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18 Products Alternative To Paracetamol

18 Products Alternative To Paracetamol

Paracetamol, one of the most prescribed drugs in the UK and probably the most popular over-the-counter medicine, has been recently subject to shortages due to increased demand in recent months. In the last 1-2 years, surgeries across the countries advised many patients to purchase paracetamol over the counter to reduce the cost of drugs prescribed on the NHS.

In today’s post, I will discuss drugs alternative to paracetamol. Firstly, I will list some common combinations of drugs, which contain paracetamol, which may be used if standard paracetamol tablets or capsules. Secondly, I will review alternatives to paracetamol analgesics commonly available in the UK.

MOTRIN
ALEVE
ANACIN
MOBIC
TORADOL
NEURONTIN
LYRICA
ROBAXIN
PAIN O SOMA

Paracetamol: Licensed Use

Paracetamol is used to help manage conditions characterized by pain and fever (high temperature).

Common conditions include:

  • Headaches, including symptomatic management of migraine
  • Backaches
  • Nerve pains
  • Dysmenorrhoea (period pain)
  • Sore throat
  • Toothache

Cold and flu symptoms include fever, aches, and pains

Quick FAQ

What are side effects of paracetamol?
Some side effects of paracetamol are Low fever with nausea, stomach pain, and loss of appetite; dark urine, clay-colored stools; or jaundice (yellowing of the skin or eyes).
Is paracetamol an anti inflammatory?
No paracetamol does not have any anti inflammatory effect.
Can I take paracetamol for 15 days?
It is recommended to follow the prescribed period of time.

Paracetamol is one of few medicines which can be used in pregnancy.

The maximum quantity of paracetamol sold to a customer is 100 tablets or capsules. The sale of paracetamol products in supermarkets or other retail outlets is usually limited to 2 packs of 16 paracetamol capsules or tables.

Forms Of Paracetamol

Over the counter paracetamol is available in the following forms:

Forms Of Paracetamol

Drugs Alternative To Paracetamol

Alongside paracetamol, ibuprofen is the most common simple analgesic (painkiller) sold in the UK. If suitable, ibuprofen can be considered the main over-the-counter alternative to paracetamol.

1. Ibuprofen

Ibuprofen belongs to a class of drugs called Nonsteroidal Anti-Inflammatory Drugs (NSAIDs). Unlike paracetamol, ibuprofen reduces inflammation in addition to a reduction of fever and pain.

Ibuprofen – available forms and strengths

Ibuprofen comes in two different strengths: 200mg and 400mg tablets or capsules. 200mg ibuprofen is widely available in shops and pharmacies for self-selection by customers. 400mg ibuprofen, on the other hand, is a pharmacy-only medication (P), which means it can only be purchased from registered pharmacies.

Ibuprofen – restrictions on supply

Similar to paracetamol, ibuprofen available for patients’ self-selection is restricted in pack sizes with a maximum allowed sale of two packs per customer.

Ibuprofen: brands and products

Ibuprofen is sold in various brands. Supermarkets and pharmacies sell their brands of ibuprofen, which is usually the cheapest option for customers.

Branded ibuprofen is also available for customers selection, for example, Cuprofen. Cuprofen contains 400mg of ibuprofen and is no different from other ‘non-branded’ versions of ibuprofen. Ibuprofen capsules are usually sold as a branded product.

Ibuprofen brands and products

Two well-known brands of ibuprofen (liquid capsules) are Anadin and Nurofen Express.

Both brands are advertised as products that provide faster pain relief than standard ibuprofen tablets.

Ibuprofen is also sold as sodium ibuprofen (known as ibuprofen lysine), a fast-dissolving form of this drug. Ibuprofen lysine gets into the body fast and provides better pain relief than standard ibuprofen. Fast-acting ibuprofen also offers a quicker initial pain reduction with longer-lasting analgesia (Moore et al., 2019).

Over-the-counter ibuprofen lysine is sold in various brands and marketed for symptomatic management of different conditions, including migraines, period pains, and tension headaches.

Ibuprofen lysines products available for self-selection by patients contains 342mg of ibuprofen lysine, equivalent to 200mg of ibuprofen.
A higher strength of ibuprofen lysine products (684mg, which is equivalent to 400mg of ibuprofen) are pharmacy-only medicines, for example:

  • Nurofen Express 684mg Caplets
  • Nurofen Maximum Strength Migraine Pain 684mg Caplets

2. Ibuprofen And Pseudoephedrine

Ibuprofen And Pseudoephedrine

A pharmacy-only medicine sold as Nurofen Cold & Flu (Nurofen Sinus Relief) contains two active ingredients ibuprofen and pseudoephedrine, a decongestant.

Nurofen Cold and Flu is ideal for people who want to relieve congestion and benefit from ibuprofen's pain anti-inflammatory actions.

If suitable, Nurofen Cold and Flu can be used as an alternative or alongside paracetamol. Pseudoephedrine (as opposed to phenylephrine) is a pharmacy-only medicine, which means it can only be sold from pharmacies/pharmacy counters and online chemists.

