OTC pain relief in Morocco: Doliprane, Ponstyl, Aspirin (2026)

01Understanding the WHO three-step analgesic ladder#

Pain management in Morocco follows the three-step classification defined by the World Health Organisation in 1986. Step 1 groups the non-opioid analgesics: paracetamol, aspirin and NSAIDs such as ibuprofen or mefenamic acid, sold under the trade name Ponstyl. Step 2 covers the weak opioids, principally tramadol alone or combined with paracetamol, and codeine. Step 3 brings together the strong opioids such as morphine.

A step 1 analgesic used carelessly is far from innocuous. Paracetamol at an excessive dose causes potentially fatal liver injury, and an NSAID taken a few days too long can trigger a haemorrhagic gastric ulcer.

The community pharmacist, the first link in the Moroccan care pathway with more than 14,000 pharmacies (14,134 registered in 2024 by the Competition Council), plays an advisory role explicitly recognised by Law 17-04. For details on each branded product, the Sahha medicines catalogue lists every drug registered for sale in Morocco.

02Paracetamol: Doliprane, Efferalgan and their equivalents#

Paracetamol remains the most consumed analgesic in Morocco. It is marketed as Doliprane, Efferalgan (UPSA), Panadol (GSK) or as local generics produced by Cooper Pharma, Sothema and Pharma 5.

The standard dose for a normal-weight adult (50 to 80 kg) is 1 gram every 6 to 8 hours, with a minimum 4-hour interval between doses and a maximum of 3 grams per 24 hours in self-medication. The official maximum can reach 4 grams per day in adults above 50 kg without risk factors, but only under medical supervision.

In children, the dose is 15 mg/kg every 4 to 6 hours, not exceeding 60 mg/kg per day. For an infant weighing 12 kg, a single dose corresponds to 180 mg.

Oral onset of action lies around 30 to 45 minutes. The effervescent form is useful in migraine or acute pain crises (20 minutes).

On the interaction side, in patients on oral vitamin K antagonist anticoagulants (VKA), prolonged paracetamol use above 2 g/day for more than a few days can potentiate the anticoagulant effect and raise the INR.

03Mefenamic acid (Ponstyl): the reference for painful periods#

Mefenamic acid, marketed as Ponstyl 500 mg, occupies a special place. Although classed among the NSAIDs, it carries a validated indication: primary dysmenorrhoea.

The validated dose for dysmenorrhoea is 500 mg every 8 hours (up to 1,500 mg/day), ideally started the evening before or on the morning of the first cramps and continued for only 2 to 3 days.

Its contraindications overlap with those of the NSAID class: peptic ulcer, severe renal or hepatic impairment, third trimester of pregnancy formally forbidden (absolute contraindication from 24 weeks), a history of aspirin- or NSAID-induced asthma (Widal's syndrome), and children under 12 in self-medication.

Critical interactions: lithium (raised lithium levels), methotrexate at antineoplastic doses, and oral anticoagulants.

04Aspirin: between historical analgesic and antiplatelet agent#

Aspirin (Aspégic, Aspirine UPSA, Catalgine, Kardégic) has been progressively displaced by paracetamol and ibuprofen, and is now used mainly as an antiplatelet agent at low dose (75 to 100 mg/day).

The practical recommendation in Morocco, aligned with the ANSM, the WHO and the FDA: aspirin should not be used first line in any febrile child, and is formally contraindicated under the age of 16 in a viral context (Reye's syndrome).

Aspégic 1000 mg: box of 20 sachets at around 30 to 35 dirhams. Kardégic 100 mg: 25 to 35 dirhams per month of treatment.

05Practical dosing: adult, child, pregnancy#

Healthy adult above 50 kg: paracetamol 1 g every 6-8 hours, maximum 3 g/day in self-medication. Ibuprofen: 200-400 mg per dose every 6-8 hours, maximum 1,200 mg/day in self-medication. Ponstyl: 500 mg three times daily, maximum 7 days.

Children: weight-based dosing. Paracetamol 15 mg/kg per dose. Paediatric ibuprofen is authorised from 3 months of age and a minimum 5 kg body weight, 7.5-10 mg/kg per dose every 6-8 hours. Mefenamic acid is not recommended before age 12. Aspirin must be entirely avoided in febrile children.

Pregnancy: paracetamol is the only authorised analgesic in self-medication, at all stages. Since 2017-2020, NSAIDs — including analgesic aspirin, ibuprofen and mefenamic acid — are discouraged throughout pregnancy and formally contraindicated from 24 weeks of amenorrhoea.

