Pain Relievers Safety

(2017 Q2 report)

Pills

Pain, everybody has it one time or the other, and some unlucky even all the time. For that reason, Pain Reliever (Also known as Pain Killer) drugs are known to all. However, what is dangerously not known to all is which drug are safer, which drugs shouldn't be used for specific issues, and which drugs are on the dangerous side of the lot. 

What makes the subject darker, is the fact that people will often remember the latest information they get and not collate it with all the facts, so if a drug got some "good" news lately, people might ignore that historically such drug is a nasty little thing that by no means becomes safe by one piece of good news - and the opposite, a new research that revealed a bad side effect on a drug might not remove it from the safe list since it is historically known to be safe and well researched.

This article merges all those news, information and research, and lists the most common OTC Pain Reliever by safety. It also lists what side effects make a drug less safe, so if you have a problem with this or that organ that is in the side effect list, such drug should be considered less safe for you specifically.

The safety score goes from 300 (as safe as a glass of water) to 0 (Last resort, under serious medical supervision, highly unsafe drug). For our list, any drug with a score over 250 is considered safe for any healthy individual (healthy as in, no chronic issue that might preclude you from taking that drug). Pain relieve Power is based on a widely used scale where 0 is placebo and 10 is the strongest drug used: Morphine (which is not on this list because it is heavily restricted and also seriously dangerous - so a last resort drug).

Drug names are the scientific name of the ingredient, not the brand name.

Drug Name Maximum safe dosage per day (6) Pain Relief Power Side Effects Safety Index
Acetaminophen / Paracetamol 3000mg / day
1500mg / day if you drink or have liver issues
2

Overdose (Liver damage) (1)

Liver

275
Metamizole / Dipyrone 3000mg / day short-term
1500mg / day long-term
2.5

Overdose by time (Agranulocytosis)  (2)

