3 ms·

Ibuprofen was already a huge step up from Paracematol, which is another step up from Aspirin. The fact that ibuprofen is also much better tolerated, has fewer s

Ibuprofen was already a huge step up from Paracematol, which is another step up from Aspirin. The fact that ibuprofen is also much better tolerated, has fewer side effects, and has to be dosed less often means you're taking the best non-opioid painkiller we know of as your first-line option.

jorvi 6y ago
> The fact that ibuprofen is also much better tolerated, has fewer side effects I'd much rather have the slight load on the liver that paracetemol has than the issues with the stomach that NSAIDs bring.
- freeone3000 6y ago
  Well, lucky for you, both (in fact, all three) are still available. But, as a statistical matter, Ibuprofen is safer. Not only because the liver is such a contentious point for drug elimination, including alcohol, but due to the ability to fix overdoses. Even with minor overdoses (such as mixing with alcohol), paracematol causes permanent liver damage, whereas stomach ulcers can be repaired. More than 100,000 people die annually from Paracematol overdoses. Ibuprofen is sold more, and has fewer than 16,000 deaths.
  - rscho 6y ago
    Kidneys cannot be repaired. You'll need hemodialysis if you overdose on ibuprofen. I don't know the state of the research on the topic, but I expect locations offering OTC NSAIDs to have issues with acute and chronic kidney injury that goes pretty much unnoticed. Especially in populations with high diabetes prevalence. One of the reasons for higher paracetamol mortality is because people commit suicide using it (especially common among teenagers).
  - hilbert42 6y ago
    "More than 100,000 people die annually from Paracetamol overdoses." The fact is we seem to be damned if we do or damned if we don't. We desperately need a reasonably effective and safe painkiller. If 100,000 actually die from paracetamol per year then there's a reasonable excuse for banning it. But what do we replace it with given that many cannot take NSAIDs for various reasons? - Pharmacists and doctors repeatedly say paracetamol/acetaminophen is very safe if taken according to directions, the trouble is, that in excess, it shuts the liver down and it cannot recover/clear the drug in time before real trouble sets in. Moreover, it's not very effective as a painkiller. - NSAIDs, ibuprofen and aspirin, cause bleeding of the stomach and other major issues, even hearing loss in high doses. - The newer COX-2 selective NSAID Rofecoxib, aka Vioxx, was very effective at certain forms of pain relief but was banned by the FDA after it was found to cause cardiac effects in susceptible people including heard attacks. (Another criticism I have of the FDA is the inordinate length of time it took for the FDA to remove Vioxx from the market after its cardiac effects became known—this was around three years. (I recall reading a paper in the AAAS journal Science that outlined Vioxx's cardiac effects and thinking to myself that the drug would have to be banned. That was some three years before the FDA actually banned it). - Celecoxib, also a newer COX-2 selective NSAID that is in the same class as Vioxx, hasn’t yet been banned but it still has the potential to cause cardiac effects. Moreover, it is not as effective a painkiller as Vioxx was. - Then there's the dangerously addictive opioids. - Once we had another rather effective painkiller but it too has been long banned. APC was a mixture of aspirin, phenacetin and caffeine and it was rather effective except for the fact that it rotted one's kidneys, many instances of kidney disease were attributed to its use Alas, there's precious little else, especially anything that's safe. It's a pathetically inadequate a list, isn't it?
- zdragnar 6y ago
  Unfortunately, my wife has very unpleasant reactions to acetaminophen / paracetamol, and I notice roughly zero reduction on pain from it. Fortunately, neither of us has stomach issues, so we stick to ibuprofen.
maxerickson 6y ago
Ketoprofen is way better. I'm not sure why they stopped selling it OTC though.
- rscho 6y ago
  TBF, they should stop selling most things OTC. In the current US system that would mean massive additional costs to the consumer, but that is really a policy problem and not a medical one.
  - kelnos 6y ago
    Where would you draw the line? Being unable to buy something simple like ibuprofen OTC would (as you point out) mean massive costs for people, and to what benefit? Is there really a huge problem with people overdosing on ibuprofen and suffering permanent damage or death? And even if there is, would we really expect requiring a prescription to fix that problem? That doesn't seemed to have kept opiates from ruining people's lives.
    - rscho 6y ago
      > Is there really a huge problem with people overdosing on ibuprofen and suffering permanent damage or death? From personal experience, it would seem that permanent damage is the norm more than it is the exception. But at large I don't know. > That doesn't seemed to have kept opiates from ruining people's lives NSAIDs are not addictive. > to what benefit? Better public health. But I concede that in the US, that's heresy.
- exikyut 6y ago
  Interesting. Chemically speaking, how so?

