Safe Use of Painkillers: Getting Relief Without Harm

Painkillers are among the most widely used medicines in Nigeria. Many are sold over the counter, and people often take them for headaches, body aches, period pain and fever without a second thought. Used correctly, they are safe and effective. Used incorrectly, they can damage the liver, kidneys and stomach, and some can cause dependence. This pharmacist’s guide explains the safe use of painkillers so that you get relief without harm.

Safe use of painkillers: the golden rules

• Know what you are taking. Read the label.

• Use the lowest dose that works.

• Use it for the shortest time.

• Do not combine products with the same ingredient.

• Take anti-inflammatories with food.

• Avoid alcohol with strong painkillers.

• Ask a pharmacist if you have other health conditions.

• See a doctor if pain lasts more than a few days or keeps returning.

These rules are the foundation of the safe use of painkillers.

Types of painkillers

The main types of pain medicines are:

• Paracetamol, for mild to moderate pain and fever
• Anti-inflammatory painkillers, also called NSAIDs, such as ibuprofen, diclofenac, naproxen  1  and aspirin
• Opioids, such as codeine, tramadol and morphine, for moderate to severe pain
• Topical painkillers, such as gels and creams
• Medicines for nerve pain, such as amitriptyline and pregabalin, which work differently

Paracetamol: safe, but limits matter

Paracetamol is one  2  of the safest painkillers when taken at the right dose. For most adults, the maximum is 4 grams in 24 hours, usually taken as two 500 mg tablets up to four times a day, at least four hours apart, as described by the NHS.

Taking more than this can cause serious liver damage, which may not show symptoms for a day or two. Lower doses may be needed for people who weigh less than 50 kg, drink alcohol regularly, or have liver disease.

Signs of a paracetamol overdose

An overdose may cause no symptoms at first. Later, there may be nausea, vomiting, abdominal pain and yellowing of the eyes. Liver damage can be fatal. If you or someone else may have taken too much paracetamol, go to hospital immediately, even if you feel well. Early treatment protects the liver.

Watch out for hidden paracetamol

Many cold and flu remedies, headache tablets and combination painkillers contain paracetamol. Taking these together with plain paracetamol can easily lead to an overdose. Always read the label and check the ingredients. Ask a pharmacist if you are unsure.

Check the label for paracetamol, sometimes called acetaminophen.

 

Anti-inflammatory painkillers: use with care

NSAIDs reduce pain and inflammation. They are useful for period pain, sprains, toothache and arthritis. However, they can cause:

• Stomach irritation, ulcers and bleeding
• Kidney damage, especially in people who are dehydrated or have kidney disease
• Raised blood pressure and fluid retention
• A higher risk of heart attack and stroke with long-term use
• Worsening of asthma in some people

To use NSAIDs safely:

• Take them with food
• Use the lowest dose for the shortest time
• Avoid them if you have stomach ulcers, kidney disease, heart failure or uncontrolled high blood pressure, unless a doctor advises
• Avoid taking two different NSAIDs together
• Avoid them in the later stages of pregnancy

Safe use of painkillers with other conditions

• High blood pressure or heart disease: avoid NSAIDs unless your doctor agrees
• Kidney disease: avoid NSAIDs
• Stomach ulcers: avoid NSAIDs
• Asthma: some people react to NSAIDs
• Liver disease: use lower doses of paracetamol
• Taking blood thinners: avoid NSAIDs and aspirin unless prescribed

A pharmacist can check your full medicine list and advise on the safe use of painkillers for you.

Opioids: effective but risky

Codeine and tramadol are opioids  3 . They can be helpful for short periods of severe pain, but they carry real risks:

• Drowsiness and slowed reactions
• Constipation, nausea and dizziness
• Dependence and addiction with regular use
• Dangerous breathing problems, especially with alcohol or sleeping tablets
• Seizures with high doses of tramadol

Use opioids only when prescribed, for the shortest time possible. Never share them or take more than prescribed.

HUBPHARM PHARMACIST’S NOTE
Many households have three or four products that all contain paracetamol, such as a cold remedy, a headache tablet and a combination painkiller, and nobody adds them up. Send a photo of your medicine shelf to a HubPharm pharmacist. We will spot duplicates, tell you the safe daily total and suggest what to keep.

