Which painkiller should you take?
South African pharmacy shelves carry dozens of painkillers, but most are built from the same few ingredients — here is how to tell them apart.
Start by reading the ingredients, not the brand
Walk into any South African pharmacy with a headache and you will be offered ten different boxes. Most of them contain the same two or three active ingredients in different combinations. The brand on the front tells you almost nothing; the small print on the back tells you everything.
Nearly every over-the-counter painkiller sold here is built from one or more of: paracetamol, an anti-inflammatory such as ibuprofen, aspirin (analgesic dose), caffeine, or codeine. Once you can spot those names, the shelf gets a lot simpler.
Paracetamol: the usual first choice
paracetamol (Panado) treats mild to moderate pain and brings a fever down. It is gentle on the stomach, it is safe in pregnancy, and it is the painkiller most people should reach for first.
The dose limit matters more than with most medicines, because the gap between a normal dose and a harmful one is smaller than people assume. Adults must not exceed 4 g in 24 hours, and you should take less if you have liver problems or drink heavily. Paracetamol overdose damages the liver quietly — someone can feel fine for a day or two and still be seriously ill.
Anti-inflammatories: better for swelling and injury
Anti-inflammatory painkillers (NSAIDs) work differently. They bring down swelling as well as pain, so they suit sprains, back pain, period pain, toothache and arthritis better than paracetamol does.
The ones you will see most often in South Africa:
Ibuprofen — Nurofen, Brufen, Advil, Ibupain
Mild to moderate pain; inflammation; fever; dysmenorrhoea
Diclofenac — Voltaren, Cataflam, Olfen, Panamor
Moderate pain; musculoskeletal and post-operative pain; inflammation
Naproxen — Synflex, Aleve, Adco-Naproxen, Naprosyn
Mild to moderate pain; inflammation; dysmenorrhoea; musculoskeletal conditions
Aspirin (Analgesic dose) — Disprin, Ecotrin, Aspro Clear, Anadin
Mild to moderate pain; fever
They share a set of cautions. Take them with food, not on an empty stomach. Be careful if you have a stomach ulcer, kidney disease, heart failure or uncontrolled high blood pressure, and speak to a pharmacist first if you have asthma, because anti-inflammatories trigger symptoms in some people. Avoid them in the last third of pregnancy.
Combination painkillers and the codeine problem
South Africa has an unusually large market for combination painkillers — Mybulen, Myprodol, Grand-Pa and similar products that stack a painkiller with caffeine, an anti-inflammatory or codeine into one tablet or powder.
They are effective, and for short-term pain they are fine. The problem is the codeine. Codeine is an opioid, and taken regularly it causes physical dependence — often in people who never thought of themselves as using anything addictive, because it came from a pharmacy shelf rather than a dealer.
When a headache is not just a headache
Most headaches are harmless. A small number are not, and the difference is usually in how the headache behaves rather than how much it hurts.
Common questions
- Can I take paracetamol and ibuprofen together?
- They are different classes of medicine and are often used together or alternated for pain that one alone does not control. The safe way to do it is to ask a pharmacist, because the risk is not the combination itself but accidentally doubling up on either ingredient through a combination product.
- Why does my painkiller have caffeine in it?
- Caffeine is added because it can make a dose of painkiller work slightly better, particularly for headaches. It is also why some people find these products keep them awake, and why stopping a daily habit can itself cause a withdrawal headache.
- What is the strongest painkiller I can buy without a prescription?
- In South Africa, low-dose codeine combinations are the strongest available without a prescription, and only in limited pack sizes. Anything stronger is Schedule 5 or 6 and needs a doctor. Stronger is not automatically better — for most everyday pain, an anti-inflammatory taken correctly outperforms a weak opioid.
Sources
- Primary Healthcare Standard Treatment Guidelines and Essential Medicines ListNational Department of Health, South Africa
- Medicines and Related Substances Act — scheduling of codeine-containing medicinesSAHPRA
Last reviewed 4 August 2026.