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Top 7 Arthritis Medicine OTC Options for Fast Over-the-Counter Relief

Last Updated on November 18, 2025 by Ugurkan Demir

Top 7 Arthritis Medicine OTC Options for Fast Over-the-Counter Relief
Top 7 Arthritis Medicine OTC Options for Fast Over-the-Counter Relief 2

Living with arthritis can be challenging, and finding the right over-the-counter (OTC) medication is crucial for managing symptoms effectively.

We understand that effective relief is a top priority, and with so many options available, it can be overwhelming to choose the best one.

At Liv Hospital, we guide you through the top choices for arthritis otc meds, ensuring you make informed decisions backed by the latest medical evidence and compassionate support.

Key Takeaways

  • OTC medications play a central role in managing arthritis symptoms.
  • Commonly used options include NSAIDs like ibuprofen and naproxen.
  • Acetaminophen and topical creams are also effective.
  • Understanding the different options is crucial for making informed decisions.
  • Consulting with a healthcare professional can help determine the best treatment plan.

The Impact of Arthritis and Why OTC Relief Matters

A close-up view of various over-the-counter arthritis medication bottles and containers, such as ibuprofen, acetaminophen, and topical creams, arranged neatly on a wooden or marble surface. The lighting is soft and diffused, highlighting the textures and colors of the products. The background is slightly blurred, creating a sense of focus on the medication. The overall mood is one of calm and thoughtfulness, conveying the importance of accessible over-the-counter options for managing the impact of arthritis.

Arthritis is a widespread condition that encompasses over 100 different diseases, each with its unique challenges. It affects millions of people worldwide, causing pain, stiffness, and discomfort that can significantly impact daily life. Understanding the different types of arthritis and their symptoms is crucial for finding effective relief.

Common Types of Arthritis and Their Symptoms

The most common forms of arthritis are osteoarthritis and rheumatoid arthritis. Osteoarthritis is characterized by the breakdown of cartilage in joints, leading to pain and stiffness, particularly in the hands, knees, hips, and spine. Rheumatoid arthritis, on the other hand, is an autoimmune disease that causes inflammation in the joints, resulting in pain, swelling, and potentially severe joint damage over time.

Other forms of arthritis include psoriatic arthritis, which occurs in conjunction with the skin condition psoriasis, and gout, a type of arthritis characterized by sudden, severe attacks of pain, redness, and tenderness in the joints. Each type of arthritis has its unique set of symptoms and challenges, making it essential to understand the specific condition to manage it effectively.

Why People Turn to Over-the-Counter Solutions

Over-the-counter (OTC) medications are often the first line of defense for managing arthritis symptoms. Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen are commonly used to relieve pain and reduce inflammation. OTC relief options are attractive because they are readily accessible and can provide quick relief from arthritis symptoms.

For those who cannot tolerate NSAIDs due to gastrointestinal or cardiovascular risks, acetaminophen is often recommended as an alternative for pain relief. Additionally, topical creams and gels containing ingredients like menthol, capsaicin, or salicylates can provide localized relief without the systemic side effects associated with oral medications.

The choice of OTC medication depends on the type of arthritis, the severity of symptoms, and individual patient factors. By understanding the available options and their mechanisms of action, individuals can make informed decisions about their care.

How Over-the-Counter Arthritis Medications Work

A detailed cross-sectional illustration of the underlying mechanisms of over-the-counter arthritis relief medications. In the foreground, a magnified view of the human joint, showcasing the inflammation reduction and pain relief effects of the active ingredients. In the middle ground, a schematic diagram highlighting the molecular targets and pathways affected by the medications. In the background, a clean, minimalist lab environment with medical equipment, conveying the scientific and pharmaceutical nature of the subject. Bright, natural lighting illuminates the scene, creating a sense of clarity and understanding. The overall tone is educational, informative, and visually compelling, suitable for a medical article on arthritis OTC relief options.

OTC arthritis medications operate through various mechanisms to alleviate pain and inflammation. These medications are designed to provide relief for individuals suffering from arthritis without the need for a prescription.

Pain Relief Mechanisms

One of the primary ways OTC arthritis medications work is by targeting pain relief mechanisms. NSAIDs (Nonsteroidal Anti-Inflammatory Drugs), such as ibuprofen, work by inhibiting the COX-1 and COX-2 enzymes, which are responsible for producing prostaglandins. Prostaglandins are mediators of pain and inflammation. By reducing their production, NSAIDs effectively decrease pain and inflammation.

