Which Painkiller, When? A Kitchen-Table Guide to Paracetamol, Ibuprofen and Codeine

Painkillers are among the most familiar medicines in the house. They sit in kitchen drawers, handbags and bathroom cabinets, often beside a half-used cold remedy. The trouble is that familiarity can make them feel interchangeable. They are not. Paracetamol, ibuprofen and codeine do different jobs, carry different risks and can overlap in ways that are easy to miss.

This is not a rulebook for every person. It is a practical starting point for adults in a typical UK household, with the prompts that matter when you are standing at the pharmacy counter.

Paracetamol: the steady default

Paracetamol is the first choice for many types of mild to moderate pain and for bringing down a temperature. It is gentler on the stomach than ibuprofen for most people and is usually the safer option for anyone with stomach problems, kidney disease or asthma that is sensitive to anti-inflammatories.

For adults, the usual dose is 500mg to 1g every four to six hours, with no more than four doses in 24 hours. That means a maximum of 4g a day for most adults. Some people need a lower maximum, including those who are very slim, frail, malnourished, heavy alcohol users or have liver problems. Ask us if that might apply to you.

The biggest trap is hidden paracetamol. Cold and flu sachets, night-time remedies, headache powders and some prescription painkillers already contain it. Taking a cold remedy alongside ordinary paracetamol is a common accidental double dose. Paracetamol overdose can be delayed and serious, so check every label. It is generally considered suitable in pregnancy at normal doses, but always confirm with a pharmacist, midwife or GP.

Ibuprofen: useful for inflammation, but check first

Ibuprofen is an anti-inflammatory painkiller. It can be helpful for muscular aches, period pain, dental pain, sprains and some headaches, and it also reduces temperature. For adults, over-the-counter tablets are usually 200mg or 400mg, taken every four to six hours with a maximum of 1,200mg a day without medical advice. Take it with or after food if it upsets your stomach.

Ibuprofen is not the right choice for everyone. Avoid it if you have had a stomach ulcer or bleeding, severe indigestion, kidney disease, heart failure or asthma that has been triggered by aspirin or similar medicines. It can interact with blood thinners, steroids, some blood pressure medicines, lithium and methotrexate. In pregnancy, avoid ibuprofen unless a clinician has specifically advised it, particularly from 20 weeks onwards. If you are breastfeeding, ask before using it.

Codeine: short-term and cautious

Codeine is a weak opioid. It is often sold in combination with paracetamol as co-codamol, or with ibuprofen, for short-term relief of acute pain that has not responded to simpler options. It can help with a bad back, dental pain or an injury, but it is not a long-term everyday painkiller.

Codeine can cause constipation, drowsiness, nausea and dizziness. It can also lead to dependence if used for too long. Over-the-counter codeine products should generally be used for no more than three days without advice. Do not drive or operate machinery if you feel drowsy, and avoid alcohol. Codeine is not suitable for children under 12, and it needs careful assessment in breastfeeding, some types of asthma and after certain surgeries. It can interact with antidepressants and other medicines that affect serotonin.

The hidden paracetamol problem appears again here. Co-codamol contains paracetamol, so you must not add extra paracetamol on top. If you are taking co-codamol, count it as your paracetamol dose.

Mixing painkillers: the common traps

Paracetamol and ibuprofen can be used together or alternated if each one is suitable for you and you keep to the daily limits. Some people find this gives better relief than either alone. It is not a free pass to double up on everything in the cupboard, though.

Check combination products carefully. A cold remedy may contain paracetamol, a headache powder may contain aspirin or paracetamol, and a prescribed painkiller may contain codeine plus paracetamol. If you are unsure, put all the boxes on the kitchen table and ask us to check them. Bring a photo of the labels if that is easier. Also check expiry dates, but do not flush old medicines down the toilet; take them to a pharmacy for safe disposal.

Questions worth asking at the pharmacy

Tell us if you have stomach problems, asthma, kidney or liver disease, heart failure, high blood pressure or a bleeding disorder. Tell us if you are pregnant, trying to conceive or breastfeeding. Tell us about everything you take, including blood thinners, antidepressants, steroids, blood pressure medicines and supplements. If you need pain relief for more than a few days, or you are using it most weeks, that is worth a conversation. Long-term pain deserves a proper plan, not just another box of tablets.

Children's doses depend on age and sometimes weight, so do not guess from an adult label. If you are choosing between products for a child, ask us or check the patient information leaflet.

When pain needs more than a painkiller

Most everyday aches settle with time, rest and sensible pain relief. Seek urgent help for severe chest pain, a sudden severe headache, severe abdominal pain, a fever with a stiff neck, vomiting blood, black stools, a serious injury or signs of an allergic reaction such as swelling of the face or difficulty breathing. For non-urgent worries, NHS 111 can guide you, and the pharmacy can help with many minor ailments.

Painkillers are useful tools, not sweets. Used carefully, with the right product for the right person, they can take the edge off a bad day without causing a bigger problem. If in doubt, ask the chemist down the street. That is what we are here for.