What is the best over-the-counter medication for osteoarthritis in the knees?

Acetaminophen (Tylenol, Panadol). Generally, the first medication recommended for osteoarthritis treatment is acetaminophen. It relieves pain but does not reduce inflammation in the body. Acetaminophen is relatively safe, though taking more than the recommended dosage can damage your liver, according to the Food and Drug Administration (FDA). If you take acetaminophen regularly, you should also take care to avoid consuming more than two alcoholic drinks a day because the combination of acetaminophen and alcohol can increase your risk for liver damage.

Nonsteroidal anti-inflammatory drugs (NSAIDs). For people who don’t respond to acetaminophen, an NSAID is often prescribed at the lowest effective dose. Common over-the-counter NSAIDs include Advil and Motrin (ibuprofen) and Aleve (naproxen). NSAIDs relieve pain and reduce inflammation, but they can trigger more side effects than acetaminophen. NSAIDs may lead to stomach upset and, with prolonged use, stomach bleeding and kidney damage may occur, warns the FDA. In addition, NSAIDs other than aspirin can increase the risk for heart attack and stroke.

Cyclooxygenase-2 inhibitors. COX-2 inhibitors like Celebrex are prescription-strength NSAIDs that have been designed to produce less stomach irritation. If you experience stomach irritation with other NSAIDs, acetaminophen doesn’t do enough to relieve your pain, and you have a low risk for heart disease, this may be your best option, according to recommendations published in BMC Medicine by the International NSAID Consensus Group in March 2015. However, although COX-2 inhibitors may lead to less stomach upset, they have the same risk of kidney damage. These medications must now carry the same warning of increased risk for heart attack and stroke as over-the-counter NSAIDs, according to the FDA. COX-2 inhibitors should be taken only at the lowest dose needed to relieve your pain.