On the other hand, acetaminophen is believed to work centrally in the brain to reduce pain perception. It is often recommended for individuals who cannot tolerate NSAIDs due to gastrointestinal or cardiovascular risks.

Anti-inflammatory Actions

In addition to pain relief, many OTC arthritis medications also have anti-inflammatory actions. NSAIDs, for example, not only reduce pain but also decrease inflammation by inhibiting the production of prostaglandins.

Topical treatments, such as diclofenac gel, provide localized relief by applying the medication directly to the affected area. These treatments are generally associated with fewer systemic side effects compared to oral medications, although they may cause skin irritation in some individuals.

Medication Type Pain Relief Mechanism Anti-inflammatory Action
NSAIDs (e.g., ibuprofen) Inhibit COX-1 and COX-2 enzymes Reduce prostaglandin production
Acetaminophen Acts centrally in the brain Limited anti-inflammatory effect
Topical NSAIDs (e.g., diclofenac gel) Localized pain relief Localized anti-inflammatory effect

Understanding how different OTC arthritis medications work can help individuals choose the most appropriate option for their specific needs. Whether it’s through pain relief mechanisms or anti-inflammatory actions, these medications provide effective relief for arthritis symptoms.

Popular Arthritis Medicine OTC Categories Available Today

The world of OTC arthritis medications is diverse, offering both oral and topical treatment options. When managing arthritis, understanding these categories can help individuals make informed decisions about their care.

Oral Medications

Oral medications are a common choice for arthritis relief. They include NSAIDs (Nonsteroidal Anti-Inflammatory Drugs) like ibuprofen and naproxen, as well as acetaminophen. These medications work systemically to reduce pain and inflammation.

Recent studies have shown that oral NSAIDs are effective for many patients, but they can have gastrointestinal side effects in some cases. Acetaminophen, on the other hand, is generally easier on the stomach but may not be as effective for inflammation.

Oral Medication Primary Use Common Side Effects
Ibuprofen (Advil, Motrin) Pain relief, inflammation reduction Gastrointestinal issues, dizziness
Naproxen (Aleve) Pain relief, inflammation reduction Gastrointestinal issues, headache
Acetaminophen (Tylenol) Pain relief Liver damage (with excessive use)

Topical Treatments

Topical treatments offer a localized approach to arthritis pain management. They come in various forms, including creams, gels, and patches, and contain ingredients like menthol, capsaicin, or salicylates. Topical treatments can provide relief without the systemic side effects associated with oral medications.

Recent trends show increased patient preference for topical gels like diclofenac, which are now widely available OTC. Diclofenac gel is a topical NSAID that has gained popularity for its targeted relief and reduced systemic side effects compared to oral NSAIDs.

Topical Treatment Active Ingredient Primary Use
Diclofenac Gel (Voltaren) Diclofenac Pain relief, inflammation reduction
Capsaicin Cream (Capzasin) Capsaicin Pain relief
Menthol-Based Topicals (Biofreeze) Menthol Cooling relief, pain management

Both oral and topical treatments have their place in managing arthritis. By understanding the different categories and their respective benefits, individuals can make more informed decisions about their treatment.

Ibuprofen (Advil, Motrin): The Most Common NSAID for Arthritis

When it comes to OTC arthritis medicine, ibuprofen stands out as a commonly used NSAID, effective in reducing pain and inflammation. We will explore its benefits, potential side effects, and proper usage guidelines to help you make informed decisions about your arthritis management.

Overview

Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that is widely used to relieve pain, reduce inflammation, and lower fever. It is available under various brand names, including Advil and Motrin. As an OTC medication, ibuprofen is easily accessible for managing arthritis symptoms.

Pros

One of the primary advantages of ibuprofen is its effectiveness in reducing both pain and inflammation associated with arthritis. It is also relatively fast-acting, providing quick relief for many users. Additionally, ibuprofen is available in various formulations, including tablets, capsules, and liquids, making it convenient for different patient needs.

