paracetamol in total. If taken correctly, this substance presents almost no risk, but overdoses can have very serious consequences. Too much paracetamol, especially after heavy alcohol consumption, can cause liver problems, such as fulminant hepatitis.
>> The derivatives of acetylsalicylic acid
Aspirin, which is two centuries old, is an analgesic, fever-reducing and anti-inflammatory drug. Its main drawback is its high toxicity to the stomach. It can cause gastritis, even ulcers or digestive hemorrhages in fragile people. It also has the property of fluidifying the blood. For Martine Perez, the risks of consuming it are higher than the benefits. It should not be taken more than three grams per day, or even two for the elderly.
>> Ibuprophen derivatives
Ibuprophen (Advil, Nurofen, etc.) is more effective than paracetamol for certain types of pain, such as toothache and sprains, and has slightly fewer side effects than aspirin. It should not be taken more than four days in a row without a prescription. It also has the property of thinning the blood.
People who take it must also be aware of two aspects: the "cocktail" effect, which consists of combining several types of analgesics, and the potentiation effect, which means that certain foods - for example alcohol - increase the effect of some of them.
What is the safest over-the-counter painkiller for an elderly relative?
For most older people, acetaminophen (brand name Tylenol) is the safest over-the-counter oral painkiller for daily or frequent use, as long as a total dose of 3,000 mg per day is not exceeded.
Acetaminophen is commonly called paracetamol outside the United States.
It is processed by the liver and can cause severe or even fatal liver damage in high doses. If an elderly person has alcohol abuse or chronic liver disease, the daily limit needs to be set even lower, and I strongly recommend that you ask a doctor what daily limit might be appropriate.
However, at the recommended dosage, paracetamol has surprisingly few side effects and rarely harms older people. Unlike non-steroidal anti-inflammatory drugs (NSAIDs, see below), there is no risk of internal bleeding in the elderly, and it appears to have minimal effects on kidney function and cardiovascular risk.
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