Which over-the-counter medications are best for osteoarthritis?

Q. Which over-the-counter medications are best for osteoarthritis?

A. Many people can manage arthritis pain with over-the-counter medications, says Suzanne Chapnick, a clinical rheumatologist at Cambridge Health Alliance, and they are usually the first line of treatment. “Start with a very low dose and increase it as needed and as tolerated,” she says, never exceeding the recommended daily dose. The benefits and side effects of each drug vary from person to person, so there is no one preferred drug. Physicians often recommend acetaminophen (Tylenol) first because it tends to have the fewest side effects. Chapnick cautions that many common medications like cold remedies also contain acetaminophen, and overdosing can damage the liver.

People who don’t respond to acetaminophen or have bothersome swelling of the joints can try an anti-inflammatory medication, including aspirin or a non-steroidal anti-inflammatory (NSAID), either ibuprofen or naproxen. Acetaminophen can be combined with an anti-inflammatory, but doubling up on anti-inflammatory medications can put you at risk for stomach ulcers. If you take a low-dose aspirin for cardiovascular health, Chapnick advises taking it at least two hours before an NSAID.

“Just because medications are over-the-counter doesn’t mean they should be considered without risk,” she says. In particular, people who are elderly, take blood thinners, have an existing chronic disease, or have a history of stomach ulcers should consult a doctor before taking these medications.

Some people with arthritis also find relief from applying over-the-counter topical creams containing capsaicin. For persistent pain, stiffness, and swelling, see a doctor for other treatment options.