New data published in Pharmacoepidemiology & Drug Safety remind us about the dangers of pain medications—not opioids this time, but over-the-counter drugs like ibuprofen. After acetaminophen, it’s the second-most used drug in the U.S., and the most commonly used nonaspirin NSAID. Many patients are using excessive dosages, however, putting themselves at risk for dose-related side effects (eg, upper gastrointestinal bleeding and acute renal injury) that can be quite severe or even fatal. The P&DS research reflects the medication diaries of 1,326 people, 15% of whom exceed the maximum recommended daily dose for ibuprofen (Motrin, Advil) or other NSAIDs like aspirin, naproxen (Aleve), celecoxib (Celebrex), meloxicam (Mobic), and diclofenac (Voltaren). Traits most common to those patients include male sex, ongoing pain, poor physical function, daily smoking, not starting with the lowest dose, and poor knowledge of the recommended one-time and 24-hour doses. When you see patients who complain of pain, ask about their OTC drug use, including how much they take and how often. Help them do the math to figure out if they’re taking more than is necessary—and more than is safe.