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Acetaminophen vs. ibuprofen
- fulafel 6mo agoCould they safer and/or higher dose acetaminophen pills if they included NAC?
- _--__--__ 6mo agoMy father, who is otherwise in very good health for a ~60 year old, has severely reduced kidney function from taking an ibuprofen+antihistamine most days of his early life to deal with allergies. I'll second the claim that no doctor at any point in his life had told him the risks of doing that, and many encouraged the use of ibuprofen over any other alternative (including the alternative of not using OTC painkillers every single day).
- i_think_so 6mo agoIf there's one thing I'm hopeful for regarding all this AI hype, it's that some day we might actually get the Expert Systems we were promised decades ago. Then, finally, we can stop expecting human doctors to know everything. There's just so much going on inside our bodies and it's unrealistic. I had a relative with a different story in the same theme. It sucks and I want to see this technology do something truly beneficial for a change....
- jeroenhd 6mo agoThe expert system relies on training data, and most of the medical data on the internet is either outdated or outright wrong. AI is not going to solve what the existence of Google hasn't solved already.
- i_think_so 6mo ago[dead]
- themanualstates 6mo agoWe have this already; the side-effect reporting and post-marketing studies.
- seemaze 6mo agoI grew up with the understanding that acetaminophen was the safe choice for fever or aches, and ibuprofen what the more potent compound for inflammation and severe pain. I recall casual anecdotes that "my doctor said 1.5x or 2x ibuprofen dose is ok when warranted" to address major incursions. I've never once thought about taking more than the recommended dosage of acetaminophen, largely because I had no expectation that it would provide additional benefit.. In reality, I try to consume 1/2 doses of anything or nothing at all, unless it's a serious medical treatment being administered by a professional.
- petesergeant 6mo agoI think most overdoses happen as a result of someone trying to hurt themselves, but I’ve also previously been in sufficient pain (always dental) that I’m counting the minutes down to when I can take more painkillers, so it’s easy to see how you could take double the expected dosage.
- kgwgk 6mo agoIt’s also easy to imagine that you may be in a state of confusion and lose track of time and/or the count of doses.
- deleted 6mo ago[deleted]
- ghosty141 6mo ago> largely because I had no expectation that it would provide additional benefit.. An interesting thing with ibuprofen is that at the regular dose of 400mg it inhibits pain but if you take 1600mg it doesn't inhibit much more pain than the 400mg dose, but the inflammatory effect does increase significantly. A lot of people don't know that and take too much thinking it scales linearly.
- mordae 6mo agoSome know that you can combine ibuprofen with paracetamol to get extra pain suppression. And when you want to be gentle, you alternate between them.
- NikolaNovak 6mo agoWell, I mean, drats. I too always assumed Ibuprofen was safer than Acetaminophen; not the least because of massively oversimplificatic "reduced inflammation - GOOD!" 'Logic'. I'm 47 now and have probably preferred ibuprofen for last 27 or so.
- jasperry 6mo agoThis is some of the most useful information I've received in a while. Like the author, the low overdose threshold of acetaminophen made me avoid it, even though I always take low doses anyway and ibuprofen gives me acid reflux almost every time.
- the_sleaze_ 6mo agoSame here. Great article. I avoid both and stick with naproxen sodium. Any issues with that one? Lasts the longest too.
- pkaye 6mo agoBoth ibuprofen and naproxen sodium are NSAIDs and are bad for your kidneys especially in long term. I had kidney failure due to what was eventually diagnosed as an autoimmune disease but they first thing the ER doctor will ask is if you have been taking NSAIDs. My nephrologists told be its still safe to take acetaminophen at the proper dose.
- jasperry 6mo agoLooking at the Wikipedia article, it seems naproxen is a NSAID like ibuprofen and can cause all the same gastrointestinal issues.
- y1n0 6mo agoSome believe naproxen sodium is worse for you because it lasts longer. Longer duration for reduced mucous membrane coverage in your stomach and intestine. Longer duration for reduced blood flow to your kidneys. I would definitely have a chat with a doctor about it.
- kirrent 6mo agoNone of us are your doctors but Naproxen has well-known gastric issues up to ulcers and stomach bleeding which is why it's advised to be taken with food and why it's also often prescribed with a PPI or H2 Antagonist. Cox-2 selectives such as Celecoxib greatly reduce this risk but seem to be associated with some small cardiovascular risk (admittedly this is a feature of all NSAIDs though less so in Naproxen apparently).
- dbg31415 6mo agoBoth of these pills are really dangerous for dogs. Ibuprofen damages the kidneys -- and that damage is often permanent. The little filtering devices inside the kidneys don't grow back once they're destroyed. A dog who survives the poisoning can end up with lifelong kidney disease, which means special diets, more frequent vet visits, and a shorter life than she should have had. (I watched this happen to my own dog after a house sitter stepped on her paw and gave her ibuprofen to "help." My dog lived, but she needed a special diet for the rest of her life.) Acetaminophen wrecks the liver, and it also can damage red blood cells so they can't carry oxygen properly. A poisoned dog may get lethargic, vomit, start to breathe heavily... This is especially dangerous for older dogs, or any dog whose red blood cells are already compromised, by conditions like IMHA.
- farmeroy 6mo agoI've known people who've overdosed on Tylenol and died. I'm not saying that ibuprofen won't give you acid reflux and won't damage your kidneys, but due to <reason> I tend to take a lot of ibuprofen and also for <reason> take another medication that constricts my arteries and for <reason> get a lot of blood/urine work done... and my kidney function is good and despite everything I'm generally healthy. So I would say, like many things, what medicines you take probably depend on your specific body and situation. Regardless, you won't die accidentally from an acute ibuprofen overdose. You just might die from taking tylenol if you don't realize your liver is already damaged for other reasons. So there you go!
- wordsunite 6mo agoUnless you’re in Rhabdo. If you’re in so much muscle pain and your kidneys are working overtime to clear broken down tissue and you then hit them with too much ibuprofen, then you can go into kidney failure and die accidentally.
- farmeroy 6mo agoAt least with the folks i hang around, liver damage from years of over-drinking is probably more likely
- foobiekr 6mo agoJust don't take it on an empty stomach.