06Liver risk: why paracetamol is not innocuous#

At therapeutic doses, paracetamol is metabolised by glucuronidation up to 95%. When the dose exceeds 150 mg/kg in a single intake or about 7.5 g in adults, the conjugation pathways are saturated and the toxic metabolite NAPQI binds to hepatocyte proteins, causing centrilobular necrosis that can be fatal.

The patient may feel well for up to 24-36 hours after the overdose. The antidote, N-acetylcysteine (NAC), should ideally be given within the first 8 hours, but remains useful up to 24 hours. The Moroccan Poison Control and Pharmacovigilance Centre (CAPM) is available on the free hotline 0801 000 180.

07NSAID ulcer and renal risk#

NSAIDs cause: dyspepsia in 10-20%, peptic ulcer in 1-4% and upper gastrointestinal bleeding in 0.5-1.5%. The risk is multiplied 4-5 fold in patients over 65, and 10-fold in those with a history of ulcer.

Prevention: intake with meals, the shortest possible duration, co-prescription of a PPI in every at-risk patient.

Renal risk: the triple combination of ACE inhibitor + diuretic + NSAID (triple whammy) is one of the leading causes of drug-induced acute kidney injury. Critical interactions: NSAIDs + lithium and NSAIDs + methotrexate.

08Prices and reimbursement in Morocco#

A box of Doliprane 1 g (8 tablets) costs around 12 to 18 dirhams, the generic equivalent 8 to 12 dirhams. Ponstyl 500 mg (10 capsules) is around 25 to 35 dirhams. Aspégic 1000 (20 sachets) costs 30 to 35 dirhams. Ibuprofen 400 mg ranges between 20 and 30 dirhams for a box of 20.

Reimbursement by AMO (CNSS for the private sector, CNOPS for civil servants) covers analgesics only on medical prescription. The reimbursement rate ranges from 70 to 80% of the National Reference Tariff (TNR).

09Tramadol and codeine in Morocco: step 2 under strict control#

Tramadol (Topalgic, Contramal, Zaldiar combined with paracetamol) has been classified as a Schedule I controlled-dispensation drug in Morocco since the 2017 ministerial order, after observation of growing misuse. Dispensation requires a medical prescription dated within the past 28 days and pharmacy register traceability. The usual adult dose is 50 to 100 mg every 4 to 6 hours, not exceeding 400 mg per day. Plasma peak occurs at 1-2 hours for the immediate-release form, 4-12 hours for the sustained-release form.

Tramadol carries a real risk of severe hypoglycaemia in diabetic patients on oral antidiabetic drugs, convulsions in epileptics or when combined with SSRIs, SNRIs, bupropion and tricyclics (serotonin syndrome). It is formally contraindicated in children under 12 (FDA 2017, ANSM 2018) and discouraged in pregnancy during the first and third trimesters. Daytime drowsiness and fall risk in the elderly justify a reduced starting dose of 25-50 mg in 2-3 daily intakes.

Codeine, metabolised to morphine via CYP2D6, is no longer dispensed alone in France since 2017 but remains accessible in Morocco in combination products (Codoliprane, Klipal codéine, Néo-codion syrup). It is contraindicated in children under 12 and strongly discouraged in 12-18 year-olds with obstructive sleep apnoea or morbid obesity, due to CYP2D6 polymorphism (ultra-rapid metabolisers face a risk of fatal respiratory depression, FDA/EMA reports).

10Paracetamol versus ibuprofen: how to decide for each situation#

The question arises at every consultation: should we favour paracetamol or an NSAID? The practical hierarchy validated by HAS, the WHO and the French Society of Paediatrics rests on three criteria: the nature of the pain, the patient's background, and the duration of evolution. For isolated fever in children, the WHO and the Moroccan Society of Paediatrics recommend paracetamol first line as monotherapy, with paracetamol-ibuprofen alternation providing no proven benefit and exposing families to dosing errors.

In inflammatory joint pain (acute osteoarthritis flare, tendinopathy, acute low back pain), ibuprofen or a stronger NSAID takes the lead through its anti-inflammatory action; paracetamol alone proves disappointing in clinical trials (Cochrane 2015, BMJ 2015 low back pain meta-analysis). Conversely, in post-vaccination pain, mild dental pain, viral ENT pain and tension headache, paracetamol covers the majority of cases without exposing the patient to NSAID gastric and renal risks.

The patient background modulates the decision: patients over 75, hypertensives on ACE inhibitors or ARBs, those with heart failure, prior ulcer, known aspirin- or NSAID-sensitive asthma, or pregnant women beyond 24 weeks of amenorrhoea — all of these warrant paracetamol monotherapy and a medical opinion before any NSAID introduction. Conversely, in a young patient without comorbidities and with disabling menstrual pain or a migraine attack, a short NSAID course (maximum 3 days) remains the most efficient option.

