Prepper’s Pill Box: NSAIDs.

Aspirin, Acetaminophen (also called paracetamol), Ibuprofen, and Naproxen are all available over the counter without prescription in the United States and most of the world. These Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) are very mild painkillers that can help you deal with a headache or take the edge of joint and muscular/skeletal pain. Sometimes this can be the difference between being able to maintain a cheerful disposition or get decent sleep, and not being able to do those things. 

(There are many other NSAIDs, but since most of them are still prescription-only in the United States they are beyond the scope of this article.)

I am not a medical professional, and what follows here should not be taken as professional medical advice. This is simply my understanding of how four over the counter medications work, and how I consider using them as part of my resiliency preparations. Your specific medical situation should be something you control under the care of a licensed medical provider, as there is a lot of “Well, what he wrote is true, but in your case...” exceptions in the medical field.

Aspirin

This is the oldest NSAID on the list, which began as a raw willow bark treatment in ancient times to the modern pills we have today. Aspirin works by completely nullifying the cyclooxygenase-1 (COX1) enzyme, and modifying the cyclooxegenase-2 (COX2) enzyme production pathway to immediately prevent inflammation, and trigger the production of anti-inflammatory molecules called aspirin-triggered lipoxins, aspirin-triggered resolvins, and aspirin-triggered maresins. Aspirin is cleared from the bloodstream through the liver, as it tacks on a urea or gluconate molecule which tags the salicylic acid molecule for excretion through the kidneys.

What Does This Mean? 

Aspirin is a very good anti-inflammatory drug and fever reducer. However, it has one other medically relevant property as an anti-coagulant. Aspirin irreversibly stops platelets from clotting by blocking the thromboxane A2 signaling pathway, which also stops the signal to create more platelets.

In a Survival Situation
If you suspect someone has internal bleeding, from a fall, crush, or other injury, you should steer clear of aspirin, no matter how much pain they are in. However, if someone starts having chest pains and other signs of a heart attack, an aspirin here is very helpful to help prevent a blood clot from further restricting oxygen to heart muscle tissue.

Historical Note

There is some speculation that the mass deaths of the Spanish Flu can partly be explained by aspirin overdoses as doctors tried to get the fever under control. The availability of generic aspirin and the Spanish Flu coincided with each other: the US patent on Aspirin expired in 1917, and the Spanish Flu hit in 1918. Many of the accounts of death by Spanish Flu, including a fluid buildup in the lungs, is consistent with aspirin toxicity.

Acetaminophen

First brought to market in 1951 under the brand name Tylenol, acetaminophen is a pain analgesic and fever reducer. We don’t exactly know how it works, but the suspected mechanism of action is an indirect impact on COX1 and COX2. Acetaminophen is cleared from the bloodstream when the liver tacks on a gluconate or sulphate group, triggering excretion through the kidneys. 

Unlike the other drugs on this list, acetaminophen is not a significant anti-inflammatory drug, meaning that if someone is suffering from swollen/inflamed joints or muscles, this is not an optimal treatment option.

What Does This Mean? 

Acetaminophen is good for reducing pain and bringing down fever, without the blood clotting concerns of aspirin, but shouldn’t be your first choice for joint/muscle inflammation.

In a Survival Situation
Acetaminophen is a low-risk option for aches and pains as well as fever reduction. In fact, it is my go-to choice for fever reduction for my family.

Ibuprofen

First patented in the 1960s, ibuprofen was designed as a better option for the treatment of rheumatoid arthritis. Ibuprofen is a COX1 and COX2 inhibitor, but unlike Aspirin, it doesn’t impact blood clotting. 

The anti-inflammatory properties of a nonspecific COX inhibitor are very appropriate for joint pain caused by swelling. Ibuprofen is cleared from the blood by oxygenation in the liver.

What Does This Mean? 

Ibuprofen is appropriate for joint pain and fever reduction, and should not impact blood clotting ability.

In a Survival Situation

If someone is having a lot of pain due to swelling of the joints, Ibuprofen is a safer option for treatment than aspirin and a better option than acetaminophen.

Naproxen

The Food and Drug Administration approved Naproxen as an OTC medication in 1994. Unlike Aspirin, Acetaminophen, or Ibuprofen, Naproxen is a selective inhibitor of the COX enzyme, specifically COX2. This is good news for people who require long term NSAID use, as the COX1 enzyme is used for other things in the body such as controlling stomach mucus. If you’ve ever heard that too much aspirin/acetaminophen/ibuprofen can lead to ulcers, this is true as inhibiting the COX1 enzyme in the stomach lining can lead to areas unprotected by stomach mucus, creating an ulcer. 

Naproxen is cleared when the liver tags on a glutonate or sulphate group for excretion through the kidneys. Naproxen is an effective anti-inflammatory drug suitable for swollen joints and inflamed muscles.

What Does This Mean? 
What does this mean to you? Naproxen is the only NSAID on this list that should be considered for someone with a history of stomach ulcers.

In a Survival Situation

Naproxen is the safest choice for someone with stomach issues for both fever reduction and pain management, but otherwise is very similar to ibuprofen.

Guidelines for NSAID Use
First and most importantly, don’t mix NSAIDs since they all seem to work on the same chemical pathways in the body, and in this case more isn’t better. If you need an NSAID to work faster, caffeine is your friend here, and a normal cup of coffee or strong tea to wash your pills down can really help clear up a headache or body ache.

All NSAIDs are associated with temporary reduction in kidney function, so anyone dealing with a kidney disease should avoid all NSAID use unless directed by a medical professional. 

Do not limit water intake when on NSAIDs. In fact, you should probably drink more. 

Never take more than the maximum dose listed on the bottle. If you need more medicine than that, you really need the guidance of a medical professional and likely a prescription for a different medicine.

Different pills have different release rates, so liquid gels and caplets will deliver the drug faster, as well as headache powders such as Goodies or BC, which are NSAID + caffeine cocktails.

Use the smallest effective amount for the shortest possible time. For people with chronic conditions the time span may be “the rest of their life,” but using the least amount that allows you to function is critical.

If NSAIDs Aren't Working...

1. If you can’t reduce fever enough with an NSAID, cold towels are a better option than more medicine. 
2. If you can’t reduce pain enough with an NSAID, rest and recuperate. 
3. If you can’t reduce swelling enough with an NSAID, remember RICE for Rest, Ice, Compression, Elevate.

In conclusion, NSAIDs are useful tools but they aren't a silver bullet. Use them wisely, but also be prepared to ditch them for other solutions if necessary.