Pregnancy/Lactation: Regular aspirin consumption during pregnancy has been associated with side effects in the pregnant mother, including bleeding and complications during labor. It is unclear if aspirin taken in the first two trimesters poses a risk to the fetus. However, when taken during the third trimester, aspirin may increase the risk of bleeding in the newborn. Although very little aspirin is secreted into milk, most authorities recommend that nursing mothers avoid using aspirin.

Viral infections in children: Because aspirin causes Reye's syndrome (a potentially fatal liver disease that occurs almost exclusively in persons under the age of 15 years), aspirin should not be given to children when a viral infection is suspected.

Drug Interactions: High doses of aspirin can increase the activity of valproic acid (Depakene; Depakote), an effect which can cause drowsiness or behavioral changes. High doses of aspirin also can enhance the effect of some sugar-lowering medications used in diabetes, e.g. glyburide (Diabeta), glipizide (Glucotrol), and tolbutamide (Orinase), which can possibly lead to hypoglycemia (low blood sugar). The effects of probenecid (Benemid) are reversed by aspirin. Aspirin can increase the toxicity of methotrexate and the risk of bleeding with warfarin (Coumadin).

Salicylates other than Aspirin

There are three other OTC salicylates; choline salicylate, magnesium salicylate, and sodium salicylate. The advantage of these drugs over aspirin is their shorter effect on the platelets that promote bleeding.

Choline salicylate (Arthropan) is available as a liquid. It is absorbed more quickly, but its onset of action is no different than that of aspirin. Some people find choline salicylate fishy. Fortunately, it can be mixed with juice or soda prior to ingestion. It is less effective at reducing fevers in children than either aspirin or acetaminophen.

Magnesium salicylate (Arthriten; Backache) is as effective as aspirin at reducing pain. Patients with chronic kidney disease should avoid magnesium salicylate, since the magnesium may accumulate in their bodies.

Sodium salicylate (Scot-Tussin Original) and aspirin are equally effective in the long-term treatment of rheumatoid arthritis, but sodium salicylate is less effective at reducing pain or fever.

Acetaminophen

Formulations: Acetaminophen comes in various oral formulations, including different types (elixirs or syrups) and flavors of liquids, capsules, tablets, caplets, and suppositories. The capsules contain tasteless granules that can be emptied onto a teaspoon containing a small amount of drink or soft food, and can then be swallowed. However, the granules should not be mixed in a glass of liquid since the granules will stick to glass itself. The amount of acetaminophen that is absorbed from rectal suppositories is about half that of the oral formulations.

Side Effects: Acetaminophen generally is safe to use, and few people develop side effects. In high doses, however, it can cause liver damage and doses of 4000mg (4 grams) per day should not be exceeded.

Pregnancy/Lactation: Acetaminophen has no known harmful effects on the mother, fetus, or infant and, therefore, can be used safely during pregnancy and during lactation.

Drug Interactions: It has been reported that patients with HIV- related diseases (e.g., AIDS) who take AZT (zidovudine; Retrovir) and acetaminophen are at an increased risk of developing suppression of their bone marrow. Such patients develop lower white and red blood cell and platelet counts and, therefore, are more susceptible to infection, anemia, and bleeding.

Nonsteroidal Anti-inflammatory Drugs (NSAIDS)

There are three OTC NSAIDs--ibuprofen, naproxen sodium, and ketoprofen. All have pain relieving (analgesic), fever reducing (antipyretic), and anti-inflammatory properties. Additionally, NSAIDs are more effective than aspirin or acetaminophen for cramps associated with the menstrual cycle (dysmenorrhea).

Formulations: Ibuprofen is available in tablets as well as in a pediatric suspension. Naproxen sodium is available in tablets. Ketoprofen is available as tablets and caplets.

Pregnancy/Lactation: NSAIDs are safe for use during the first or second trimesters of pregnancy, but should not be taken during the third trimester, since they can prolong labor and delay birth, increase bleeding in the mother following birth, and can cause cardiac (heart) and vascular (blood vessels) complications in the newborn. Ibuprofen and naproxen sodium also are safe for use by nursing mothers. Due to insufficient data, ketoprofen is not recommended for use by nursing mothers.

Side effects: The most frequent side effect of NSAIDs is damage to the lining of the stomach and duodenum that can lead to abdominal pain, nausea, and loss of appetite. NSAIDs also can cause ulcers and bleeding from the stomach and duodenum, but less frequently and less severely than occurs with aspirin use. NSAIDs, like aspirin, affect platelets and can inhibit the formation of blood clots, and, therefore, they should be discontinued at least 24 hours before surgery or dental procedures. Because alcohol intensifies the effect of NSAIDs on bleeding, alcohol should not be taken with NSAIDs. NSAIDs also can cause kidney damage, particularly in the elderly or patients with high blood pressure, diabetes, atherosclerosis, or who take diuretic medications ("water pills"). Patients who are allergic to aspirin should not take NSAIDs since they are likely to be allergic to NSAIDs as well. NSAIDs may cause fluid retention in persons with congestive heart failure, and, therefore should not be used in this setting.