- burnt-resistor 6mo agoThat's ibuprofen. Which can be partially mitigated by famotidine. IBU: -stomach -kidneys -bp+ -clotting --NERD --NECD --NEUD --SNIUAA --SNIDR --DRESS APAP: -liver --DRESS -- extreme, rare side-effects
- sph 6mo agoYou expect us to know those acronyms?
- throwanem 6mo ago> You should not switch medications based on the uninformed ramblings of [crazy] people.
- wonnage 6mo agoThis is pretty misguided.A casual mistake like forgetting your cough syrup has acetaminophen can easily cause an overdose and then you fucking die. That’s not the risk profile you want for “most people in most circumstances”.
- nirava 6mo ago500mg from a capsule and 500 from cough syrup 4 times a day is still fine. With a 100% safety margin still. If you’re taking more meds than that without clinical supervision Id say something is wrong in the system or your medicine practices. Where I’m from it’s common to walk to the nearest pharmacy and get meds when needed. Even over the counter stuff like paracetamols. And talking to the pharmacist. They’ll ask what you’re already taking and tell you what else to get.
- nalllar 6mo agoYeah this is optimizing for the good case instead of tail risks and mistakes and we see too many overdoses already. Of course, we could press the fix this immediately button by requiring acetaminophen to be sold mixed with NAC but that would be too easy.
- salex89 6mo ago8g is not an insignificant amount. That's 16 500mg pills. You really need to mess up to take 16 pills and not realise you're doing something wrong. If a patient is not lucid than we have bigger issues. And from what I see in pharmacies, you would rarely see a "cough syrup" called just like that if it contains paracetamol. It would usually be marketed as a flu-relief all-around symptom relief.
- aaron695 6mo ago[dead]
- pugio 6mo agoReally lovely article. In paramedicine we usually treat 10g of acetaminophen in a 24-hour window as a potentially fatal overdose. That's also why the law in Australia was changed to require acetaminophen to come in blister packs (harder to get each pill out) of no more than 16. At 500 mg, that only gets you up to 8 g if you eat the whole thing, which is still hopefully non-fatal. I always thought a simple over-the-counter supplement (NAC) being the cure for an overdose was so cool. It's a pretty cool substance in a lot of ways, and this is a great spur to myself to research it more thoroughly.
- tokyobreakfast 6mo agoYou can still die if you take your idiot-proof Aussie blister packs with alcohol. So it's more an inefficient use of cabinet space. You can overdose on water too, they haven't banned 5-gallon jugs (yet).
- adithyareddy 6mo agoYes, and you can still die in a car crash if you're wearing your seatbelt, and wearing a helmet on your motorcycle won't save you from a head-on with a truck, and you can still drown in a pool with a lifeguard, and you can still die in a burning building with smoke detectors. Harm reduction is about shifting probability distributions, not guaranteeing outcomes. Kids can still get into pill bottles with childproof medication caps, but accidental ingestion of aspirin by children reduced by 40-55% after they were mandated. [0] [0]: https://pubmed.ncbi.nlm.nih.gov/440889/ https://pubmed.ncbi.nlm.nih.gov/440889/
- epcoa 6mo agoNo. Ethanol and tylenol compete for CYP2E1 that produces toxic NAPQI, so no, acute alcohol intoxication has a protective effect at least where it comes to tylenol toxicity.
- Flashtoo 6mo agoThis is correct.
- rramadass 6mo agoThe following article showing a link between Acetaminophen/Paracetamol usage and decline in positive empathy is highly relevant here; The medications that change who we are - https://www.bbc.com/future/article/20200108-the-medications-that-change-who-we-are https://www.bbc.com/future/article/20200108-the-medications-... Excerpt: Mischkowski’s own research has uncovered a sinister side-effect of paracetamol. For a long time, scientists have known that the drug blunts physical pain by reducing activity in certain brain areas, such as the insular cortex, which plays an important role in our emotions. These areas are involved in our experience of social pain, too – and intriguingly, paracetamol can make us feel better after a rejection. Mischkowski wondered whether painkillers might be making it harder to experience empathy And recent research has revealed that this patch of cerebral real-estate is more crowded than anyone previously thought, because it turns out the brain’s pain centres also share their home with empathy. For example, fMRI (functional magnetic resonance imaging) scans have shown that the same areas of our brain become active when we’re experiencing “positive empathy” –pleasure on other people’s behalf – as when we’re experiencing pain. Given these facts, Mischkowski wondered whether painkillers might be making it harder to experience empathy. Earlier this year, together with colleagues from Ohio University and Ohio State University, he recruited some students and spilt them into two groups. One received a standard 1,000mg dose of paracetamol, while the other was given a placebo. Then he asked them to read scenarios about uplifting experiences that had happened to other people, such as the good fortune of “Alex”, who finally plucked up the courage to ask a girl on a date (she said yes). The results revealed that paracetamol significantly reduces our ability to feel positive empathy – a result with implications for how the drug is shaping the social relationships of millions of people every day. Though the experiment didn’t look at negative empathy – where we experience and relate to other people’s pain – Mischkowski suspects that this would also be more difficult to summon after taking the drug. Also see the previous thread; A social analgesic? Acetaminophen (paracetamol) reduces positive empathy - https://news.ycombinator.com/item?id=31263305 https://news.ycombinator.com/item?id=31263305
- croes 6mo ago> Mischkowski suspects that this would also be more difficult to summon after taking the drug. Why should I trust someone who doesn’t test properly but just suspects?
- Fnoord 6mo agoAfter severe cramps once when I had to use a lot of ibuprofen (dental surgery / wisdom tooth) I now only use ibuprofen with a stomach protector to avoid stomach cramps, H. Pylori, and reflux. Acetaminophen is part of ECA stack weight loss formula, while article says not OK with fasting. Either way, more safe solutions are known these days.
- kazinator 6mo agoYou don't want either of these; what you want is naproxen. It works similarly, but stays a lot longer (half life is cited as being anywhere from 12 to 17 hours). Acetaminophen and ibuprofen are just for temporary problems, like a headache that would go away on its own in a couple of hours. They are uneconomic and inconvenient if you have something more persistent to keep at bay. Four ibuprofens or one naproxen? No brainer. The main disadvantage of naproxen is that it's not approved for kids. So there is no naproxen syrup for infants or anything of the sort. Thus, you still need acetaminophen for that.
