Dear Lifehacker,
Every time I go to the pharmacy, I'm confused. What's the difference between something like Tylenol and Advil? When should I use each one? What about sleep aids or cough medicines? Are generics okay, or should I spring for the brand name instead?
Sincerely,
Brand Skeptic
Dear Brand Skeptic,
The names and ingredients in common over-the-counter pain relievers and cold remedies can be confusing, so we don't blame you for asking. To break down the language and figure out whether there are any real differences between brand names and generics, we sat down with Dr. Daniel Weiswasser, a board-certified internist and pediatrician who's been in outpatient practice in Western Massachusetts for nine years. He's seen the brand names and the generics in action, and offered his expertise to the subject.
Which Pain Reliever Should I Use, and When?
Although many people have their own method of choosing what pain reliever to take when, there's no cheat sheet for "use ibuprofen for x and y symptoms, and use acetaminophen or a and b symptoms." The real answer is that the most popular pain relievers are so similar that it doesn't matter, as long as you're using something that doesn't react badly with medication you're taking, affect a condition you already have (like high blood pressure or liver disease), and as long as you don't take too much.
The most popular pain relievers boil down to two families: ibuprofen/naproxen and acetaminophen. We'll get into each one in a moment, but both have their own pros and cons. In most cases, a doctor will tell you to try ibuprofen first (or naproxen if you want something longer lasting), and if there's an issue with it or there's a specific reason you should take acetaminophen, take that instead. Here's why.
Common Pain Medications and Their Brand Names
When you hit the grocery store to pick up something to soothe a throbbing headache or pulled muscle, you have tons of options. You might have a favorite, but if you're confused by terms like naproxen sodium or acetaminophen, here's a quick rundown of the most popular painkillers and their branded names. Obviously, these basics will help, but if you have any questions about which medication is right for you, don't hesitate to ask a medical professional who can assess your individual situation.
Aspirin, also known as acetylsalicylic acid (ASA), is widely available as a generic (sometimes called ASA, other times just Aspirin), and the active ingredient in brand names like Bayer, Ecotrin, Fasprin, and Anacin (Aspirin with caffeine added). It used to be popular for aches and pains, but as Dr. Weiswasser notes, Aspirin is rarely used for that at all anymore, in favor or more modern pain relievers:
I would point out that aspirin is typically not used for pain relief anymore; it's used more typically for its platelet inhibition, which leads to thinning of the blood, which is thought to reduce the risk of heart attacks in those who have had heart attacks already in the past (also known as "secondary prevention"). While many use aspirin to prevent heart attacks in the first place ("primary prevention"), there is some new data that aspirin increases the risk of a certain eye disease, macular degeneration, so the use of it for primary prevention is being called into question. (See this study in the Journal of the American Medical Association (JAMA) Internal Medicine) There's also some recent data suggesting that routine aspirin use reduces the risk of some solid cancers, like colon cancer. (See this study in The Lancet.)
Ibuprofen is an NSAID (Non-Steroidal Anti-Inflammatory Drug) pain reliever, is generally considered the best and most accessible for most day-to-day aches and pains. It's also used to bring down a fever. It's also an anti-inflammatory, meaning it reduces swelling. It too is widely sold as a generic just called "ibuprofen," but it's also the active ingredient in Advil, Motrin, Midol, Nurofen, Nufren, Caldolor, NeoProfen, Ibu and the original, Brufen. Most doses usually last 4-6 hours.
Ibuprofen (and really, any NSAID pain reliever) is not without side effects though. Dr. Weiswasser explains:
NSAID side effects include stomach upset and ulcers. Like their cousin, aspirin, they also inhibit platelet action, although to a lesser degree. They interfere with the cardioprotective effect of aspirin, may exacerbate heart failure, and may raise blood pressure. They can also worsen kidney disease.
