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Dr. Lee: Many pain medications are available over-the-counter (without a prescription, or OTC) in the . for short-term relief of joint pain , muscle aches , headache , menstrual cramps , and fever . These OTC analgesics are generally well tolerated and safe when used properly. But side effects do occur and in some instances can be serious. Today, we will ask Dr. William Shiel how to use these analgesics properly in order to minimize risks and side effects. We will also ask him to compare traditional pain relievers with the newer pain relievers, the selective COX-2 inhibitors.

What pain medications are available in this country without a doctor's prescription?

Monoamine oxidase inhibitors (phenelzine, isocarboxazid), clonidine , selegiline , guanethidine, and ergotamines (ergotamine tartrate, dihydroergotamine mesylate) may increase blood pressure when used at the same time as ephedrine. Methyldopa or reserpine may reduce ephedrine levels in the blood and thereby lessen the effectiveness of ephedrine. Tricyclic antidepressants ( desipramine , amitriptyline , doxepin , and imipramine ) may block the effect of ephedrine. The carbonic anhydrase inhibitors acetazolamide and dichlorphenamide may increase ephedrine blood levels and the risk of side effects from ephedrine. Patients taking any medications should consult with their physician or pharmacist before starting OTC ephedrine.

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