- binoct 6mo agoAs pointed out in the article, naproxen is an NSAID like Ibuprofen, though slightly more COX1 selective. It likely has a somewhat lower risk of serious renal and cardiovascular events, but higher risk of GI bleeds. There are some studies that show little to no increase cardiovascular risk, but most do show some or even comparable to ibuprofen. Convenience vs ibuprofen is a thing given the longer half life, but it still generally comes with similar risks. If you are taking anything for more than just an occasional headache, definitely discuss with a doctor, COX2 selectives like celecoxib may be a better risk profile and even more convenient. (COX1 and COX2 selectivity loosely separate which systems get the brunt of the side effects)
- kazinator 6mo agoThe higher risk of GI bleeds is could be somewhat balanced by not having to take as many. There are also slow release forms of naproxen. (Which make sense given its long action: lets people fade in the next one while the previous dose slowly fades out). That could also help make it easier on the GI tract.
- KaiserPro 6mo ago> The higher risk of GI bleeds is somewhat balanced by not having to take as many! Unless I am missing something, the data really doesn't back that up. naproxen is much more longer lasting and has a higher chance of causing ulcers. Hence why its not over the counter in the UK and is prescribed with omeprazole to reduce the risk of issues.
- deleted 6mo ago[deleted]
- KnuthIsGod 6mo agoThis is why asking for medications based on the last thing you saw on social media is a really bad idea.
- pupppet 6mo agoIf you don't make a habit of taking either, what actually performs better?
- petesergeant 6mo agoDepends what you’re taking it for. Generally people take NSAIDs for muscle and dental pain, or anything that’s obviously inflammation, and paracetamol for anything else, particularly headaches, and is a common adjunct treatment if you have a cold or flu.
- bonsai_spool 6mo ago> If you don't make a habit of taking either, what actually performs better? Tylenol/acetaminophen is good for fever which NSAIDs won't help. Otherwise, take both and alternate their dosing times for better pain coverage.
- ButlerianJihad 6mo ago"Good for fever"? Only ignorant consumers would attempt to counteract the body's very own defenses against infection and disease. A fever is not dangerous within normal parameters, except for being dangerous to the virus and bacteria that threaten the body. Your body runs a fever because it engages in a battle to the death with these microbes. If you defeat the body's own defenses by lowering the fever, for example if you are a nervous mother who hates her baby's fussing, or if you're hospitalized and the nurses are laser-focused on "number go down" treatments, then you can expect to be ravaged by the contagion for much longer than expected.
- Phui3ferubus 6mo agoThe priorities have drifted. In the middle of night I don't care about getting healthy, I need to get rid of fever, so I can fall asleep and able to got to work/school in the morning. And somehow there is never right time to be sick and everyone just want to supress syndromes here and now.
- bonsai_spool 6mo ago
- rubatuga 6mo agoIf you take either of these medications regularly talk to your doctor.
- burnt-resistor 6mo agoIANADATINMA. Max dose combination (IBU/APAP FDC) can be useful as a substitute in emergency therapeutic situations compared to opiates. Not recommended ordinarily because of liver, kidney, and stomach impairment.[0] Taking ibuprofen with questionable stomach condition may want to consider taking a famotidine adjuvant or duexis [1] or acetaminophen instead. Overdose treatment of acetaminophen poisoning is the stinky N-acetylcysteine (NAC), so that maybe worth stocking whenever Tylenol is kept in a house with kids. Overdose of ibuprofen is palliative, requiring IV fluids and dialysis. 0. https://www.researchgate.net/publication/382639515_Ibuprofenacetaminophen_fixed-dose_combination_as_an_alternative_to_opioids_in_management_of_common_pain_types https://www.researchgate.net/publication/382639515_Ibuprofen... 1. https://pubmed.ncbi.nlm.nih.gov/25516006/ https://pubmed.ncbi.nlm.nih.gov/25516006/
- alok-g 6mo agoOMG! I have been taking Dayquill/Nyquill in syrup form when having cold/cough and often without formally measuring! Will be careful from now on.
- janandonly 6mo agoThis is a repost from an article that was posted last week: https://news.ycombinator.com/item?id=47799088 https://news.ycombinator.com/item?id=47799088
- justinc8687 6mo agoI lived with an ICU nurse for years and one of the things he emphasized was the risk of acetaminophen overdose. He's more than once treated the liver failure (and death) from it and by his words, it's one of the worse ways to go. The positive of it is it got me in the habit of logging whenever I take it, either in a note on my phone or just a sheet of paper I place on my dresser under the bottle. This helps make sure I stay under the 3-4g/d limit. Last year I was diagnosed with a rare headache disease (NDPH). We thought it completely came out of nowhere, but I had logs in my phone recording headaches and acetaminophen use intermittently from a few weeks prior. This proved useful in the diagnosis. Moral of the story: log when you take it to avoid overdosing. Combine that with some basic symptom logging (like 1 line, 10 words or less). You never know when that might be useful for your doctors later on.
- justinc8687 6mo agoP.S. like someone mentioned in a comment below happened to them, be careful with NSAIDs over the long term. Until recently I took them daily for better part of 3 years. I was recently diagnosed with chronic kidney disease. Can't definitively say causation, but they definitely contributed. They're fine for short term use but can really f$%# you up with long term, daily use.
- vidarh 6mo agoIt is absolutely valid to warn about long term use, and NSAIDs in particular (I was lucky and had a gastroscopy before they'd done any serious damage, but they found significant erosion of my stomach lining due to NSAIDs), but acetaminophen/paracetamol isn't an NSAID (ibuprofen and aspirin, for example, are)
- justinc8687 6mo agoTo be clear, it was nabumetone, celecoxib or meloxicam (at various times, not overlapping) for me.
- isoprophlex 6mo agoI'm not disagreeing with you or trying to be disagreeable, but how do people accidentally exceed 3-4 grams daily? That's 6-8 pills!