Cons

While ibuprofen is generally well-tolerated, it can cause gastrointestinal side effects, especially with long-term use. These may include stomach upset, nausea, and in more severe cases, ulcers or bleeding. It’s crucial to follow the recommended dosage and consult with a healthcare provider if you have a history of gastrointestinal issues. 

Features and Dosage Guidelines

The typical dosage of ibuprofen for adults is 200-400 mg every 4-6 hours, not exceeding 1200 mg per day for OTC use. It’s essential to read and follow the label instructions or consult with a healthcare professional for personalized advice. We emphasize using the lowest effective dose for the shortest duration necessary to minimize potential side effects.

By understanding the benefits and potential drawbacks of ibuprofen, you can make informed decisions about using this medication as part of your arthritis management strategy. Always consult with a healthcare provider if you have concerns or questions about your treatment.

Naproxen Sodium (Aleve): Longer-Lasting NSAID Relief

When it comes to managing arthritis pain, Naproxen Sodium (Aleve) stands out as an NSAID that offers longer-lasting relief compared to some other options. We examine its benefits, potential risks, and appropriate dosage guidelines to help you make informed decisions about your arthritis management.

Overview

Naproxen Sodium is an over-the-counter NSAID that is widely used for its anti-inflammatory and pain-relieving properties. It is particularly known for its longer half-life, which allows for less frequent dosing compared to other NSAIDs like ibuprofen.

Pros

The primary advantage of Naproxen Sodium is its prolonged action, providing relief for up to 12 hours. This makes it a convenient option for individuals with arthritis who need consistent pain management throughout the day.

  • Longer-Lasting Relief: Provides pain relief for up to 12 hours.
  • Effective for Various Arthritis Types: Useful for managing pain associated with osteoarthritis, rheumatoid arthritis, and other inflammatory conditions.
  • Anti-inflammatory Properties: Helps reduce inflammation, which is a key component of arthritis pain.

Cons

While Naproxen Sodium offers several benefits, it’s crucial to be aware of its potential side effects and risks.

  • Increased Cardiovascular Risk: Long-term use may be associated with a higher risk of cardiovascular events.
  • Gastrointestinal Side Effects: Can cause stomach upset, nausea, and potentially serious gastrointestinal complications.
  • Interaction with Other Medications: May interact with other medications, including blood thinners and certain antidepressants.

Features and Dosage Guidelines

Naproxen Sodium is available in various formulations, including tablets and caplets. The typical dosage for adults is one 220mg tablet every 8 to 12 hours as needed, not exceeding two tablets in 12 hours unless directed by a healthcare provider.

Dosage Form Recommended Dose Maximum Daily Dose
220mg Tablet 1 tablet every 8-12 hours 2 tablets (440mg) in 12 hours

It’s essential to follow the recommended dosage and consult with a healthcare professional before starting Naproxen Sodium, especially if you have pre-existing medical conditions or are taking other medications.

Acetaminophen (Tylenol): When NSAIDs Aren’t an Option

When NSAIDs are not suitable, acetaminophen provides an effective over-the-counter solution for arthritis relief. Acetaminophen is widely recognized for its pain-relieving properties and is often recommended for individuals who cannot tolerate NSAIDs.

Overview

Acetaminophen, commonly known by the brand name Tylenol, is a widely used over-the-counter pain reliever. It is primarily used for pain relief and is considered safer for individuals who cannot tolerate NSAIDs. Unlike NSAIDs, acetaminophen does not have anti-inflammatory properties, but it is effective in reducing fever and alleviating pain.

Pros

One of the significant advantages of acetaminophen is that it is less likely to cause gastrointestinal side effects compared to NSAIDs. This makes it a preferable option for individuals with a history of stomach ulcers or those who are at risk of gastrointestinal complications. Additionally, acetaminophen is generally well-tolerated when used as directed.

Cons

However, acetaminophen can cause liver damage if taken in overdose or with prolonged use. It is crucial to follow the recommended dosage guidelines to minimize the risk of liver toxicity. Patients with liver disease should consult their healthcare provider before taking acetaminophen.

Features and Dosage Guidelines

The typical dosage of acetaminophen for adults is 325-1000 mg every 4-6 hours, not to exceed 4000 mg in 24 hours. It is available in various forms, including tablets, capsules, and liquid suspensions. When using acetaminophen, it is essential to read and follow the label instructions carefully to avoid accidental overdose.

