X
More than 60,000 patients use Brite
4.6 stars
Your health finally understandable with Brite
1
Enter email and you're done. No subscription, no credit card.
2
Search, tap and you're done. Over 3,400 medicines.
3
Check, remind, get an overview.
Sarah K., 34
I finally understand my therapy. The app reminds me, answers my questions — and I don't feel alone with it anymore.
With headaches, toothache, fever or joint complaints, most people reach for over-the-counter painkillers from the pharmacy. But which is the right one? Ibuprofen, paracetamol, diclofenac and acetylsalicylic acid (ASA, e.g. aspirin) are the four most commonly used — and they differ clearly in their effect, areas of use and risks.
To understand the four painkillers, it helps to divide them fundamentally into two groups with a different working principle:
This group includes ibuprofen, diclofenac and ASA. They inhibit the enzyme cyclooxygenase (COX) and thus the formation of prostaglandins — messenger substances involved in pain, inflammation and fever. NSAIDs therefore act in three ways: pain-relieving, anti-inflammatory and fever-reducing. Their anti-inflammatory effect makes them especially good for inflammatory and tissue pain — but also brings the typical risks (stomach, kidney, heart), because prostaglandins also have protective functions in the body.
Paracetamol does not belong to the NSAIDs. Its mechanism of action is still not fully understood; it mainly acts centrally in the brain as a pain reliever and fever reducer, but has barely any anti-inflammatory effect. The big advantage: it burdens the stomach and kidney considerably less than NSAIDs. The most important danger, by contrast, lies with overdose in the liver.
This fundamental distinction — NSAIDs with an anti-inflammatory effect and corresponding risks, paracetamol without notable anti-inflammatory effect and with a different risk profile — is the key to the right choice.
Ibuprofen is one of the most widely used painkillers of all — a well-tolerated NSAID with a balanced profile.
Ibuprofen is often a good first choice for pain with an inflammatory component (e.g. toothache, period pain, joint pain). Like all NSAIDs, it should be used at the lowest effective dose and for as short a time as possible.
Paracetamol is the painkiller with the gentlest profile for stomach and kidney — for which the liver is the critical point.
Diclofenac is a strong NSAID with a particularly pronounced anti-inflammatory effect — often used for joint and muscle complaints.
Diclofenac as a tablet is usually prescription-only or pharmacy-only in low doses; the gel is over-the-counter. Especially for local complaints, the external use as a gel is a sensible, gentler alternative to the tablet.
ASA (known as aspirin) is a classic with a special feature: it has two very different areas of use depending on the dose.
The four painkillers at a glance — their most important properties compared:
In short: paracetamol is the gentlest agent for stomach, kidney and heart, but has barely any anti-inflammatory effect and a liver risk with overdose. The NSAIDs (ibuprofen, diclofenac, ASA) additionally have an anti-inflammatory effect, but burden the stomach, kidney and cardiovascular system more. Which one fits depends on the type of complaint and individual risk factors.
A practical orientation — but the final choice always depends on individual factors (pre-existing conditions, other medications):
For inflammatory and tissue pain, the NSAIDs are often superior; for simple pain and fever without inflammation, paracetamol is a gentle choice. With persistent or severe pain, the choice belongs in a doctor's hands.
Over-the-counter painkillers also have relevant risks — above all with higher doses, long use and pre-existing conditions. The most important organs in focus:
NSAIDs (ibuprofen, diclofenac, ASA) can damage the gastric lining — from stomach pain to ulcers and bleeding. The risk rises with continuous use, older age, previous ulcers and combination with other agents (cortisone, blood thinners). ASA is the most critical here. Paracetamol is gentle on the stomach.
NSAIDs can impair blood flow to the kidneys — risky with pre-existing kidney disease, fluid deficiency, older age and combination with certain blood-pressure agents (the "triple whammy" of NSAID + ACE inhibitor/ARB + diuretic).
With longer use and higher doses, NSAIDs can slightly raise the risk of heart attack and stroke and increase blood pressure — diclofenac tends to do so more than ibuprofen. With pre-existing cardiovascular conditions, consult a doctor.
Paracetamol can severely damage the liver with overdose. At the correct dose it is very safe — what is critical is overdose, pre-existing liver disease and regular alcohol consumption.
A common question — the answer depends on the combination:
Basic rule: different NSAIDs are not combined. The combination of paracetamol + NSAID is the only common sensible combination, but it too should be discussed and time-limited. Always check whether an active ingredient is already contained in another preparation.
Over-the-counter painkillers can also interact with other medications. Important examples:
Anyone who regularly takes medications or has pre-existing conditions should ask a doctor or the pharmacy before taking over-the-counter painkillers. More under drug interactions and taking medications correctly.
Combining painkillers and alcohol is generally unfavourable — with different emphases:
Practical recommendation: if possible, do not take painkillers and alcohol together — above all do not combine paracetamol with regular alcohol consumption (liver), and do not take NSAIDs with alcohol if you have a sensitive stomach.
Over-the-counter painkillers are intended for temporary, mild to moderate pain. In certain situations they are not enough or even dangerous, because they mask serious causes:
Important: pain is a warning signal. Anyone who regularly or permanently needs painkillers should have the cause medically clarified, instead of just suppressing the symptoms.
Ten golden rules that apply to all over-the-counter painkillers:
With over-the-counter painkillers in particular, the typical mistakes happen unnoticed: accidental double dosing (paracetamol in a cold remedy + a tablet), risky combinations (NSAID + blood thinner), creeping overuse. brite helps exactly there:
Interaction check
Check whether an over-the-counter painkiller is compatible with your other medications (blood thinners, blood-pressure agents, cortisone).
Medication plan
All medications in one place, to avoid accidental double dosing (e.g. paracetamol in several preparations).
Intake tracking
Document painkiller use and recognize too-frequent use (risk of overuse headache) early.
Health record
Document pain, triggers and effect — helpful for the doctor's appointment.
Digital medication plan
Clearly laid out for the GP and pharmacy.
Prevent accidental double dosing, check interactions with blood thinners or blood-pressure agents, recognize overuse headache early — avoid the typical painkiller pitfalls.