- atoz03 6mo ago[dead]
- alexcpn 6mo agoI created this open-source application (https://alexcpn-faers-signal-detection.hf.space/ https://alexcpn-faers-signal-detection.hf.space/) to analyse the FDA FAERS data set a few weeks back, just to do some good work and use Claude Code completely. I got roasted on Reddit for attempting this. But this is meant for specialists to use, as most platforms that analyse this data charge a lot from what I read. FDA FAERS is the official dataset for reporting Adverse events from taking a drug. FDA adverse event reports about 2 million cases and 4,067 unique drugs I agree the results are not easy for non medical professionals to interpret correctly. For example DEATH is very strong with Parecetemol and so is DEPENDECE. The latter because from AI it is a confounding factor. Acetaminophen/parecetemol is frequently co-formulated with opioids (like Hydrocodone or Codeine). The "Dependence" signal is likely attributed to the opioid, not the Acetaminophen itself... Adverse Event Acetaminophen PRR (95% CI) Acetaminophen n ibuprofen PRR (95% CI) ibuprofen n ACUTE KIDNEY INJURY 0.87 (0.80-0.96) 498 4.27 (3.91-4.67) * 483 ANAPHYLACTIC REACTION 0.61 (0.51-0.72) 122 9.85 (8.90-10.90) * 382 ANGIOEDEMA 1.31 (1.13-1.53) 170 15.26 (13.77-16.92) * 378 DEATH 1.44 (1.40-1.49) 3958 0.07 (0.06-0.10) 42 DEPENDENCE 237.12 (231.51-242.88) * 39679 0.02 (0.01-0.05) 4 DEPRESSION 2.18 (2.05-2.31) * 1157 0.39 (0.29-0.52) 43 DRUG EFFECTIVE FOR UNAPPROVED INDICATION 16.77 (16.11-17.46) * 3180 44.17 (42.18-46.25) * 1921 DRUG HYPERSENSITIVITY 0.57 (0.51-0.64) 327 3.30 (2.98-3.65) * 372
- krupan 6mo agoI once read that if acetaminophen were introduced today it 100% would require a prescription because of how dangerous an overdose is. Unrelated, but it feels like an oversight that this article said nothing about how both acetaminophen and ibuprofen reduce fevers. They aren't used solely for reducing pain.
- jeroenhd 6mo agoI kind of doubt that, to be honest, given how much more effective and less directly damaging it is during normal use compared to NSAIDs. I find it interesting that people take these as fever reduction mechanisms. Fevers are a defence mechanism, not just an inconvenience. Maybe it makes more sense in places without decent workers' rights (like having a limited amount of sick days you need to manage), but it feels weird for me to actively harm your body's defence mechanisms unless you're in "you should see a doctor" territory already.
- phillc73 6mo agoYou can combine the two for better effect. 1g of Paracetamol with 400mg of Ibuprofen gives similar pain relief as 2mg of IV morphine.[1] [1] https://pubmed.ncbi.nlm.nih.gov/29017585/ https://pubmed.ncbi.nlm.nih.gov/29017585/
- Phui3ferubus 6mo agoPlus caffeine, for those who don't drink coffee. Quite standard combo for people suffering from migraine. I stick to 500mg+200mg and I find it suspicious adverts for painkillers somehow always show 2 pills while dosage recommend in leaflet is just one.
- CalChris 6mo agoFor migraines, I take two CVS Migraine about every week to ten days. It's a cocktail of acetaminophen, aspirin and caffeine which tallies to 500 mg of acetaminophen, well under then 4g limit. It's good for four hours but you can only take two per day. I didn't know about this acetaminophen risk. So I'll be looking for alternatives. Ibuprofen is for inflammation and not headaches. Naproxen is a candidate.
- crustaceansoup 6mo ago> Ibuprofen is for inflammation and not headaches Ibuprofen is very well supported as a treatment for migraines. Not necessarily headaches generally, but definitely migraines. But there are multiple classes of abort drugs now that a doctor might be able to prescribe you, like triptans and CGRP inhibitors, that work much better than either NSAIDs or acetaminophen.
- dilyevsky 6mo agoHigh dose aspirin (1000mg) + caffeine worked much better for me for migraines than paracetamol/ibuprofen/naproxen which did nothing. There're some studies supporting this too...
- keithnz 6mo agohttps://www.eurekalert.org/news-releases/1086746 https://www.eurekalert.org/news-releases/1086746 This is semi recent research on how it might be blocking pain
- topham 6mo agoThe right tool for the right job. When it comes to medication, in the right dosage. I'm aware of acetaminophen's down sides, and yet recently I was taking it combined with 2 other medications at the time. Why? Because all three medications are recommended for dealing with the issue I had. (Alone and in combination) The moment it wasn't helping further? Done. There is this broken idea, particularly apparent in North America, but in western society that more is better for many things. It's not. More pain killers don't do anything if they max out the relief they can give you, overloading their mechanism doesn't reduce anything, but taxing your liver or your kidneys. All medications are potentially toxic, your body wants to dispose of them. In appropriate dosages they will benefit you, but more isn't inherently better. Even water can kill you in sufficient quantity. We do the same with diet; where someone declares one ingredient in a meal healthier than another; it isn't. A single ingredient isn't better or worse for you in a meal. Your diet however can be good or bad; over time that matters.
- wouldbecouldbe 6mo agoTry dealing with a herniated disc, more ibu is definitely better. Too little wont do anything, proper dose and you feel healed
- e40 6mo agoSpine issues are the single thing that pish me to ibuprofen or naproxen over acetaminophen. The latter does nothing for my issues.
- wouldbecouldbe 6mo agoyeah, its the inflammation going down that reliefs the nerve. Took me 3 months, out of 2 i wasn't able to sit. Luckily I could walk and that give me great relief. So walked for hours. Keeping the habit, will mostly being coding from my phone & walking from now on.
- e40 6mo ago
- cybersol 6mo agoI had intestinal bleeding after double ibuprofen dosage over several weeks for back pain. Definitely watch out for any prolonged and heavy use of NSAIDs.
