Should I Take a Pain Reliever Before or During a Marathon?

Marathon Runners
Marathon Runners. Cameron Spencer/Getty Imagrd nred

Question: Should I Take a Pain Reliever Before or During a Marathon?

Marathon runners and walkers often want to take pain relievers before or during a marathon. Which are the safest to take?

It is Best to Avoid Pain Relievers Before and During the Marathon

Unfortunately, pain relievers can cause problems during the marathon. A study of almost 4000 marathon runners found more five times more adverse effects during the race among those who took over-the-counter pain relievers before the race.

The most common problem was gastrointestinal upset. The expert physician panel at the 2005 Marathon Directors College advised to avoid pain relievers before and during a marathon.

Marathon Problems with NSAIDS

The most common over-the-counter non-steroidal anti-inflammatory medications are ibuprofen (Advil) and naproxyn sodium (Aleve). They have two effects: pain relief and prevention of inflammation. They can cause nausea and they decrease kidney perfusion. In the marathon study, five racers who took ibuprofen reported they were hospitalized with temporary kidney failure.

If you plan to use these drugs before or during the marathon, you should be using them on your longest training runs or walks to see if can tolerate them and whether they have ill effects on you.

Marathon Problems with Acetaminophen (Tylenol)

Acetaminophen has two effects: pain relief and fever reduction.

It can be toxic to the liver when you are overheated and at oxidative stress, as when running or walking a marathon. Some people get nausea from acetaminophen.

Marathon Problems with Aspirin

Aspirin has two effects: pain relief and fever reduction. It also inhibits the ability of the blood to clot effectively in most people.

This can result in in bleeding more if you have an injury, and experts suspect you have more micro-bleeding and burst capillaries from the 26.2 miles of pounding your feet and legs take during a marathon. Many people experience nausea and even gastric bleeding from aspirin. In the large marathon study, four racers who took aspirin reported being hospitalized with bleeds and two with cardiac infarctions.


While presented with humor, the Marathon Directors' College medical panel noted that beer provided hydration, carbohydrates, salts, and pain relief when taken during the marathon. In fact, it was prescribed by one physician as a quick remedy for muscle cramps. Personally, I can attest to the amazing restorative qualities of Belgian beer in the final mile of the Blankenberge Two-Days Walk. Portland Marathon Race Director Les Smith experimented with beer as his sole hydration during a marathon and the results were "When I finished, I was looped." It was noted that beer decreases athletic performance, "It was a slow marathon."

Bottom Line: Try Nothing New on Race Day

It is best to avoid pain relievers before or during the marathon. Use your long training days to experiment with how you feel running or walking without any pain relief, and what effects you have if you resort to using pain relievers.

As always, Try Nothing New on Race Day.


Marathon Directors' College. Meeting hall, Portland, OR. 06 OCT 2005.

Küster M, Renner B, Oppel P, Niederweis U, Brune K. "Consumption of analgesics before a marathon and the incidence of cardiovascular, gastrointestinal and renal problems: a cohort study." BMJ Open. 2013 Apr 19;3(4). pii: e002090. doi: 10.1136/bmjopen-2012-002090. Print 2013.

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