Acetaminophen
Best for: Headaches and other mild pains not linked to inflammation
How it works: “Whereas NSAIDs work all over the body to decrease inflammation and pain, acetaminophen reduces cyclooxygenase activity only in the brain,” Vardeny says. Therefore, acetaminophen offers some pain relief but won’t do anything to alleviate inflamed muscles, joints, or tissues.
Nissen says its effect is, overall, weaker than NSAIDs. So why choose acetaminophen? “If you take Tylenol in the appropriate doses, it works well enough to relieve mild pain and is relatively safe,” Nissen says. “It’s not linked to kidney, heart, or GI complications.”
Recommended dose: 325 milligrams to 1 gram every four to six hours as needed
Maximum daily dose: 4 grams
Downsides: While acetaminophen’s safety profile is very good, because it’s weak, people tend to take multiple doses per day. “You’d be surprised how easy it is to get to 4 grams a day, especially if you use Tylenol Extra Strength,” Nissen says. “Too much can be damaging to the liver — a good number of Americans get liver failure each year from acetaminophen.”
That’s because, unlike NSAIDs, acetaminophen is metabolized mainly in the liver. For that reason, combining it with alcohol, which the liver also must filter out, can overtax the organ, says Vardeny. Never mix the two. Finally, “if you use acetaminophen to treat headaches three or more times a week, you can get a rebound headache from the drug itself,” she adds.
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