Introduction
Painkillers are among the most commonly bought medicines in Nigeria. Headache, body pain, toothache, period pain, back pain after a long day at the market, most of us reach for a tablet without thinking twice.
Because painkillers are so easy to buy, many people assume they are completely safe. Used correctly, most of them are. Used wrongly, they can quietly damage your liver, stomach, and kidneys.
Understanding which painkillers to use, how much to take, and when to seek professional advice can protect you and your family from serious complications.
Paracetamol: Safe, Up to a Limit
Paracetamol (Panadol, Emzor Paracetamol, and many others) is one of the safest painkillers when taken at the right dose. The danger comes from taking too much.
For most adults, the usual dose is 500mg to 1g (one or two 500mg tablets) every 4 to 6 hours as needed. Always leave at least 4 hours between doses.
Never take more than 4g (eight 500mg tablets) in 24 hours. This is the maximum adult dose, not a target. Some people need a lower limit.
Too much paracetamol can cause serious liver damage, often with no obvious symptoms during the first day or two.
Many cold, flu, and combination pain products already contain paracetamol. Taking them together with plain paracetamol is a common way people overdose by accident.
If you have liver disease, regularly drink alcohol, are malnourished, or weigh less than 50kg, ask a healthcare professional about an appropriate lower dose.
Important: If you think you have taken too much paracetamol, go to a hospital immediately, even if you feel completely fine. Early treatment can prevent serious liver damage.
What About Children?
For children, use a product suitable for their age and follow dosing instructions based on their weight whenever possible.
Always use the measuring syringe or cup provided, not a kitchen spoon. Different children's syrups may contain different strengths of paracetamol, so check the label carefully.
Never estimate a child's dose using adult tablets.
Anti-Inflammatory Painkillers (NSAIDs)
Ibuprofen, diclofenac, piroxicam, and naproxen belong to a group of medicines called non-steroidal anti-inflammatory drugs (NSAIDs).
They are effective for pain involving inflammation or swelling, including sprains, joint pain, period pain, and toothache.
However, they carry real risks, especially when taken frequently, at high doses, or for long periods.
The Main Risks
Stomach irritation, ulcers, and bleeding: Taking NSAIDs with or after food may reduce stomach discomfort, but it does not completely prevent ulcers or bleeding.
Kidney damage: The risk is higher if you are dehydrated, elderly, or already have kidney problems.
Raised blood pressure: NSAIDs can increase blood pressure and make hypertension harder to control.
Heart problems: Some NSAIDs, particularly diclofenac, can increase the risk of heart attack or stroke, especially when taken at high doses or for extended periods. Cardiovascular risks differ between individual NSAIDs.
Dangerous combinations: Do not combine two NSAIDs, such as a diclofenac injection with ibuprofen tablets. This increases the risk of harmful side effects without providing meaningful additional pain relief.
Who Should Be Especially Careful?
Avoid NSAIDs unless a healthcare professional confirms they are suitable if you have:
Stomach ulcers or a history of gastrointestinal bleeding
Kidney disease
High blood pressure
Heart disease or a previous stroke
Asthma that worsens after taking certain painkillers
Pregnancy, particularly from 20 weeks onward
Even if you have none of these conditions, use the lowest effective dose for the shortest necessary time.
Remember: A painkiller being available without a prescription does not mean it is safe for everyone.
Aspirin and Children
Aspirin should not be given to children under 16 for pain or fever unless specifically prescribed by a doctor.
This is particularly important during viral illnesses such as flu and chickenpox.
Aspirin use in children during certain viral infections has been linked to Reye's syndrome, a rare but serious condition affecting the liver and brain.
Use age-appropriate children's paracetamol or ibuprofen instead, following the correct dosing instructions. Ibuprofen is not suitable for every child, particularly those who are dehydrated.
Tramadol and Codeine: A Serious Concern
Tramadol and codeine are opioid painkillers. They have legitimate medical uses, particularly when other pain treatments are insufficient, but they are also widely misused in Nigeria, including northern communities.
Nigeria has tightened regulatory controls on tramadol products and restricted codeine-containing cough preparations because of concerns about misuse and dependence.
However, these medicines still have an important role in treating certain patients with significant pain when prescribed and properly supervised.
Why Are They Dangerous When Misused?
Dependence: Regular use can lead to physical dependence, making it difficult to stop without withdrawal symptoms.
Dangerous breathing problems: Combining tramadol or codeine with alcohol, sleeping tablets, or other sedating medicines can slow breathing and may cause coma or death.
Seizures: Tramadol can trigger seizures, sometimes even at prescribed doses, particularly in people with additional risk factors or those taking interacting medicines.
Overdose: Taking more than prescribed can cause serious poisoning and potentially fatal complications.
These medicines should only be used under appropriate medical supervision and for as long as clinically necessary.
What If Someone Is Already Dependent?
If you or someone you love is struggling to stop using tramadol or codeine, remember that dependence is a health problem, not a moral failing.
Speak to a doctor or pharmacist in confidence. Professional treatment and support can help people reduce or stop their use safely.
If someone becomes unconscious or is breathing slowly after taking an opioid, seek emergency medical help immediately.
