Many people think there’s not much of a difference between over-the-counter pain relievers. While they’re all generally effective, each analgesic has its own set of side effects and risks. Nonsteroidal anti-inflammatory drugs (NSAIDs) also known as cyclooxygenase inhibitors (COX-inhibitors) like ibuprofen (Advil) or naproxen (Aleve) have side effects that can affect the quality of your everyday life—they can even raise your risk of heart problems. Acetaminophen (Tylenol), called paracetamol in other countries, if taken in safe doses, offers none of the same untoward side effects as NSAIDs, so it’s worth considering when you’re seeking relief. 1. Acetaminophen is relatively safer than other pain relievers. In almost any situation, acetaminophen is safer than NSAIDs, as long as adults don’t take more than 4000 milligrams per day and as long as you don’t have liver problems—that is, you’re not a heavy drinker, have active hepatitis, or other hepatocellular problems. One of the common fears about acetaminophen from the medical community is when it is combined with another drug in a single pill, because then consumers lose sight of how much acetaminophen they are taking. The U.S. Food and Drug Administration (FDA) estimates that there are over 600 acetaminophen-containing compounds on the market, so read your labels! Of particular concern are the combination opioid-acetaminophen products such as Norco, Vicodin, Percocet, etc. In January of 2014, the FDA mandated that no more than 325 milligrams of acetaminophen be included in one pill as a way to reduce risks of acetaminophen overdose. Many consumers don’t realize how much acetaminophen they are taking, so they can experience the consequences the hard way. If you take too much acetaminophen, you can severely damage your liver. But again, under the right doses, acetaminophen is safe; in fact, it is estimated to be the most widely used analgesic in the world. NSAIDs, however, come with the risks of developing gastritis, peptic ulcer disease, kidney injury, bleeding, and other issues. NSAIDs have also been shown to increase the risk of cardiovascular adverse events, like heart attack or stroke. 2. Acetaminophen is the safer choice for heart patients. Acetaminophen has, as far as we know, almost no effect on the cardiovascular system. So, especially for patients with cardiovascular risk, like those who have had a previous heart attack or stroke, or patients with high cholesterol, high blood pressure, diabetes, etc., acetaminophen is a very safe drug. On the flip side, NSAIDs can increase blood pressure over time when used at higher doses and on a more consistent or daily basis. That’s not to say you couldn’t use NSAIDs for a day or two or around the time of a surgery or acute injury. The big concern is if you’re taking an NSAID every day and it starts becoming weeks and months—then we do get concerned about the effects of NSAIDs on blood pressure and risk of cardiovascular adverse events. 3. Acetaminophen doesn’t impact the effectiveness of aspirin for heart health. Many people take a daily dose of baby aspirin for heart health. Aspirin is also an NSAID and it reduces the production of a substance (thromboxane A2) that causes the platelets in your blood to aggregate. In other words, aspirin prevents your platelets from sticking together and clotting. This is important because blood clots are a major cause of heart attack and stroke. If you take non-aspirin NSAIDs while taking aspirin, the effects of the non-aspirin NSAIDs might negate the beneficial effects of the aspirin, and you won’t gain the benefits of your aspirin therapy. Additionally, taking an NSAID while on aspirin therapy has been shown to increase the risks of side effects like stomach bleeding, gastritis, peptic ulcer disease, kidney injury, and other issues—so it’s rarely ever recommended to combine NSAIDs. If you choose to take an NSAID, aspirin or otherwise, acetaminophen can be combined with it to help with your pain management.