Naproxen is, by comparison, new to the party. It's available as a generic (Naproxen Sodium), but depending on where you live, it might be prescription-only. You may know it as Aleve, Anaprox, Antalgin, Apranax, Feminax Ultra, Flanax, Inza, Midol Extended Relief, Nalgesin, Naposin, Naprelan, Naprogesic, or Naprosyn. It's an NSAID, like ibuprofen, what means it offers the benefits (and risks) that ibuprofen does. The major difference though is that it lasts much longer. Dr. Weiswasser explains:
Without getting too technical, the only real difference between ibuprofen and naproxen is that naproxen has a longer half-life, i.e. it lasts longer. Specifically, naproxen's analgesic effects last about 7 hours whereas ibuprofen's are about 4-6 hours. The advice is typically that ibuprofen be taken no more than every 6 hours and naproxen no more than every 8-12 hours.
So, if you need long-lasting pain relief, or don't want to pop ibuprofen every 6-8 hours, try naproxen.
Acetaminophen is a mild pain reliever, used for more minor aches and pains, and as a pain reliever in combination with other drugs. It's available as a generic under its own name, and is the active ingredient in brand names like Tylenol, Panadol, Anacin-3 (or Anacin Aspirin Free), Acamol, Tempra, Datril, Feverall, and Ofirmev, among others. You'll also find it in cough and cold remedies, used to soothe aches and pains while you get over a bad cough or runny nose.
It's not an NSAID, so while it has similar pain relieving properties, it doesn't have anti-swelling properties, although it is often used to bring down a fever. However, Dr. Weiswasser reminded us that acetaminophen overuse is the most common cause of acute liver failure in the United States, and it's important never to exceed the recommended dose. People who drink or have liver problems should avoid it entirely.
In general, Acetaminophen is ideal for people who don't need anti-swelling, who want to avoid the side effects of NSAIDs, or for whom NSAIDs don't work as well.
Combination Drugs (Like Excedrin)
Combination or cocktail drugs that contain a combination of caffeine, acetaminophen, and aspirin (or alternatively, caffeine, acetaminophen, and ibuprofen) are often marketed as relief from migraines and tension headaches. Excedrin, one brand name of the type, is a combination of caffeine, acetaminophen, and aspirin. Generic "migraine medications" sold over the counter offer similar combinations, and when we asked Dr. Weiswasser about them, he noted that there's nothing about Excedrin or any other cocktail brand that's special that you couldn't make at home with the appropriate combination doses of their component pain relievers along with a strong cup of coffee.
That said, there's something to paying for the convenience of a pill, especially if you already have a headache and the last thing you want to do is the math to make sure you're not taking too much of any one component drug. Keep in mind however that because these combination drugs contain acetaminophen, aspirin, and/or ibuprofen, they come with the side effects and risks of each when taken improperly. Always follow the instructions on the label, and see a medical professional if you're tempted to do otherwise.
Generic vs. Brand Name Drugs
So now that you know what you want, which brand should you buy? That's pretty easy: Since all of these are available as generics, there's no reason to buy marketed brand names over their more affordable generics. Some brand names offer different tablet styles, like liqui-gels or gel-capsules (which can be absorbed more rapidly than tablets), and others coat their pills with sugar, add caffeine, or add other inactive ingredients. You'll have to decide whether those features are worth your money. As for the active ingredients, there's no difference between brand name and generic. We'd say save your money.
What About Other Over-the-Counter Medicines?
Sleep Aids
Sleep aids can be even more confusing than pain relievers, mostly because their active ingredients are harder to say, more mysterious, and the generic versions are rarely marketed with their actual pharmacological names. The language barrier makes this a tricky issue, because people who would never buy brand name ibuprofen will make sure to pick up ZZZQuil over anything else, or swear by Unisom to help them fall asleep. There are two major groups of over-the-counter sleep aids:
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Diphenhydramine, a strong sedating antihistamine, or in other words the ingredient in Benadryl or ZZZQuil that tends to make you so sleepy. It's still an antihistamine though, which also makes it an active ingredient in many allergy medications. You'll find this marketed as a sleep medication as a generic (but you'll have to flip over the package to see it), and as the active ingredient in ZZZQuil, Unisom, and Sominex.