Simple Rules for Safe Painkiller Use
Protect yourself and your family by following these basic rules:
Read the label: Check every medicine you take for paracetamol, ibuprofen, diclofenac, or other pain-relieving ingredients.
Use the lowest effective dose: Take only what is needed, for the shortest appropriate time.
Avoid unnecessary daily use: Do not take painkillers every day for more than a few days without medical advice. Persistent pain needs proper assessment.
Buy from licensed pharmacies: Avoid unregulated roadside sellers and open-market medicines that may be fake or substandard.
Tell your pharmacist about other medicines: This includes prescribed drugs, over-the-counter products, and herbal remedies.
Never share prescription painkillers: A medicine that is suitable for one person may be dangerous for someone else.
When Pain Needs a Doctor, Not a Tablet
Painkillers relieve symptoms, but they do not always treat the underlying cause.
Seek immediate medical attention for:
A sudden, extremely severe headache, especially the worst headache of your life
Chest pain, particularly when it spreads to the arm, back, or jaw
Severe abdominal pain, especially with vomiting, fever, or a rigid abdomen
Pain after an injury when you cannot move or bear weight
Severe pain accompanied by difficulty breathing, confusion, or fainting
You should also arrange a medical assessment if pain repeatedly returns, becomes worse, or lasts longer than a week.
Do not keep increasing your painkiller dose to cover up a problem that needs treatment.
Conclusion
Painkillers are useful medicines, not sweets.
The right painkiller, at the right dose, for the right length of time, is generally safe for most people. But taking too much paracetamol, using anti-inflammatory drugs carelessly, or misusing stronger medicines such as tramadol and codeine can have serious consequences.
If you are unsure which painkiller is suitable for you, especially if you have high blood pressure, kidney problems, stomach ulcers, liver disease, or are pregnant, always seek professional advice.
At Amkamed Pharmaceuticals in Gombe State, our pharmacists are here to help you understand your medicines, avoid dangerous combinations, and choose safer ways to manage pain.
Not sure which painkiller is safe for you?
Visit Amkamed Pharmaceuticals, Gombe State, for trusted pharmaceutical advice and professional care.
Your safety matters. Use painkillers wisely.
References
FDA Orange Book.FDA Orange Book. 2026.
National Poison Center Calls Before vs After Availability of High-Dose Acetaminophen (Paracetamol) Tablets in Switzerland.JAMA Network Open. 2020. Martinez-De la Torre A, Weiler S, Bräm DS, et al.Observational
Interventions for paracetamol (acetaminophen) overdose.Cochrane Database of Systematic Reviews. 2018. Angela L Chiew, Christian Gluud, Jesper Brok, et al.SR
Acetaminophen. FDA Drug Label.Food and Drug Administration. Updated date: 2023-11-01.
Oral Nonprescription Pain Medications for Adults.The Journal of the American Medical Association. 2023. Vordenberg SE.Clinical Reference
Common Drug Side Effects and Drug‐Drug Interactions in Elderly Adults in Primary Care.Journal of the American Geriatrics Society. 2017. Merel SE, Paauw DS
Toxic Nephropathies.Evidence-Based Nephrology, 2nd Edition. 2022. Joseph B. Pryor, William M. Bennett, Ali Olyaei
The Primary Care Management of Chronic Kidney Disease (CKD) (2025).Department of Veterans Affairs. 2025. Jonathan Casey Brown DO MPH, Wendy Caesar-Gibbs RD, Cynthia Delgado MD FASN FNKF, et alGuideline
Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association.Circulation. 2017. McCrindle BW, Rowley AH, Newburger JW, et al.Guideline
Public Health Service Study of Reye's Syndrome and Medications. Report of the Main Study.The Journal of the American Medical Association. 1987. Hurwitz ES, Barrett MJ, Bregman D, et al.
Reye's Syndrome in the United States from 1981 through 1997.The New England Journal of Medicine. 1999. Belay ED, Bresee JS, Holman RC, et al.Observational
Metabolic diseases of the liver.Yamada's Textbook of Gastroenterology 7e. 2022. Jacob Bilhartz, Fred Askari
Protocol for a scoping review study on the prevalence and public health consequences of non-medical use (NMU) of tramadol in Africa.PloS One. 2023. Sabi Boun S, Omonaiye O, Yaya S.
The burden of unlawful use of opioid and associated epidemiological characteristics in Africa: A scoping review.PloS One. 2023. Onohuean H, Oosthuizen F.Review15.ConZip. FDA Drug Label.Food and Drug Administration. Updated date: 2025-12-29.
TRAMADOL HYDROCHLORIDE. FDA Drug Label.Food and Drug Administration. Updated date: 2026-03-05.
Tramadol Hydrochloride. FDA Drug Label.Food and Drug Administration. Updated date: 2023-01-25.
tramadol hydrochloride. FDA Drug Label.Food and Drug Administration. Updated date: 2026-08-27.
Pain, Policy, and the Opioid Dilemma in Sub-Saharan Africa: A Systematic Review of Access, Regulation, and Health Governance From 1990 to 2024.Health Policy and Planning. 2026. Nyarko S, Atinga RA, Mahama JC.RecentSR
Management of Osteoarthritis: Expert Opinion on NSAIDs.Pain and Therapy. 2021. Magni A, Agostoni P, Bonezzi C, et al.Review