Nonprescription Analgesics: Balancing Evidence, Safety, and Global Access

Session Title: Nonprescription Analgesics: Balancing Evidence, Safety, and Global Access

Topic: CLINICAL SCIENCE

Description of Workshop: Nonprescription analgesics are among the most frequently used medicines worldwide, and essential for pain relief and self-care. Yet their use often diverges from best evidence and may be associated with harms and misuse with stark inequities in global access.

This workshop brings together multidisciplinary experts to discuss current evidence regarding nonprescription analgesics with three integrated aims:
(1) Evaluate current, robust evidence for what works and what doesn’t work among common nonprescription analgesics and combinations;
(2) Discuss the harms and risks with nonprescription analgesics, including misuse of codeine-containing products and harms associated with paracetamol; and
(3) Explore context-appropriate strategies for the needs of low- and middle-income countries (LMICs) and the limited generalisability from high-income countries.

Efficacy of nonprescription analgesics
We will examine efficacy of nonprescription analgesic considering head-to-head and indirect comparisons, dose and formulation effects (including fast-acting NSAID formulations), and where combinations add value—or do not (e.g. limited incremental benefit of low dose codeine combinations). For example, ibuprofen typically outperforms paracetamol at standard doses for acute pain conditions and fixed dose ibuprofen and paracetamol combinations demonstrate the greatest efficacy in postoperative dental models. Combination analgesics containing caffeine confer a modest but clinically relevant benefit, particularly for headache and post-surgical dental pain. Use of nonprescription analgesics for chronic conditions (e.g. osteoarthritis) will be addressed with appropriate caution regarding modest benefits and tolerability.

Are nonprescription analgesics as safe as perceived?
With our research and clinical expertise, we will present a clear, balanced overview of harms associated with paracetamol. Beyond hepatotoxicity in overdose, we will discuss the evidence for cardiovascular, renal and gastrointestinal side effects, and contextualise these with NSAID risks, always ensuring ‘the lowest dose for the shortest period’. We will directly address misinformation in public discourse—specifically, recent claims linking paracetamol to autism—considering why observational associations do not establish causation and risks of untreated fever/pain in pregnancy.
Furthermore, as misuse and dependence on nonprescription codeine remains a global concern, we will discuss the evidence for misuse with nonprescription codeine containing analgesics and review strategies adopted to prevent misuse; including the value of restricting availability to prescription only, pack size limits, using prominent warnings on packaging, and behavioural interventions.

LMIC perspectives on nonprescription analgesics
In many LMICs, the use of nonprescription analgesics is driven by affordability, informal supply chains and workforce constraints. We will highlight scalable solutions such as strengthening community pharmacy regulation, embedding continuing professional development, and aligning national formularies with the World Health Organization Model List of Essential Medicines. Examples from Malaysia, Thailand, and Indonesia will illustrate regional challenges and successes. Emerging digital health tools, including mobile-based pharmacovigilance reporting and patient-education apps, will be discussed as cost-effective supports for rational self-care.

Format and outcomes
Three concise, evidence rich talks will be followed by a moderated panel discussion applying findings to real-world scenarios (such as musculoskeletal pain, dental pain and migraine). Interactive live polling will capture availability and highlight concerns of nonprescription analgesics globally. Participants will leave with evidence-based strategies to promote safe, equitable nonprescription analgesic use across diverse healthcare contexts.

Speakers