Pseudoephedrine is an effective oral decongestant used to relieve cold symptoms, particularly sinus symptoms, such as congestion, sinus pain, and pressure.

Pseudoephedrine may not be suitable for everyone. Patients who take certain drugs or have an underlying condition(s) should speak to the pharmacist before taking pseudoephedrine.

Pseudoephedrine should not be used continuously for longer than 7 days. Pseudoephedrine has a limit on sale – one box per customer.

3. Aspirin

Aspirin is another NSAID on the list which can be used as an alternative to paracetamol. When used as a painkiller, aspirin is usually sold as aspirin 300 (each tablet contains 300mg of aspirin) on its own or with other ingredients such as caffeine or paracetamol.

A lower dose of aspirin, 75mg (baby aspirin), is taken to prevent cardiovascular diseases, for example, strokes or heart attacks.

Aspirin

Over-the-counter aspirin is sold in different forms and rands.

Soluble aspirin, for example, Alka-Seltzer, may provide faster pain relief than standard tablet formulations, which is beneficial in treating conditions,

which require fast-acting medicines, such as relief of headaches during a migraine episode. Read more about the best painkillers for migraine headaches.

4. Naproxen (Feminax Ultra)

Naproxen is the 3rd and last NSAID available over the counter. Naproxen 250mg tablets used to be sold as a branded product called Feminax Ultra. Feminax Ultra was licensed for short-term management of period pain and menstrual cramps in women aged 15-50.

Feminax Ultra has been discontinued due to ‘marketing’ reasons and is no longer available over the counter. It is possible to get naproxen or other NSAIDs prescribed by a doctor. Naproxen is more effective than ibuprofen as an anti-inflammatory and pain medicine with low side effects but slightly higher than ibuprofen (NICE BNF, 2021).

Topical Product Alternative To Paracetamol

Topical gels can be useful as alternatives to paracetamol. Over the counter, medicated gels usually contain NSAIDs as active drugs, for example, diclofenac and ibuprofen.

The topical gel may suit some customers for whom oral ibuprofen is not recommended. Topical gels are suitable for managing painful and inflammatory conditions, including backaches, muscular pain, sprains, osteoarthritis, and sports injuries.

5. Ibuprofen gel

Ibuprofen gel comes in two strengths, 5% and 10%. Ibuprofen gel is sold in various brands. Supermarket brands, for example, Tesco Ibuprofen gel 5% and 10% are usually cheaper than other brands of ibuprofen gel.

6. Diclofenac Gel (Voltarol)

Diclofenac belongs to the same class of drugs like ibuprofen – NSAIDs. Diclofenac is considered a more effective drug than ibuprofen. Over-the-counter diclofenac is sold as Voltarol gel, which comes in two different strengths – 1.16% and 2.32% (double the strength).

Voltarol 1.16% vs. Voltarol 2.32% – what is the difference?

Voltarol Pain Relief Gel, 12 Hour Joint Pain Relief 2.32% (Voltarol Extra Strength Emulgel) is a higher strength formulation than 1.16% Voltarol Back & Muscle Pain Relief Gel, which is the main difference between both products.

Voltarol, a 12-hour gel, can be applied twice a day. Voltarol Back and Muscle Pain Relief can be applied up to four times daily.

Non-drug Alternatives To Paracetmol

Plenty of non-drug options can be used in the management of pain. These usually include heat and cold patches and sprays, and various gels. I have included two popular gels used for symptomatic control of distinct conditions.

7. Flexiseq Osteo Topical Gel

Flexiseq offers a unique non-drug gel formula, which is used to manage symptoms of osteoarthritis. As described by the manufacturer of Flexiseq, the gel is composed of phospholipid vesicles, which penetrate the skin and lubricate joints, although this mechanism of action is not certain.

A clinical trial with Flexiseq in 1300+ patients demonstrated a response in pain, stiffness, and joint function. During a 12-week trial, Flexiseq was better than ‘treatment’ with a placebo – a dummy product (Conaghan et al., 2014).

Flexiseq may be a suitable alternative for patients in whom other paracetamol alternative drugs (NSAIDs) are not appropriate.

Currently, Flexiseq is not approved as a treatment on the NHS, mainly due to the high cost.

8. Biofreeze Pain Relieving Gel

Biofreeze Pain Relieving Gel is another non-medicated gel containing menthol as an active ingredient. Menthol creates the sensation of coolness, which, in turn, block pain signals to the brain.

Combination Products Alternative To Paracetamol

There are several products available on the market which contain paracetamol. Commonly, paracetamol is added to cold and flu products, decongestant products, and in combination with other painkillers such as ibuprofen, aspirin, and codeine.

Some paracetamol combination products can be used as an alternative treatment when required or when one struggles to find paracetamol due to shortage, for example.