Key Considerations:

  • Always follow the recommended dosage to avoid liver damage.
  • Consult a healthcare provider if you have liver disease.
  • Be aware of other medications that may contain acetaminophen to avoid accidental overdose.

Diclofenac Gel (Voltaren): Targeted Topical NSAID Relief

Diclofenac gel, known by its brand name Voltaren, offers a localized approach to managing arthritis symptoms. As a topical NSAID, it provides targeted relief with reduced systemic absorption compared to oral NSAIDs. We will explore its benefits, potential side effects, and proper application guidelines.

Overview

Diclofenac gel is a topical formulation of the NSAID diclofenac, applied directly to the skin over the affected joint. This method of delivery allows for localized treatment, potentially reducing the systemic side effects associated with oral NSAIDs. Topical treatments like diclofenac gel are particularly useful for patients who cannot tolerate oral NSAIDs or have specific areas of pain that need targeting.

Pros

The benefits of using diclofenac gel include:

  • Localized Relief: Direct application to the affected area allows for targeted pain relief.
  • Reduced Systemic Side Effects: Lower systemic absorption compared to oral NSAIDs may result in fewer gastrointestinal and cardiovascular side effects.
  • Easy to Apply: The gel formulation is straightforward to apply, making it a convenient option for patients.

Cons

While diclofenac gel offers several benefits, there are also some drawbacks to consider:

  • Skin Reactions: Some patients may experience local skin reactions, such as redness, itching, or dryness.
  • Limited Penetration: The effectiveness of diclofenac gel can depend on its ability to penetrate the skin, which may vary among individuals.
  • Cost: Topical NSAIDs like diclofenac gel can be more expensive than their oral counterparts.

Features and Application Guidelines

To maximize the effectiveness of diclofenac gel, follow these application guidelines:

  1. Apply a thin layer of gel to the affected area, typically 2-4 grams, 4 times a day.
  2. Gently rub the gel into the skin until it is fully absorbed.
  3. Wash your hands after application, unless the hands are the treated area.

By following these guidelines and understanding the benefits and potential drawbacks, patients can effectively use diclofenac gel as part of their arthritis management strategy.

Capsaicin Creams (Zostrix, Capzasin): Natural Heat Therapy

The active ingredient in chili peppers, capsaicin, is harnessed in topical creams to provide a natural heat therapy for arthritis sufferers. Capsaicin creams, available under brand names like Zostrix and Capzasin, work by depleting substance P, a neurotransmitter that transmits pain signals to the brain.

Overview

Capsaicin creams are a popular over-the-counter (OTC) treatment for arthritis pain relief. They are derived from chili peppers and contain capsaicin, which is responsible for the “hot” sensation. When applied topically, these creams produce a warming sensation that helps to alleviate pain.

Pros

The benefits of using capsaicin creams include:

  • Natural Pain Relief: Capsaicin creams offer a natural alternative to oral medications for managing arthritis pain.
  • Targeted Relief: They can be applied directly to the affected area, providing localized pain relief.
  • Non-Systemic: Topical application means that the active ingredient is not distributed systemically, potentially reducing side effects.

Cons

While capsaicin creams are beneficial, there are some drawbacks to consider:

  • Initial Burning Sensation: Upon application, capsaicin creams can cause a burning sensation, which may be uncomfortable for some users.
  • Skin Irritation: Some individuals, especially those with sensitive skin, may experience skin irritation or redness.
  • Variable Efficacy: The effectiveness of capsaicin creams can vary from person to person.

Features and Application Guidelines

When using capsaicin creams, it’s essential to follow the application guidelines for optimal results:

Brand Concentration of Capsaicin Application Frequency
Zostrix 0.025% 3-4 times daily
Capzasin 0.025% 3-4 times daily

To apply, gently rub a small amount onto the affected area until absorbed. It’s recommended to wash hands after application to avoid accidental exposure to eyes or other sensitive areas.

We recommend consulting with a healthcare professional before starting any new treatment, including capsaicin creams, to ensure they are suitable for your specific condition and needs.

Menthol-Based Topicals (Biofreeze, Icy Hot): Cooling Relief

For those seeking immediate relief from arthritis pain, menthol-based topicals like Biofreeze and Icy Hot offer a cooling sensation that can be a game-changer. These products are applied directly to the skin, providing a temporary but effective solution for managing arthritis discomfort.

