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If there is anything like a magic cure, over-thecounter pain relievers come close. Headaches, joint and muscle aches, fevers and other minor discomforts subside as these popular remedies take effect. They’re cheap, easy to tolerate and have few side effects. Yet they should not be taken for granted.

Acetaminophen, sold under the brand name Tylenol, prevents the body from making chemicals that enhance pain sensations, explains Dr. Lauren Ludwig, a physician specializing in internal medicine with Washington University Clinical Associates at Maryland Medical. Ibuprofen (sold as Motrin and Advil), naproxen (sold as Aleve), and aspirin form a class of medications known as non-steroidal anti-inflammatory drugs (NSAIDs) and prevent the body from making chemicals that produce swelling and pain.

The Consumer Healthcare Products Association estimates that more than $2 billion worth of over-thecounter pain medications were sold in 2010, the last year for which data are available. Only cough and cold remedies, many of which contain pain relievers, exceeded that figure for over-the-counter medications.

However, some people should steer clear of these ubiquitous medications. Anyone with a history of gastrointestinal bleeding or ulcers and those who take blood-thinning medications should avoid NSAIDs because they increase risk of bleeding.

“Ibuprofen and naproxen in people with heart disease do increase the risk of heart attack and can worsen heart failure,” warns Dr. Lauren King, a physician with Mercy Clinic Internal Medicine. “Anyone with liver disease, or a high potential for it, such as an active alcoholic, should avoid acetaminophen due to the risk of liver toxicity in those situations.”

Dr. Bishnu Devkota, a SLUCare physician specializing in internal medicine, also emphasizes the importance of caution. “People who use other medications like steroids (prednisone) or people who drink alcohol have a higher risk of developing stomach ulcers or developing liver problems,” he says. “Because of drug-drug interactions and drug-disease interactions, there is no absolutely safe dose for all people.”

The list of potential NSAID side-effects is enough to give anyone pause: headaches, tinnitus, dizziness, fluid retention, high blood pressure, swelling, abnormal liver function tests, asthma, rashes, kidney problems, hyperkalemia (high potassium) proteinuria (protein loss in urine), and rare cases of congestive heart failure, heart attacks, strokes and blood disorders.

“Acetaminophen is pretty safe, as long as you don’t take more than directed on the bottle,” King notes. “Many multi-symptom cold medications have acetaminophen in them, also, and taking too much acetaminophen can lead to permanent liver damage.”

Overdosing with over-the-counter pain relievers is uncommon, but physicians emphasize that patients should heed the dosing instructions. Taking a combination of different types of pain relievers or chasing a dose with an alcoholic beverage can have dangerous results.

“The most important thing to remember is that what may be safe for you may not be safe for your neighbor,” Ludwig says. “It’s important that each patient understand the medications they are currently on before beginning therapy with an additional medication—yes, even over-the-counter products.”