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Doxylamine is another antihistiamine. It's a short term sedative, and while diphenhydramine is the active ingredient in ZZZQuil, it's actually doxylamine that's in the original NyQuil. It's also available as a generic, sometimes side by side with diphenhydramine. It's even more confusing because Unisom uses doxylamine as an active ingredient in one formulation, but not the other. You could go to the pharmacy right now and find both, side by side on the same shelf, both labeled "Unisom." They may be different colors or in slightly different packages, but they'll be there.
Both medications can help you get to sleep, but to say they "treat insomnia" is a stretch. Dr. Weiswasser explains, and offers some alternatives:
According to most research, diphenhydramine does not improve insomnia, and it may cause sedation the next day (due to its long half-life). It can also lead to delirium, dry mouth, blurred vision, urinary retention, and constipation. [Ed note: You can read more about these side effects here for diphenhydramine and here for doxylamine.]
Some people use the herbal product valerian, which also has virtually no better impact than placebo, and it can injure your liver. Melatonin can be helpful for some and is generally well tolerated, so that may be worth a try. Because, like all herbals, it's not under FDA regulation, however, you can never really be sure exactly what you're getting.
Finally, it's worth noting that many people try to treat their sleep problems with alcohol, but alcohol-induced sleep is of poor quality and increases the presence of sleep apnea. Of course, you might also be hung-over the next day and can become dependent upon it.
If you choose to take a sleep aid, sticking to the label is extremely important, and if you're taking them to alleviate chronic insomnia, stop and see a professional. If your issue is poor sleep hygiene, we have some tips that can help.
Should buy the brand name, as in Unisom over the generic store-brand doxylamine succinate? No—like with pain relievers, there's little to no difference at all between them. There may be some inactive ingredients or formulations that make the sleep aid easier to absorb, but again, nothing that's really worth the extra money, especially not in this case.
Cough and Cold Medicines
Much like sleep aids, many people will swear by Sudafed over the generic brand because they have anecdotal experience with the name. In reality, the difference is almost always perceived (for example, if the active ingredient in both is pseudoephedrine, there's no difference). When we asked about other medications people may be confused about, like cough and cold remedies, Dr. Weiswasser reminds us that regardless of the the medication we're looking to take, it's critical to read the label:
This is getting at a broader issue, which is that people should pay attention to "active ingredients" on labels and not brand names. Although people will swear otherwise, there should be no difference between the guaifenesin (which loosens phlegm) in Robitussin Chest Congestion or in the non-name brand version. Same for pseudoephedrine/phenylephrine (decongestants) and dextromethorphan (cough suppressant). Some of these medications are, however, formulated for more extended release, which can be an advantage, especially when trying to sleep.
Always Read the Label
So the next time you're standing in the cough and cold aisle with a sniffly nose, wondering if Robitussin Chest Congestion or Mucinex is the better option, flip the labels over and read the active ingredients. You'll find they're both guaifenesin, and should feel comfortable reaching for the generic. Robitussin (and many other brands) are well known for using different decongestants for different formulations, so always read the label for the type appropriate for your condition, make note of the active ingredient, then consider the generics.
This rule applies to cough and cold remedies, antacids and stomach relief medicines, laxatives, antidiarrheals, just about everything available over the counter. Like Dr. Weiswasser noted, the only real reason you may want to consider one brand over another, or a brand name over a generic, is because one of them is available in a form or formula that's easier to absorb and offers quick relief, has an active ingredient that doesn't interact with a medication you're taking or a condition you have, or if your doctor suggests one over another. Otherwise, save your money, buy generic, and read the label.
Dr. Daniel Weiswasser is a board-certified internist and pediatrician who's been in outpatient practice in Western Massachusetts for nine years. He offered his expertise with this feature, and we thank him.
Photos by Robert Kneschke (Shutterstock), Iakov Filimonov (Shutterstock), Sage Ross, Matt Robinson, Quinn Dombrowski, Zack Mccarthy, Michelle Tribe, Eleanor Ryan, and Adam Hertz.