Overview

Menthol-based topicals work by stimulating cold receptors in the skin, which helps to reduce the perception of pain. This mechanism provides a dual benefit: it not only numbs the area but also distracts from the pain, offering relief to arthritis sufferers.

Pros

The advantages of using menthol-based topicals for arthritis relief are several. Firstly, they are easy to apply and provide quick relief. Secondly, they are available over the counter, making them accessible without the need for a prescription. Lastly, they can be used in conjunction with other treatments, offering a complementary approach to pain management.

Key Benefits:

  • Fast and effective pain relief
  • Easy to apply
  • Available over the counter
  • Can be used with other treatments

Cons

While menthol-based topicals are generally safe, there are some potential drawbacks to consider. Some users may experience skin irritation or allergic reactions to the ingredients. Additionally, the relief provided is temporary, requiring repeated application as needed.

Features and Application Guidelines

When using menthol-based topicals, it’s essential to follow the manufacturer’s instructions for application. Typically, a small amount is applied to the affected area and gently massaged in until absorbed. The frequency of application can vary depending on the product and the severity of symptoms.

Product Key Ingredients Application Frequency
Biofreeze Menthol Up to 4 times daily
Icy Hot Menthol, Methyl Salicylate Up to 3-4 times daily

By understanding how menthol-based topicals work and how to use them effectively, individuals with arthritis can find an additional tool in their pain management arsenal. As with any treatment, it’s crucial to be aware of the potential side effects and to consult with a healthcare professional if concerns arise.

Salicylate Creams (Aspercreme, Bengay): Traditional Topical Relief

Salicylate creams, such as Aspercreme and Bengay, offer a traditional approach to topical relief for arthritis sufferers. These creams contain ingredients related to aspirin and are applied directly to the skin, providing localized pain relief.

Overview

Salicylate creams are a type of over-the-counter (OTC) medication used for arthritis pain management. They work by being absorbed through the skin, delivering the active ingredient directly to the affected area.

Pros

One of the main advantages of salicylate creams is their targeted action. By applying the cream directly to the painful area, patients can experience localized relief without the systemic side effects associated with oral medications.

  • Localized Relief: Direct application to the painful area.
  • Reduced Systemic Side Effects: Minimizes the risk of stomach upset and other systemic issues.
  • Easy to Use: Simple application process.

Cons

While salicylate creams are generally well-tolerated, there are some potential drawbacks to consider.

  • Skin Irritation: Some users may experience redness, itching, or irritation at the application site.
  • Variable Absorption: The effectiveness can vary based on skin type and the severity of the condition.

Features and Application Guidelines

When using salicylate creams, it’s essential to follow the application guidelines for optimal results.

  1. Clean the Affected Area: Wash and dry the area before application.
  2. Apply a Thin Layer: Gently rub the cream into the skin until absorbed.
  3. Frequency of Use: Follow the product’s instructions for how often to reapply.

As with any medication, consulting a healthcare professional before starting salicylate creams is advisable, especially for those with sensitive skin or allergies.

Safety Considerations and Best Practices for OTC Arthritis Medications

While OTC arthritis medicines are generally safe when used as directed, there are important safety considerations to keep in mind. We will discuss potential drug interactions, when to consult a doctor, and concerns related to long-term usage.

Drug Interactions to Watch For

OTC arthritis medications can interact with other drugs, including prescription medications, over-the-counter medicines, and certain foods. For instance, NSAIDs like ibuprofen can interact with blood thinners, increasing the risk of bleeding. It’s essential to inform your healthcare provider about all the medications you’re taking.

Some common interactions to be aware of include:

  • NSAIDs with blood thinners or other NSAIDs, which can increase the risk of bleeding and stomach ulcers.
  • Acetaminophen with alcohol or certain medications, which can lead to liver damage.

When to Consult a Doctor

If you’re considering using OTC arthritis medications, it’s crucial to know when to seek medical advice. Consult a doctor if you experience any of the following:

  • Severe side effects, such as stomach pain, allergic reactions, or difficulty breathing.
  • No improvement in symptoms after following the recommended dosage.
  • You’re taking other medications that could interact with your OTC arthritis medicine.

dLong-Term Usage Concerns

Using OTC arthritis medications long-term can lead to potential health risks. NSAIDs, for example, can cause stomach ulcers and kidney damage with prolonged use. Acetaminophen can lead to liver damage if taken in high doses or combined with alcohol.

