Nonopioid Analgesics

“Nonopioid” does not mean harmless, and the drugs in this group are not interchangeable. Acetaminophen is primarily an analgesic and antipyretic. It is often useful when inflammation is not the main driver of pain, but excessive total exposure can injure the liver. The danger is easy to miss when acetaminophen is hidden in combination products for pain, colds, or sleep. Add the amount from every product before deciding whether another dose is safe; follow the prescribed or package maximum and ask a pharmacist or prescriber when the total is unclear. Ibuprofen and naproxen are traditional nonsteroidal anti-inflammatory drugs (NSAIDs). They are useful when inflammation contributes to pain, but their benefits must be weighed against gastrointestinal, renal, blood-pressure, and cardiovascular risk. A patient with an inflammatory joint flare and normal renal function has a different risk profile from an older adult taking an anticoagulant who reports dark stools. The first question is therefore not “Which analgesic is strongest?” It is “What is causing the pain, and what could this patient be harmed by?”