- lnxg33k1 6mo agoThe article is not signed, we don't even know if the person writing it has any sort of medical background, take it with a grain of salt, the about page lists people and none of them has a medical background
- cowlby 6mo agoI keep reading about this lately but what doesn't make sense then is how few deaths/injuries there are relative to how much acetaminophen is consumed. If tens of millions take it every day, that's billions of doses a year of acetaminophen. Why don't we see MORE injuries/deaths?
- Eisenstein 6mo ago"Acetaminophen toxicity is the second most common reason for liver transplantation worldwide and the most common cause of acute liver failure in the United States. Responsible for 56,000 emergency department visits and 2600 hospitalizations, acetaminophen poisoning causes 500 deaths annually in the United States." 56,000 emergency room visits is the key here, because "the mortality associated with acetaminophen overdose is low if recognized and treated within the first 8 hours after an acute ingestion." So I guess it depends on if you think 56,000 is low or not. Source: "Acetaminophen Toxicity", David H. Schaffer; Brian P. Murray; Babak Khazaeni. 2026/02/19. https://www.ncbi.nlm.nih.gov/books/NBK441917/ https://www.ncbi.nlm.nih.gov/books/NBK441917/
- robocat 6mo agoAbout 50% of overdoses are intentional (especially suicidal teenagers), with the other 50% accidental. So when pondering the issue of numbers, it matters what path people took to overdose.
- Eisenstein 6mo agoFor all accidental acute poisonings leading to hospitalizations from OTC drugs amongst adults and adolescents, the top culprits are: 1. Acetaminophen: Dangers noted in article, and stats given in my parent comment 2. NSAIDs: "NSAIDs are ingested commonly in overdose, however severe toxicity is rare" 3. Salicylates "Severe salicylate poisoning follows ingestion of greater than 500 mg/kg". For an adult weighing 150lbs that is 68kg, which means severe poisoning requires 34g of aspirin, which at 325mg per pill is 104 pills total. Hardly easy to do this accidentally. [1] "Acute poisoning: understanding 90% of cases in a nutshell", S L Greene, P I Dargan, A L Jones, Postgrad Med J 2005;81:204–216
- georgeburdell 6mo agoI went from introvert only-child to married with kids. As they hit daycare, I was perpetually riddled with disease for about 15 months. I still had to take care of the kids though, so I was liberally taking Ibuprofen. At some point, I started to get horrible heartburn. I tried all kinds of dietary restrictions until I realized it was probably the Ibuprofen. Now, if I take even one pill, the heartburn comes back. I switched to Acetaminophen and found it was much more effective at reducing fever with no apparent side effects.
- kakacik 6mo agoYeah our son became eligible for creche just when covid came. All at home but we couldn't take full time care for him forever so eventually he started going in (they can start at 6 months here in Switzerland if you are lucky and get the spot, we did it gradually since 9 months). Then daughter came and same cycle. Needless to say we had covid at least 12 times at this point, all with positive tests so no mistake there. Plus few other questionable cases without tests. Some were brutal, like first and second one, that was before vaccines, and then a recent one when we seem to have lost most of immunity. Back then I lost taste for few weeks completely and smell didn't fully come back till 6 months after (sniffing bottle of vodka did smell like forest air, even later my perfume smelled rotten). Weird times, eating nice looking gunk and trying to imagine how it tasted before. I don't think I had flu that many times over my whole life, hate that shit with fiery passion and having small kids in creche/school is just a 24/7 virus importing service. None of our peers had it as bad as we did, no idea why the 'luck'.
- yumraj 6mo agoI’ve alternated these for fever, especially for kids, especially when it’s high and hard to control. That way you keep below the daily limit of each and don’t overdose on either. Have gotten into a habit of keeping a note of which med when on the fridge.
- a3w 6mo agoNice, now do Acetminophen vs Dexibuprofen.
- blueblisters 6mo agoAcetaminophen (paracetamol) is the drug of first choice for addressing pain and fever, in India at least. To the extent that it's regularly abused, and I know people who have been hospitalized because of abuse. Even then, doctors are usually disapproving of ibuprofen (or some combination of it with paracetamol) unless paracetamol is contraindicated for some reason, and I had always wondered why.
- timvdalen 6mo agoI did listen to this 99% Invisible story about the use of NSAIDs in India once[1] What you describe in an interesting contrast to the situation in The Netherlands. Here, virtually no one is prescribing ibuprofen _without_ also prescribing a baseline of paracetamol. [1]: https://99percentinvisible.org/episode/579-towers-of-silence/ https://99percentinvisible.org/episode/579-towers-of-silence...
- magicalhippo 6mo ago> But if acetaminophen is safer, then why don’t official sources tell you that? Guess it depends on country. Here in Norway official sources[1][2] do say acetaminophen (paracetamol here) should be the default for treating fever and pain in kids, adults, pregnant women and elderly, and have for some time. Ibuprofen they say should be used with caution. [1]: https://www.dmp.no/nyheter/behov-for-smertestillende-slik-velger-du-riktig https://www.dmp.no/nyheter/behov-for-smertestillende-slik-ve... [2]: https://nhi.no/for-helsepersonell/nytt-om-legemidler/arkiv-2022/paracetamol-nye-doseringsanbefalinger https://nhi.no/for-helsepersonell/nytt-om-legemidler/arkiv-2...
- socalgal2 6mo agoHere in my body, it tells me acetaminophen does absolutely nothing for pain where as ibuprofen does. I wouldn't take ibuprofen for fever
- bluGill 6mo agoI once got it to make a small difference for pain - but I was in the hospital (surgery recovery) where the doctors were giving me more than the daily maximum.
- criddell 6mo agoThis might sound like woo, but sometimes I'll find a quiet place and just sit there and focus on the pain. I try to really understand the sensation that's being registered as pain by trying to notice all the properties of it (is it throbbing, burning, etc...). Occasionally I'll find that the more I try to identify specific features of the sensation, the harder it gets to do so and the pain sensation fades away.
- vjvjvjvjghv 6mo agoI do that too. But at least if you are a meditator on my level, there are limits. I sometimes get migraines and focusing on the pain while you are shivering, sweating and close to throwing up at the same time just doesn’t work for me.
