OTC Pain Med Options After Tylenol And NSAIDs

In our latest question and answer, the pharmacist discusses alternative OTC pain med options if Tylenol and NSAIDs aren't safe options for a particular medical situation.

OTC Pain Med Options After Tylenol And NSAIDs
Jul 06, 2020

Denise asked

What OTC pain meds can I take for knee and lower back pain while taking Lasix, Lactulose, and Keppra. I have NASH liver disease and must take Lasix for fluid retention in legs/feet.

At a glance

  • Acetaminophen should be minimized due to its extensive metabolism in the liver.
  • Oral NSAIDs like ibuprofen should be avoided due to risk of kidney injury while taking furosemide.
  • Topical pain relievers such as lidocaine patch or diclofenac gel are minimally absorbed and might be a good option.


Hi Denise and thanks for writing to us. I always appreciate when a patient takes a moment to make sure that their OTC choices are safe with their other medications or disease states.

First, acetaminophen (or under the brand name Tylenol) might be safe in small amounts, but this heavily depends on the severity of your liver disease. If you are in the early stages of your liver disease, you can probably take a small dose of acetaminophen (such as 650mg) once or twice a day without needing to worry much. If your liver disease has progressed further along, I would recommend avoiding it entirely since acetaminophen is extensively metabolized in the liver and could potentially damage it. Since I don't know your particular medical situation in regard to your liver disease, you need to check with your doctor about this.

Additionally, be sure to check other over the counter medications that may contain acetaminophen, as many common cough and cold medications contain it to help with pain and fever. These should likely be avoided unless directed otherwise by your doctor.

Normally, patients with liver disease can safely take nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Motrin, Advil) or naproxen (Aleve), but this is probably not a safe option either for you.

NSAIDs can decrease blood flow through the kidneys. This is typically not a big deal, but it can cause kidney damage when paired with furosemide (Lasix). For that reason, I would avoid any over the counter ibuprofen or naproxen. 

I think that your best option over the counter, all things considered here, would be a topical drug such as lidocaine patch or diclofenac gel.

First, lidocaine patches are commonly available over the counter. Lidocaine numbs the affected area and the patches can typically be worn for up to 12 hours at a time.

Alternatively, diclofenac gel (under the brand Voltaren) is a topical NSAID. As long as you only apply a small amount, only an extremely small dose would be absorbed, so it’s much safer than ibuprofen or naproxen which I mentioned above. As long as you keep hydrated, it shouldn’t have any noticeable effects on your kidneys. I think that both of these would be a good option for knee and back pain.

Ready for a more personal experience with your meds?