Pain management: How much over-the-counter painkillers are safe to take? |

Pain management: How much over-the-counter painkillers are safe to take?

Charles Merriman, PharmD, Sierra Nevada Memorial Hospital

Hi, my name is Charles Merriman, PharmD, and I practice as a clinical pharmacist at Sierra Nevada Memorial Hospital here in beautiful Grass Valley. In addition to my duties as a clinician, I am also a member of the Transformational Care Pain Management Team and Bioethics Committee.

I completed my training and graduated from the University of the Pacific School of Pharmacy in Stockton, California in 2006. Shortly after, I began my career as a clinical staff pharmacist at Santa Barbara Cottage Hospital in Southern California.

I also spent some time as a clinical staff pharmacist at Enloe Medical Center in Chico, California which is my hometown.

I have found that my time here at SNMH has been the most enjoyable and fulfilling to this point in my career.

Q & A: Common questions you might have for your local clinical pharmacist regarding over the counter (OTC) medications for pain management.

QuestioN: How much Tylenol consumption is too much?

Answer: The daily maximum consumption of Tylenol for an adult is 4 grams or 4,000 milligrams! This means, the total amount of Tylenol ingested over any 24-hour period should be less than 4,000 milligrams.

QuestioN: How do I know which of my pain medications contain Tylenol?

Answer: Any combination drug that includes “acetaminophen'”or “APAP” in the description has Tylenol. The associated Tylenol dose for each tablet is usually written as the second number, for example: hyrdrocodone/APAP 10/325mg contains 325mg of Tylenol.

QuestioN: Is it ok to take over the counter (OTC) pain medications in addition to my prescribed narcotic pain medications?

Answer: Always consult with your prescribing physician or pharmacist before adding anything on your own. In general, taking acetaminophen, ibuprofen or naproxen products to supplement your narcotic pain med regimen can be beneficial. (Remember, never take more than 4 grams of acetaminophen in any 24-hour period.)

QuestioN: Can I take both acetaminophen and ibuprofen at the same time?

Answer: Yes. As long as you don’t have an allergy and/or intolerance to either drug, the combination of both is fine. A common misconception is that these two drugs are the same, but in fact they are structurally very different and hence have completely separate mechanisms of action in the body.

QuestioN: What are the maximum doses for Tylenol (acetaminophen) and Motrin (ibuprofen) that is allowed to give to a child?

Answer: Tylenol (acetaminophen) 15mg/kg/dose maximum; not to exceed 5 doses/day or 4,000mg/24-hour period

Motrin (ibuprofen) 10mg/kg/dose maximum; not to exceed 40mg/kg/24 hour period

QuestioN: What drugs can cause stomach bleeding or ulcers?

Answer: Any NSAIDs (non-steroidal anti-inflammatory drugs) can cause stomach bleeding or ulcers. This class of drugs includes: aspirin, ibuprofen, and naproxen. Tip: Take with a snack, glass of milk or small meal to help coat your stomach to avoid irritation and/or potential bleeding/ulcers. ONLY TAKE AS DIRECTED.

QuestioN: Should I avoid taking more than one NSAID at the same time for my pain?

Answer: YES! Unless specifically directed by a physician, you should never take more than one NSAID at the same time. The main reason for this is to avoid adverse drug reactions such as stomach bleeding or ulcers.

To submit your question log onto and click on “submit a question to Katherine Medeiros, CEO,” or mail to SNMH, P.O. Box 1029, Grass Valley, CA 95945, Attn. Ask the CEO.

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