- raverbashing 6mo agoHonestly this article is mixing a lot of different factors > Acetaminophen has a scarily narrow therapeutic window. The instructions on the package say it's okay to take up to four grams per day. If you take eight grams, your liver could fail and you could die. Gee I don't know, I think this is a wide enough window to not miss it. That difference is 8 500mg pills > that for most people in most circumstances, acetaminophen is safer than ibuprofen, provided you use it as directed. I think most doctors agree with this. Could be but I think a lot of doctors underestimate the dangers of paracetamol as well All of the factors the author mentions about IBP are true. But it's all about the details. Safer? Safer in which condition? "Dehydrated" ok take a glass of water. Active bleeding? Most NSAIDs interfere with that, and no you won't become a hemophiliac by taking one Ibuprofen Also, some countries do add a notice for kidney problems for Paracetamol as well (e.g.) https://www.medicines.org.uk/emc/product/5164/pil https://www.medicines.org.uk/emc/product/5164/pil An as a conclusion, I find it "funny" that nobody considers how healty/safe it is to take paracetamol and have mild analgesia (translation - you're still in pain) and taking ibp and having better analgesia
- 01100011 6mo agoThe article doesn't touch on it, but from what I've read NSAIDs like ibuprofen also slow healing. I have also read, but am unsure how reliable this is, that they can harm the remodeling process during healing and lead to chronic pain. That said, I've found great relief at times taking a moderately large dose of ibuprofen for several days to break what seems to be a cycle of persistent inflammation. YMMV I guess.
- oliyoung 6mo agoIt's a very strange cultural thing too, Australians (and I presume other Commonwealth countries) default to paracetamol (acetaminophen) before ibuprofen Paracetemol has always been seen as first thing you'd take for pain relief, and you'd "step up" ibuprofen as an escalation, but that might more to do with marketing of Panadol (paracetemol) vs Nurofen (ibuprofen). We'd look on at the US where you were taking Advil like candy in confusion. One great thing you learn as a parent, you can alternate acetaminophen and ibuprofen. Both of them are recommended every four hours, but you can stagger one by two hours to maintain consistency of pain-relief taking ibuprofen then paracetemol two hours later
- niek_pas 6mo ago> Australians (and I presume other Commonwealth countries) default to paracetamol The same is the case in the Netherlands.
- unmole 6mo ago> I presume other Commonwealth countries) default to paracetamol (acetaminophen) before ibuprofen Can confirm this is true in India. Paracetamol is widely used. Paracetamol + Ibuprofen is more common than Ibuprofen by itself.
- carlsborg 6mo ago"since 2019, on the advice of the National Agency for the Safety of Medicines and Health Products, French health workers have been told not to treat fever or infections with ibuprofen." [1] But yet in some countries pediatricians will libreally prescribe it to toddlers [1] https://www.bmj.com/content/368/bmj.m1086 https://www.bmj.com/content/368/bmj.m1086 Also from [2] "In this systematic review of NSAID use during acute lower respiratory tract infections in adults, we found that the existing evidence for mortality, pleuro-pulmonary complications and rates of mechanical ventilation or organ failure is of extremely poor quality, very low certainty and should be interpreted with caution." https://bpspubs.onlinelibrary.wiley.com/doi/10.1111/bcp.14514 https://bpspubs.onlinelibrary.wiley.com/doi/10.1111/bcp.1451...
- KaiserPro 6mo agoOne of the problems is that if you give it to kids with chicken pox it can cause complications. There was also some hints early in the pandemic that ibuprofen had a similar effect on covid-19. However as you link to, the data doesn't really support that view anymore.
- limbero 6mo agoCool, throughout this entire read I was thinking "I'm gonna save this, it reads a lot like dynomight". And then at the end it turns out it was dynomight all along. I guess I should read headers more carefully.
- mirekrusin 6mo agowhy they don't make pills with ibuprofen + nac?
- i_think_so 6mo agoDon't forget ye olde aspirin. It has a cheat mechanic: https://en.wikipedia.org/wiki/Salicylate_poisoning https://en.wikipedia.org/wiki/Salicylate_poisoning You take too much and it can give you a fever, which might entice you to take more aspirin. Nasty. Obligatory Reye's mention: https://www.uspharmacist.com/article/reyes-syndrome-a-rare-but-serious-pediatric-condition https://www.uspharmacist.com/article/reyes-syndrome-a-rare-b... and my own editorializing -- this is not just a problem for little kids. As various articles explain, if you've had flu-like symptoms (from whatever cause) you should be wary of aspirin. Will one standard dosage kill you? Unlikely. But if you've got better options, particularly pre-loading NAC before Tylenol, why not consider them first? Further reading: https://www.nhs.uk/medicines/low-dose-aspirin/who-can-and-cannot-take-low-dose-aspirin/ https://www.nhs.uk/medicines/low-dose-aspirin/who-can-and-ca... And for those of you with kids: https://www.nhs.uk/conditions/kawasaki-disease/ https://www.nhs.uk/conditions/kawasaki-disease/ Of course it's not all bad. There's even some discussion of anti-cancer potential. How might this work? One hypothesis: https://www.nature.com/articles/srep45184 https://www.nature.com/articles/srep45184 This topic is a bit personal for me and I'm glad it's getting some attention here. Bravo, hackers.
- wolfi1 6mo agothere is an antidote for paracetamol: ACC (Acetylcysteine)
- globular-toast 6mo agoInteresting! In the UK the common wisdom is paracetamol is the safest. Ibuprofen is available but not the first choice. Aspirin is considered bad. I wish people would stop saying "drinking" to mean alcohol consumption. I genuinely thought it meant after drinking any fluid until I read the description and realised it meant alcohol. I also don't like how alcohol is singled out as a "special" drug. What about other drugs? Is alcohol special in this regard?
- pazimzadeh 6mo agoDon’t anyone mentioning this, but alternating acetaminophen and ibuprofen every 6 hours as needed works well
- Melatonic 6mo agoWhy are COX-2 drugs like Celebrex still prescription only ? Seems like it would theoretically be a lot safer to offer a medium low dose of it over the counter vs other NSAIDs That being said I weirdly find Naproxen the most effective of all of these. Everyone is different though
- hilbert42 6mo ago"Why are COX-2 drugs like Celebrex still prescription only ?" Why? Because Celebrex (celecoxib) is a dangerous drug which can cause irreparable harm (heart attacks and related) if taken for long periods. In fact, its sister drug Vioxx (rofecoxib) was banned and Merck had to pay billions in damages. There's more here: https://news.ycombinator.com/item?id=47835635#47862704 https://news.ycombinator.com/item?id=47835635#47862704 Whilst Celebrex is safer than Vioxx it still has the same side effects profile as the latter. I'd also recommended you watch the YouTube video in the link on Vioxx, it demonstrates the dangers of COX-2 drugs shouldn't be underestimated.
