Background: Rational use of medicine can be defined as receiving medications appropriate to the clinical needs, in doses that meet the individual requirements and for an adequate period of time. Relieving or treating pain is one of the most common reasons for using analgesics. It has been reported that non-prescribed and improperly used analgesics has reached worrisome levels. Objectives: The aim of the present study wasto assess the magnitude and to determine the pattern of analgesics utilization among adults in Alexandria, to identify the factors associated with frequent analgesics use and misuse, and to investigate the adults' knowledge concerning analgesics use. Methods: The study was conducted using a cross-sectional approach. It included 607 adults attending 30 private pharmacies in the 8 districts of Alexandria. A predesigned structured interviewing questionnaire was used to collect data from the adults attending the selected pharmacies. Results: More than three quarters of the adults (82%) reported taking one or more analgesics. Nearly two-thirds (64.1%) used to take only one analgesic, while 29.9% used to take two analgesics and 6% used to take three or more analgesics. There was a statistically significant association between age, gender, hyperacidity and analgesics use. Paracetamol was used by more than one quarter (27.5%) of analgesic users, while non steroidal anti-inflammatory drugs (NSAIDs) were used by 86.6% of them. More than one third (37.3%) of the studied adults were considered frequent analgesic users, while about 16.5% were misusers. Conclusion: Utilization of analgesics was widely prevalent among adults in Alexandria, and it is the responsibility of Ministry of Health and Population, universities, physicians and pharmacists to rationalize the use of analgesics.