What over‑the‑counter analgesics and supplements (including vitamins) are recommended for an adult with mild‑to‑moderate osteoarthritis?

Over-the-Counter Recommendations for Osteoarthritis

Start with acetaminophen at regular doses up to 4000 mg daily as your first-line over-the-counter medication for mild-to-moderate osteoarthritis, as it provides effective pain relief with the safest profile compared to all other options. 1, 2, 3

First-Line OTC Analgesic: Acetaminophen

• Acetaminophen is the strongest guideline-recommended initial pharmacologic treatment, endorsed by the American College of Physicians and American Geriatrics Society as the safest option for osteoarthritis pain. 1, 2, 3

• Use regular scheduled dosing rather than "as needed" for chronic osteoarthritis pain, as this provides more consistent and sustained pain control throughout the day. 1, 2

• The maximum daily dose is 4000 mg (4 grams), but strongly consider limiting intake to ≤3000 mg daily in patients over 60 years to reduce hepatotoxicity risk. 1, 2, 3

• Clinical trials demonstrate that acetaminophen at full doses (4000 mg/day) has comparable efficacy to ibuprofen for mild-to-moderate osteoarthritis pain, making it cost-effective and safer than NSAIDs. 4, 5

Second-Line OTC Option: Topical NSAIDs

• If acetaminophen provides insufficient relief after an adequate trial, switch to topical NSAIDs (such as over-the-counter diclofenac gel) before considering oral NSAIDs. 1, 2, 3

• Topical NSAIDs have minimal systemic absorption and markedly lower gastrointestinal, renal, and cardiovascular risk compared to oral NSAIDs, making them substantially safer for long-term use. 1, 2

• Apply diclofenac sodium topical solution to clean, dry skin using 2 pump actuations (40 mg) on each painful joint, 2 times daily. 6

• Wash hands completely after application and avoid showering/bathing for at least 30 minutes after application to ensure adequate absorption. 6

• Wait until the treated area is completely dry before covering with clothing or applying sunscreen, insect repellent, or other topical products. 6

• Evidence shows topical NSAIDs produce statistically significant improvements in pain, stiffness, and function compared with placebo, with ketoprofen gel achieving a 63% response rate versus 48% with placebo. 1

Alternative Topical Agent: Capsaicin

• Topical capsaicin cream is an over-the-counter alternative localized agent that may provide pain relief, though therapeutic benefit typically requires continuous application for 2–4 weeks before meaningful effect is seen. 1, 2

Supplements and Vitamins: NOT Recommended

• Do not use glucosamine or chondroitin products, as current evidence does not demonstrate efficacy for osteoarthritis. This is a strong guideline-level recommendation from the American Academy of Orthopaedic Surgeons. 1, 2, 3

• Major clinical practice guidelines explicitly advise against omega-3 fatty acid supplements (EPA/DHA) as adjunct therapy for osteoarthritis pain, citing absence of robust efficacy data. 1

• The National Institute for Health and Care Excellence (NICE) provides no endorsement for omega-3 supplementation or other vitamin supplements for osteoarthritis pain control. 1

Essential Non-Pharmacologic Treatments (Mandatory Core Therapy)

• Structured exercise programs focusing on local muscle strengthening and general aerobic fitness are essential core therapy that must accompany any medication regimen—these are not optional adjuncts but required treatment. 1, 2, 3

• Weight-loss interventions are advised for patients with BMI ≥25 kg/m², as weight reduction directly lessens joint load and improves pain symptoms. 1, 2, 3

• Patient education is crucial to dispel misconceptions that osteoarthritis is inevitably progressive and untreatable, as this improves adherence and outcomes. 1, 2, 3

• Local heat or cold applications may provide temporary symptom relief and can be used as adjunctive measures. 7

Critical Safety Pitfalls to Avoid

• Never exceed 4000 mg of acetaminophen per day, and strongly consider a lower ceiling of 3000 mg in elderly patients (age ≥60 years) to prevent hepatotoxicity. 1, 2, 3

• Do not apply topical diclofenac to open wounds or allow contact with eyes, nose, or mucous membranes. 6

• Avoid skin-to-skin contact between other people and the treated area until completely dry, as transfer of medication can occur. 6

• Do not apply external heat or occlusive dressings to areas treated with topical NSAIDs. 6

• Protect treated areas from natural and artificial sunlight to prevent photosensitivity reactions. 6

When OTC Options Fail

• If acetaminophen and topical NSAIDs both fail to provide adequate relief, oral NSAIDs become necessary but require prescription-strength dosing and mandatory gastroprotection with a proton-pump inhibitor—this moves beyond over-the-counter management. 1, 2, 3

• Intra-articular corticosteroid injections are indicated for short-term (1–3 weeks) pain relief in moderate-to-severe knee osteoarthritis unresponsive to oral medications. 1, 2