- Melatonic 6mo agoWouldn't the other non selective NSAIDs also have this risk ? Or is Celebrex unique ?
- d--b 6mo agoTo me it's obvious that acetaminophen and ibuprofen do not target the same kind of problems. I am not a woman, but my wife says acetaminophen does not work on menstrual pain for instance. I take acetaminophen for fever, and those kind of full-body diffuse ill-feeling. I take ibuprofen for localized intense pain. I take aspirin for headaches and sore muscles.
- m12k 6mo agoI feel like this article leaves out the latest research pointing to acetaminophen having a negative effect on fertility, hindering embrionic development and potentially also also follicular development in baby girls. It's a trade-off for sure, but if you're trying to have a baby, you may want to swing back to ibuprofen. [1] https://pubmed.ncbi.nlm.nih.gov/40819833/ https://pubmed.ncbi.nlm.nih.gov/40819833/ [2] https://ddeacademy.dk/ddea/what-new-research-reveals-about-paracetamol-disrupts-early-embryonic-development-and-fertility-hormones/ https://ddeacademy.dk/ddea/what-new-research-reveals-about-p...
- rXwubXUGAm 6mo agoIn my personal experience, paracetamol hardly does anything when it comes to alleviating fever symptoms. Like I'm not sure whether I'd be able to distinguish it from placebo. I always default to ibuprofen and the difference it makes is like night and day. I only take it like a handful of times a year and usually no more than 1000mg a day so I'm hoping I'll be fine.
- antirez 6mo agoIn the article it is mentioned but it is worth stressing that N-acetylcysteine is a trivially available antidote for paracetamol overdose (and you may have it at home without knowing, Fluimucil, Mucomyst, NAC or alike). Also: in Europe everybody normally takes paracetamol and not FANS as a first reach to minimize adverse effects. So this article looks like very US centric. AFAIK liver failure because of paracetamol in Europe is very rare. So here there could be cultural issues at play (medical culture of what is prescribed, and the fact that Europeans in general take lower dosages of everything). EDIT: trick, if you very rarely take paracetamol and other pain medications, the next time try to take just 250mg. It works for most people, no need to take 750 or even 1 gram of paracetamol. 500 works for almost everybody, 250 for many folks.
- xen0 6mo ago> Also: in Europe everybody normally takes paracetamol and not FANS as a first reach to minimize adverse effects. So this article looks like very US centric. This is not my experience. After moving to Germany from the UK, I feel like people take and expect Ibuprofen far more often than Paracetamol. It seems like the first port of call for colds and general headaches, with Paracetamol being treated with some suspicion, despite it being far more effective in my experience for certain things (I've taken a lot of Ibuprofen and other NSAIDs in my time so am quite familiar with how they affect me).
- antirez 6mo agoDidn't expect that, my feeling was that the situation in most continental Europe was like in Italy and the UK, and even more in France! (I believe they have the record of use), in such places paracetamol is very strong.
- cmiles8 6mo agoIf acetaminophen was invented today it would almost certainly be available by prescription only because of the safety concerns. There are far more benign medications that are Rx only.
- throwawayffffas 6mo agoTo the author, my guy, you are clearly not an endocrinologist stop pretending you are, and trust the people that study these things for a living. Not only you can't take more than 4 grams of paracetamol per day, you must not take it for more than 3 days straight, it says so on the leaflet. Biochemistry and medicine are hard and complex, all the quacks out there that preach snake oil treatments went down the path of thinking their domain specific knowledge in random domains somehow transfers to medicine it does not.
- sobjornstad 6mo agoIs this comment in the wrong place? The article is literally about how the medical establishment gives good advice on acetaminophen and ibuprofen, but it's not getting through to people.
- throwawayffffas 6mo agoHe gets there after exposing a bunch of "research" he did himself and after admitting he was using ibuprofen for a long time because he "thought" it was safer.
- beAbU 6mo agoFor the rest of the world: Acetaminophen = Paracetamol
- nmeofthestate 6mo agoReminds me when I was on a business trip in California and bought some Acetaminophen thinking "I'm in the USA - this has to be the hard stuff, right?", only to discover it was just paracetamol.
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- TrackerFF 6mo agoOnly twice have I ever used Acetaminophen close to the max daily limit, and those were both when I was experiencing a raging tooth infection. I'd pop 2x500 mg paracetamol 4 times a day, which helped just enough to get through the day. The tooth infections were so severe that the dentist had to put anesthesia directly into the root / nerve, multiple times - felt like a lightning strike each time. One of these times I'd put the pain level at a 9 out of 10. I'm just going to assume that 10 out of 10 pain is when you basically consider ending it all, purely in the heat of the moment. Having gout, I've also had some pretty severe bouts where the pain level has been in the 8/10 range. Unfortunately nether paracet or ibuprofen worked. In any case, when I see regular people eating these painkillers as candy, I'm starting to wonder what pain levels they are experiencing. I'm generally very cautious of using this stuff.
- vanderZwan 6mo agoPain is weird. It's extremely subjective, not only between people but also within your own body. Paraphrasing something Paul Rozin mentioned in a paper on so-called benign masochism: people can learn to enjoy eating the most extremely spicy food, but even those people will still scream out in pain you rub the ghost pepper they're eating in their eyes. Pain sensation is therefore localized and contextual. So we should not be too quick to dismiss the pain of others. As far as 10/10 pain goes, I've heard cluster headaches can get so bad it has driven people to suicide during an episode.
- lr4444lr 6mo agoAfter reading this, I wonder whether maybe low doses of morphine over a short period are safer than either.