jorvi 6y ago

> The fact that ibuprofen is also much better tolerated, has fewer side effects I'd much rather have the slight load on the liver that paracetemol has than the issues with the stomach that NSAIDs bring.

freeone3000 6y ago
Well, lucky for you, both (in fact, all three) are still available. But, as a statistical matter, Ibuprofen is safer. Not only because the liver is such a contentious point for drug elimination, including alcohol, but due to the ability to fix overdoses. Even with minor overdoses (such as mixing with alcohol), paracematol causes permanent liver damage, whereas stomach ulcers can be repaired. More than 100,000 people die annually from Paracematol overdoses. Ibuprofen is sold more, and has fewer than 16,000 deaths.
- rscho 6y ago
  Kidneys cannot be repaired. You'll need hemodialysis if you overdose on ibuprofen. I don't know the state of the research on the topic, but I expect locations offering OTC NSAIDs to have issues with acute and chronic kidney injury that goes pretty much unnoticed. Especially in populations with high diabetes prevalence. One of the reasons for higher paracetamol mortality is because people commit suicide using it (especially common among teenagers).
- hilbert42 6y ago
  "More than 100,000 people die annually from Paracetamol overdoses." The fact is we seem to be damned if we do or damned if we don't. We desperately need a reasonably effective and safe painkiller. If 100,000 actually die from paracetamol per year then there's a reasonable excuse for banning it. But what do we replace it with given that many cannot take NSAIDs for various reasons? - Pharmacists and doctors repeatedly say paracetamol/acetaminophen is very safe if taken according to directions, the trouble is, that in excess, it shuts the liver down and it cannot recover/clear the drug in time before real trouble sets in. Moreover, it's not very effective as a painkiller. - NSAIDs, ibuprofen and aspirin, cause bleeding of the stomach and other major issues, even hearing loss in high doses. - The newer COX-2 selective NSAID Rofecoxib, aka Vioxx, was very effective at certain forms of pain relief but was banned by the FDA after it was found to cause cardiac effects in susceptible people including heard attacks. (Another criticism I have of the FDA is the inordinate length of time it took for the FDA to remove Vioxx from the market after its cardiac effects became known—this was around three years. (I recall reading a paper in the AAAS journal Science that outlined Vioxx's cardiac effects and thinking to myself that the drug would have to be banned. That was some three years before the FDA actually banned it). - Celecoxib, also a newer COX-2 selective NSAID that is in the same class as Vioxx, hasn’t yet been banned but it still has the potential to cause cardiac effects. Moreover, it is not as effective a painkiller as Vioxx was. - Then there's the dangerously addictive opioids. - Once we had another rather effective painkiller but it too has been long banned. APC was a mixture of aspirin, phenacetin and caffeine and it was rather effective except for the fact that it rotted one's kidneys, many instances of kidney disease were attributed to its use Alas, there's precious little else, especially anything that's safe. It's a pathetically inadequate a list, isn't it?
zdragnar 6y ago
Unfortunately, my wife has very unpleasant reactions to acetaminophen / paracetamol, and I notice roughly zero reduction on pain from it. Fortunately, neither of us has stomach issues, so we stick to ibuprofen.

maxerickson 6y ago

Ketoprofen is way better. I'm not sure why they stopped selling it OTC though.

rscho 6y ago
TBF, they should stop selling most things OTC. In the current US system that would mean massive additional costs to the consumer, but that is really a policy problem and not a medical one.
- kelnos 6y ago
  Where would you draw the line? Being unable to buy something simple like ibuprofen OTC would (as you point out) mean massive costs for people, and to what benefit? Is there really a huge problem with people overdosing on ibuprofen and suffering permanent damage or death? And even if there is, would we really expect requiring a prescription to fix that problem? That doesn't seemed to have kept opiates from ruining people's lives.
  - rscho 6y ago
    > Is there really a huge problem with people overdosing on ibuprofen and suffering permanent damage or death? From personal experience, it would seem that permanent damage is the norm more than it is the exception. But at large I don't know. > That doesn't seemed to have kept opiates from ruining people's lives NSAIDs are not addictive. > to what benefit? Better public health. But I concede that in the US, that's heresy.
exikyut 6y ago
Interesting. Chemically speaking, how so?