Medication Type Potential Long-Term Risks Precautions
NSAIDs Stomach ulcers, kidney damage Use the lowest effective dose for the shortest duration necessary.
Acetaminophen Liver damage Avoid exceeding the maximum daily dose and consuming alcohol.
Topical Treatments Skin irritation, allergic reactions Follow application guidelines and monitor for side effects.

To minimize risks, always follow the recommended dosages and consult your healthcare provider if you have any concerns. By being informed and cautious, you can safely use OTC arthritis medications to manage your symptoms effectively.

Conclusion: Choosing the Right OTC Arthritis Relief Strategy

By understanding the different over-the-counter (OTC) arthritis medication options, individuals can make informed decisions about their treatment plans. We have explored various OTC arthritis meds, including oral medications like ibuprofen and naproxen sodium, as well as topical treatments like diclofenac gel and capsaicin creams.

When choosing an OTC arthritis relief strategy, it is essential to consider individual health needs, potential side effects, and interactions with other medications. For instance, individuals with certain medical conditions may need to avoid specific NSAIDs or opt for acetaminophen instead.

The best otc medicine for arthritis will vary depending on the type of arthritis, the severity of symptoms, and individual tolerance to different medications. We recommend consulting with a healthcare professional to determine the most suitable OTC arthritis relief option.

By considering these factors and understanding the various OTC arthritis relief options available, individuals can effectively manage their arthritis symptoms and improve their quality of life. We hope this information helps individuals make informed decisions about their care and find the most effective otc arthritis relief.

FAQ

 

 

What are the most common over-the-counter (OTC) medications used to treat arthritis?

The most common OTC medications used to treat arthritis include NSAIDs like ibuprofen (Advil, Motrin) and naproxen sodium (Aleve), as well as acetaminophen (Tylenol). Topical treatments like diclofenac gel (Voltaren), capsaicin creams (Zostrix, Capzasin), menthol-based topicals (Biofreeze, Icy Hot), and salicylate creams (Aspercreme, Bengay) are also popular.

How do NSAIDs work to relieve arthritis pain?

NSAIDs work by inhibiting enzymes called COX-1 and COX-2, reducing the production of prostaglandins, which are mediators of pain and inflammation.

What is the difference between ibuprofen and naproxen sodium?

Ibuprofen and naproxen sodium are both NSAIDs, but naproxen sodium offers longer-lasting pain relief. Ibuprofen is typically taken every 4-6 hours, while naproxen sodium is taken every 8-12 hours.

Can I use acetaminophen if I’m taking NSAIDs?

It’s generally not recommended to take acetaminophen and NSAIDs together without consulting a doctor, as this can increase the risk of side effects like stomach ulcers or liver damage.

Are topical treatments effective for arthritis pain relief?

Yes, topical treatments like diclofenac gel, capsaicin creams, menthol-based topicals, and salicylate creams can be effective for arthritis pain relief. They work by being applied directly to the skin over the affected joint.

What are the potential side effects of OTC arthritis medications?

Potential side effects of OTC arthritis medications include stomach ulcers, liver damage, and kidney damage. Topical treatments can cause skin irritation or allergic reactions.

Can I take OTC arthritis medications long-term?

Long-term use of OTC arthritis medications should be done under the guidance of a doctor, as it can increase the risk of side effects. It’s essential to follow the recommended dosage and to monitor your health for any adverse effects.

Are there any drug interactions I should be aware of when taking OTC arthritis medications?

Yes, OTC arthritis medications can interact with other medications, such as blood thinners, diabetes medications, and certain antidepressants. It’s crucial to consult with a doctor or pharmacist before taking any new medication.

When should I consult a doctor about my arthritis treatment?

You should consult a doctor if your arthritis symptoms worsen, if you experience side effects from your medication, or if you’re unsure about the best treatment option for your condition.

Can I use OTC arthritis medications in combination with other treatments?

Yes, OTC arthritis medications can be used in combination with other treatments, such as physical therapy, lifestyle changes, or alternative therapies. However, it’s essential to consult with a doctor to ensure that the combination is safe and effective.

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