Painkiller injections

In some places, people receive painkiller injections, such as diclofenac, for minor aches. Injections carry extra risks, including infections, abscesses and nerve damage, and usually offer no benefit over tablets. Avoid injections unless a qualified health worker considers them necessary.

Children and painkillers

• Use medicines made for children, with the correct dose for age or weight
• Use the measuring syringe or spoon provided
• Never give aspirin to children under 16, because it can cause a rare but serious condition called Reye’s syndrome
• Check with a pharmacist before giving ibuprofen to children with asthma or dehydration

Pregnancy and breastfeeding

Paracetamol is usually the preferred painkiller in pregnancy, used at the lowest effective dose. NSAIDs should generally be avoided, especially after 20 weeks, unless a doctor advises. Check with a pharmacist or doctor before taking any painkiller in pregnancy or while breastfeeding.

Safe use of painkillers for older adults

Older adults are more likely to have side effects. NSAIDs raise the risk of stomach bleeding and kidney problems. Opioids increase the risk of falls and confusion. Paracetamol is often the safest first choice. Gels can help joint pain with fewer side effects. Regular medicine reviews help prevent problems.

Myths about painkillers

“More tablets work faster.” Extra doses add risk, not relief.

“Herbal pain mixtures are natural, so they are safe.” Some contain hidden steroids or anti-inflammatories.

“Injections work better than tablets.” For most pain, tablets work just as well and are safer.

“Paracetamol is too weak to help.” Taken correctly, it works well for many types of pain.

Safe use of painkillers at home

Keep a written list of all medicines in the household, with doses and times. Keep painkillers out of children’s reach and out of sight. Do not keep large stocks of strong painkillers. Check expiry dates regularly. Teach teenagers about the dangers of misusing pain medicines. These household habits support the safe use of painkillers for everyone.

Ask your pharmacist

Pharmacists are trained to help with the safe use of painkillers. Bring a list of everything you take, including herbal products. Ask which painkiller is safest for you, how much to take, and how long to use it. Ask what to do if the pain does not improve.

When pain needs more than painkillers

Painkillers treat symptoms, not causes. Pain that is severe, persistent or getting worse needs a medical check. Chest pain, severe abdominal pain, sudden severe headache and pain with fever need urgent care. Ongoing pain may need physiotherapy, exercise or treatment of an underlying condition.

Medication overuse headache

Taking painkillers for headaches on more than about 10 to 15 days a month can cause medication overuse headache, where headaches become more frequent. If you need painkillers this often, see a doctor.

Storing painkillers safely

Keep medicines in their original packaging, out of the reach of children, in a cool, dry place. Return unused or expired medicines to a pharmacy.

Painkillers and alcohol

Alcohol and painkillers are a risky mix. Regular drinking increases the risk of liver damage from paracetamol. Alcohol with anti-inflammatory tablets raises the risk of stomach bleeding. Alcohol with opioids slows breathing and can be fatal. If you drink, tell your pharmacist. The safe use of painkillers includes avoiding alcohol when you take them.

Getting help

The safe use of painkillers protects your liver, kidneys and stomach. Read more about different kinds of pain in our article on acute and chronic pain. For advice on which painkiller is safest with your other medicines, or for genuine products, message a HubPharm pharmacist or chat with Afiya on WhatsApp.

Medicines and products in this article

#	Medicine or product	What to know
1	Ibuprofen Pharmacy medicine	Take with food, lowest dose, shortest time.
2	Paracetamol Over the counter	Maximum 4 g in 24 hours for most adults. Watch for hidden doses.
3	Codeine and tramadol Prescription only	Short-term use only. Risk of dependence.

 

To order any of these, or to ask a pharmacist a question first, message HubPharm on WhatsApp or visit hubpharmafrica.com. Prescription medicines are supplied against a valid prescription.

References

• NHS. Paracetamol for adults.

• NHS. Ibuprofen for adults.

• US Food and Drug Administration. NSAIDs may cause rare kidney problems in unborn babies. 2020.

• World Health Organization. Opioid overdose: fact sheet.