Kidney L

274
Celecobix (NSAID) 300mg / day 3.5

Cardiovascular (3) F M Q

Stroke

Stomach

Intestines

255
Acetylsalicylic Acid / Aspirin  (NSAID) 3000mg / day
1000mg / day if stomach issues
1

Allergic Reaction

Stroke

Stomach J

Intestines

Kidney

Bleeding

Overdose

226
Dicoflenac Sodium/Potassium (NSAID) 200mg / day
100mg / day if have heart issues
3

CardiovascularQ

Stroke

Stomach I

Intestines

Kidney

223
Ibuprofen (NSAID) 3000mg / day 2.5

Cardiovascular (4) K F Q

Stroke

Stomach

Intestines

Kidney

Respiratory

216
Nimesulide (NSAID) 150mg / day for no more than 15 days 2.5

CardiovascularQ

Stroke

Stomach

Intestines

Kidney

Liver P

Overdose P

208
Naproxen (NSAID) 1200mg / day 3

CardiovascularQ

Stroke

Stomach

Intestines

Kidney

204
Tramadol 300mg / day 3.8

Cardiovascular

Stroke

Stomach

Intestines

Kidney

Liver

Respiratory

Hypertension

Psychological

Overdose

Addictive

General Metabolism

Can lead to organ damage

176

Notes

  1. Paracetamol has been receiving consistent bad attention due to the increase in Overdose Fatalities - now the leading drug overdose in western countries (irreversible Liver Failure that can happen in just 2 days of excessive Overdose). However, it should be noted this is only on Overdose. The normal dosage has little side effects, thus the high safety rate.
  2. Metamizole was banned in many countries due to its link with lethal Agranulocytosis as a precautionary action. However, even during the early reports, there were inconsistencies in the findings. More recent studies show that Agranulocytosis happens only over extended usage and usually near or above the maximum daily dosage. Under the maximum dosage use, and for short term, is considered very safe, as it does not lead to Agranulocytosis. The drug has been receiving more support latelly, but few countries are willing to retreat the ban because “there are better alternatives”, not because Metamizole is that dangerous G H L
  3. The NSAID COX-2 inhibitors as Celecoxib (shortened to Cobix) have been widely banned due to extremely cardiovascular damage. Celecoxib is the last NSAID COX-2 inhibitor still considered safe. However, recent studies have revealed that it shows no increase in Cardiovascular risk compared to other NSAID and it even has less risks related to Kidney issues F M
  4. In the last decade, Ibuprofen has been found to cause high risk of Cardiovascular issues, Kidney issues and Astha attacks. In 2010 and 2015 it got its safety profile downgraded. While still the safest NSAID in regards to Gastrointestinal issues, these recent findings on serious side-effects put its safety in discussion.
  5. On NSAID, all share the same side effects with small alterations: A B C D E F M O Q
    • Cardiovascular risks (reduced in Naproxen, Celecoxib and void in Aspirin)
    • Stroke (increased in Aspirin due to micro-bleeding)
    • Stomach issues (reduced in Ibuprofen)
    • Intestinal issues (reduced in Ibuprofen and Diclofenac)
    • Kidney issyes (reduced in Celecoxib)
    • Not suggested during pregnancy
    • Small Hypertension (except Aspirin)
  6. Note that most medications have a per-application maximum dosage smaller than the daily limit, that is, the maximum dosage is reached after taking the drug multiple times per day. Do not take all the maximum dosage in one time.

NOTICE: While extensively researched and constantly updated, this is still a layman's view on the subject, since I have no Medical/Health degree. All sources are from trustworthy publications, and care was taken not to leave outdated information and research not considered. It should be also added that every value has been erred on the safe side. For instance, Maximum Dosages listed here are smaller than the actual dosages, and dangers are slightly exacerbated, so if anything, this article seems scarier than reality for safety sake.

 

Safety Index Penality list

This is how each characteristic of a medicine was accounted for on each drug listed. Damage to specific organs that happen only on Overdose are listed under "Overdose" and not the organ itself, so damage to the organ in the list is considered only on safe dosage. Safety Index is calculated by (300 - Penalty)

System/Organ Aspirin Naproxen Ibuprofen Celecobix Diclofenac Acetaminophen Metamizole Nimesulide Tramadol
Cardiovascular 3 12 30 6 30 0 0 30 36
Stroke 20 20 20 10 10 0 0 10 10
Stomach 20 20 5 10 10 0 0 10 5
Intestines 8 16 4 8 8 0 0 8 4
Kidney 16 16 16 8 16 0 4 8 16
Liver 0 0 0 0 0 4 0 8 8
Respiratory 0 0 6 0 0 0 0 0 12
Hypertension 0 1 1 1 1 0 0 1 1
Overdose 5 0 0 0 0 20 10 15 10
Psychological 0 0 0 0 0 0 0 0 4
Addictive 0 0 0 0 0 0 0 0 5
Metabolic/General 2 8 2 2 2 1 2 0 8
Permanent Damage 0 0 0 0 0 0 10 2 5
TOTAL 74 96 84 45 77 25 26 92 124

References and sources

A http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)60900-9/fulltext
B http://www.bmj.com/content/332/7553/1302.long
C https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3019238/
D https://www.fda.gov/ForConsumers/ConsumerUpdates/ucm453610.htm
E https://www.ncbi.nlm.nih.gov/pmc/articles/PMC558288/
F http://time.com/4568552/ibuprofen-naproxen-inflammation-safety/
G https://medicalxpress.com/news/2016-07-metamizole-alternative-classical-nsaids.html
H https://www.researchgate.net/publication/8148359_Agranulocytosis_associated_with_dipyrone_metamizol
I http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)60900-9/fulltext
J http://www.nature.com/ajg/journal/v95/n9/full/ajg2000570a.html
K http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(87)90499-5/abstract
L https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4405027/
M http://www.bmj.com/content/354/bmj.i4857
N http://www.npr.org/sections/health-shots/2016/11/13/501033431/safety-of-painkiller-celebrex-affirmed-in-new-study
O http://www.emedexpert.com/compare/nsaids.shtml
P https://www.ncbi.nlm.nih.gov/pubmed/26991794
Q http://www.bbc.com/news/health-39858179

Last update: May 2017