11Migraine, dysmenorrhoea, dental pain: dedicated strategies#

In Morocco, the acute migraine attack benefits first line from aspirin 1,000 mg (Aspégic) or ibuprofen 600 to 800 mg as a single dose taken as early as possible, ideally within 30 minutes after prodrome onset (Moroccan Society of Neurology). If recurrence or resistance occurs, a triptan (sumatriptan 50-100 mg, zolmitriptan 2.5-5 mg) on prescription becomes necessary. The key rule: no more than 8 days of analgesic use per month to avoid medication-overuse headache, a major plague of Moroccan neurology consultations.

For primary dysmenorrhoea, Ponstyl 500 mg three times daily started the evening before or the morning of the period and continued for 2-3 days maximum covers 70-80% of patients (HAS 2019, Cochrane 2015). Alternative: ibuprofen 400 mg every 6 hours, or naproxen 500 mg twice daily. In case of recurrent failure (4 consecutive cycles), endometriosis must be investigated by pelvic ultrasound and MRI; its prevalence reaches 10% of women of reproductive age in Morocco according to CHU Ibn Sina series.

Acute dental pain (complicated caries, pulpitis, pericoronitis) responds better to an NSAID than to paracetamol: ibuprofen 400 mg or Ponstyl 500 mg, combined with paracetamol 1 g if insufficient. Dental consultation remains non-negotiable within 48 hours: no analgesic treats the infectious cause, and drug wandering exposes the patient to cervico-facial cellulitis (15 daily hospitalisations in Moroccan teaching hospitals in 2024 according to Ministry data).

12Pregnancy, breastfeeding, frail elderly#

Pregnancy: paracetamol remains the only step 1 analgesic usable at any stage, at the lowest effective dose for the shortest possible duration (CRAT, ANSM 2021 after neurodevelopmental re-evaluation). Recent data (a Nature Reviews Endocrinology 2021 meta-analysis) suggests an association — no causality proven — between prolonged paracetamol and attention disorders in children. Reasonable conduct: do not exceed 3 g/day, and limit treatment to 5-7 consecutive days.

NSAIDs are formally contraindicated from 24 weeks of amenorrhoea because of the risk of premature closure of the foetal ductus arteriosus and oligohydramnios from foetal renal toxicity documented since the ANSM 2017 alert echoed by the FDA in 2020. Before 24 weeks, NSAIDs are discouraged except for a major indication validated by an obstetrician. Analgesic-dose aspirin is also contraindicated from 24 weeks; at low dose 75-150 mg/day, however, it is prescribed for pre-eclampsia prevention in at-risk women, started before 16 weeks and continued until 36 weeks (HAS, ACOG 2018, NICE 2019).

Breastfeeding: paracetamol and ibuprofen are compatible (milk transfer below 1% of the maternal dose, CRAT). Aspirin is discouraged due to the risk of Reye's syndrome and platelet toxicity in the infant. Codeine is strictly contraindicated in breastfeeding mothers (fatal cases reported by FDA/Health Canada).

Patients over 75: paracetamol is by far the best tolerated, at a dose adapted to weight and hepatic function. NSAIDs carry a relative risk of 4-5 for serious gastrointestinal complications and 2-3 for acute kidney injury, especially when combined with ACE inhibitors or diuretics (triple whammy). Moroccan geriatric guidelines (Moroccan Society of Geriatrics 2022) recommend cautious introduction, short duration, with systematic PPI gastroprotection in any elderly patient on NSAIDs for more than 5 days.

13When to consult a doctor#

Self-medication, when correctly practised, covers the majority of everyday minor pains. Pain that persists beyond 5 days must lead to a medical opinion. Warning signs: fever above 39 °C resisting 48 hours of paracetamol, neck stiffness with photophobia, altered consciousness, chest pain radiating to the left arm, abdominal pain with absence of stools and gas, jaundice, dark urine (suspicion of paracetamol-induced hepatitis or otherwise), unexplained skin purpura, haematemesis or melaena on NSAIDs.

In pregnancy, any abdominal pain, uterine contraction or intense headache with visual disturbance must lead to obstetric emergencies without prior self-medication. In infants, any fever lasting more than 48 hours, any refusal to feed, any hypotonia, any purpuric rash demands immediate paediatric consultation — analgesic self-medication alone has no place before medical evaluation in this age group.

Important information: this article is educational in nature and is in no way a substitute for personalised advice from a doctor or pharmacist. For any drug interaction or suspicion of poisoning, the Moroccan Poison Control and Pharmacovigilance Centre (CAPM) is reachable 24/7 on 0801 000 180. For rapid medical orientation, [Sahha Live teleconsultation](/teleconsultation) covers common painful conditions 7 days a week.