Many combinations of products are available in pharmacies. Patients with underlying conditions who take different drugs need to check if they can take a combination product. Common combination products available in pharmacies:

9. Paracetamol + Decongestant (Such As Pseudoephedrine)

Several products which contain paracetamol and pseudoephedrine can be purchased from a pharmacy.

Two popular brands representing a combination of paracetamol are Contact Non-Drowsy Dual Relief Tablets and Sinutab tablets.

Both products contain the same active ingredients and can relieve congestion and pain.

10. Paracetamol And Phenylephedrine

Phenylephedrine is widely sold as a decongestant drug, off the shelf in shops, supermarkets, and pharmacies. Phenylephedrine may benefit decongestant medication; however, it is a much ‘weaker’ decongestant compared to pseudoephedrine.
Examples of products containing a combination of paracetamol and phenylephrine:

  • Sudafed Sinus Max Strength Capsules.
  • Benylin Cold & Flu Max Strength Capsules.
  • Lemsip Max Sinus.

11. Paracetamol + Codeine (Co-codamol)

Co-codamol is the most popular over-the-counter codeine-containing product. Each ‘standard’ co-codamol tablet contains 500mg of paracetamol and 8mg of codeine.

I previously reviewed codeine-containing drugs in two posts: Co-codamol over the counter: Everything you need to know & codeine over the counter – 17 OTC products. You can learn more about over-the-counter codeine products from both posts.

12. Paracetamol + Caffeine (Panadol Extra Advance)

Various branded versions of paracetamol can be bought over the counter. Branded products may be available solely as paracetamol and combined with caffeine, for example:

13.Paracetamol + Aspirin + Caffeine (Anadin Extra)

Paracetamol is available in combination with aspirin. Anadin Extra offers the benefit of two painkillers (paracetamol and aspiring) with the addition of caffeine.
Paracetamol & ibuprofen
An adult can take paracetamol and ibuprofen at the same time. Nuromol is the only drug available from pharmacies, which contain paracetamol and ibuprofen in one pill.
Nuromol is advertised as a product with a favorable formulation, which provides better relief of pain than taking each drug alone (paracetamol and ibuprofen).

‘Cold and flu’ Products Containing Paracetamol.

Plenty of cold and flu products exist from supermarkets and pharmacies sold off the shelf. Below are some popular brands of cold and flu medicines.

14. Day And Night Nurse

One of the most recognized cold and flu products. Day and Night nurse comes as a combination pack containing ‘day’ and ‘night’ capsules or separate products in tablet and liquid forms.

Day Nurse capsules contain three active ingredients:

  • Paracetamol
  • Pseudoephedrine hydrochloride (decongestant)
  • Pholcodine (cough suppressant)

Night capsule contains the following active ingredients:

  • Paracetamol
  • Promethazine hydrochloride (sedative antihistamine)
  • Dextromethorphan hydrobromide (cough suppressant)

15. Beechams All-in-One Max Strenght

Beechams All in one contain three active ingredients:

  • Paracetamol
  • Guaifenesin (expectorant which loosens the mucus – a common ingredient found in chesty cough syrups)
  • Phenylephrine hydrochloride (a weak decongestant)

Beechams All-in-One is a general sale item, which can be sold in any retail outlet.

16. Benylin Day And Night

Benylin Day & Night Tablets is another combination product available from pharmacies only. Each pack contains ‘day’ and ‘night’ tablets.
Benylin Day tablets contain a combination of paracetamol and pseudoephedrine, whereas ‘night’ tablets, paracetamol, and diphenhydramine hydrochloride, a sedative antihistamine.

17. Benylin Four Flu

Benylin Four Fly is related to the above product. There are three active ingredients (paracetamol, pseudoephedrine, and diphenhydramine hydrochloride) in one tablet.

18. Other Combination Products

There are plenty of combination products available in pharmacies. Generally speaking, products available directly from a pharmacy counter offer a better choice in the symptomatic management of different conditions, particularly ‘colds and flu symptoms, than products available for self-selection in shops and supermarkets.

References

Conaghan PG, Bijlsma JW, Kneer W, Wise E, Kvien TK, Rother M. Drug-free gel containing ultra-deformable phospholipid vesicles (TDT 064) as a topical therapy for the treatment of pain associated with osteoarthritis: a review of clinical efficacy and safety. Curr Med Res Opin. 2014 Apr;30(4):599-611. doi: 10.1185/03007995.2013.860018. Epub 2013 Nov 26. PMID: 24164189. Available at: https://doi.org/10.1185/03007995.2013.860018 Accessed on 13/1/2021

Moore RA, Derry S, Straube S, Ireson-Paine J, Wiffen PJ. Faster, higher, stronger? Evidence for formulation and efficacy for ibuprofen in acute pain. Pain. 2014 Jan;155(1):14-21. doi: 10.1016/j.pain.2013.08.013. Epub 2013 Aug 19. PMID: 23969325. Available at: https://doi.org/10.1016/j.pain.2013.08.01 3Accessed on 11/01/2021