- Mordisquitos 6mo agoNo, even if morphine were metabolically safer (I don't know), its addictive potential would outweigh the potential safety benefit. On the other hand, if in the early 2000s you were to share those concerns with certain doctors, they would propose a more effective and non addictive alternative to morphine instead. Only the first part of what they would tell you was true.
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- cue_the_strings 6mo agoIt is a damn shame bordering conspiracy that metamizole (https://en.wikipedia.org/wiki/Metamizole https://en.wikipedia.org/wiki/Metamizole, known as Analgin in eastern Europe and the Balkans, apparently also India) is not more widely available in the west. It's literally a wonder drug, the only non-narcotic (hence non-addictive) that actually relieves serious pain (including post-op) pain in my experience. Since I've had a fair share of it in my life so far (more than 1kg of it so far, in total), and I investigated the disparaging studies and they are definitely not convincing at all; more recent ones somewhat absolve it (check the Wikipedia page). I've never had any side effects from it, and I don't know anyone who did, unlike for any other painkiller (diclofenac, ketoprofen, ibuprofen, acetaminophen / paracetamol). It is a medicine where I'm almost 100% sure the studies against it are intentional sabotage by pharma companies, and the vigor and persistence this is done with is really telling (lots of doctors and pharmacists in my extended family, including in regulatory bodies). The campaign against it never ends.
- meew0 6mo agoMetamizole is an amazing drug, I'm always grateful that I work and live in an area where it is available. But it is not a miracle drug. Metamizole-induced agranulocytosis absolutely exists, and the insidious thing is that you don't know in advance if you will get it or not. You're trading common but avoidable side effects (ibuprofen, APAP/paracetamol) for rare but unavoidable ones (metamizole). I've seen patients with severe side effects of all three classes of non-opioid painkillers (severe GI bleeds from ibuprofen-induced ulcers; acute liver failure from APAP overdose; metamizole-induced neutropenic fever). None of them seemed very pleasant. But if I had to choose, I'd still use APAP first line because it's the only one where you can avoid the severe side effect with certainty, by simply staying under the recommended maximum intake.
- glimshe 6mo agoMy US doctors almost never recommended Ibuprofen over Acetaminophen for mild pain. In fact, I don't remember them ever recommending Ibuprofen for anything while I hear about Tylenol pretty often. I've had doctors prescribing short runs of opioids (2 weeks for surgery recovery) but they always said "try Tylenol first and if the pain is too much you can fill the prescription". I liked having the option but never really used it up to this point.
- jovial_cavalier 6mo agoFrankly, very few people should be taking either of these drugs. Sometimes I forget how often people pop these things, it's really crazy. Consider just having a headache and dealing with it.
- ZoomZoomZoom 6mo agoConsidering its ubiquitous and regular consumption in general population, doesn't alcohol shift the balance in favour of ibuprofen? Also, possible blood clotting or stomach issues sound scary, but Aspirin has similar (opposite) issues. Pharmacists regularly push its combinations with Acetominophen (which has, of course, synergetic bonuses, but is not the reason) under multitude of brands with a hefty premium when people ask for either one. So in many situations you need to consider the added risks from Aspirin too. Ideally, I'd like to have an optimized strategies of using all three of the aforementioned substances for common situations. Like, is rotating ibuprofen/acetominophen during the day safer than consuming just one?
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- benj111 6mo agoFor those wondering why it's acetaminophen and paracetamol, the name difference is because they both took different random letters from an even longer name.
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- FigurativeVoid 6mo agoAcetaminophen has a quirky effect if you’re on a CGM. It makes your interstitial glucose read higher than your blood glucose. Context: I’m t1 diabetic. I was recovering from an injury, and I switched from ibuprofen to acetaminophen. But the whole time I was on it, my sensor glucose was reading 50-60 mg/dl higher than my blood glucose. This is really bad on a closed loop system as my pump kept trying to lower my blood sugar, but it was pushing me into hypoglycemia (50 mg/dl). Turns out this is a common effect, but a relatively new discovery that no one told me about.
- butlike 6mo agoAnectdotally, I had a headache, and the woman I was seeing in the UK said get the paracetamol unless it was killer, then get the Nurofen (ibuprofen) if I needed the heavy-duty medicine.
- oliveiracwb 6mo agoWithout resorting to research or statistical inference engines, based only on the average knowledge explained by my colleague OP, I will say that paracetamol is also toxic in continuous doses (people with chronic pain who resort to the medication for daily use) and has drug interactions with other agents (such as alcohol). Aspirin and Ibropufen are great but really do have a risk of ulcers. As for the thrombo-prophylactic issue, it is very poorly explained and I completely disagree. My readings to date have shown that both have a very slight rebound effect on the formation of thrombi and the main problem is the release of thrombi that have already formed, prior to the use of the medication.
- diogenes_atx 6mo agoScattered throughout this discussion are a number of comments concerning the potential damage to the stomach lining from ibuprofen, naproxen and aspirin. This is an important consideration when choosing a painkiller. According to a recent Washington Post article by Trisha Pasricha, MD, "You should avoid taking nonsteroidal anti-inflammatory drugs, or NSAIDs — such as ibuprofen, naproxen and aspirin — whenever possible. If you do need to take them, use the smallest dose for the shortest time feasible." Dr. Pasricha adds: "I don’t get too concerned if my patients take one or two doses every now and then. But through regular use, such as several times a month or more, NSAIDs are well-known to increase intestinal permeability. In other words, NSAIDs can damage the lining of our guts. That’s because NSAIDs reduce the blood flow in the tiny vessels feeding our guts and disrupt the intestinal cells forming a barrier between the outside world and your insides. This has been proven over and over again through decades of research." Conclusion: Acetaminophen is generally safer than ibuprofen, naproxen and aspirin. https://www.washingtonpost.com/wellness/2024/12/09/ibuprofen-risks-side-effects-nsaids/ https://www.washingtonpost.com/wellness/2024/12/09/ibuprofen... https://archive.is/XRZEU https://archive.is/XRZEU
- squidbang 6mo agoAnecdotal, but this is what got me to finally see a doctor about purpose-made migraine abortives. I was taking huge doses of naproxen multiple times a week, until I started to get terrible heartburn with every dose.
- AdamN 6mo agoWhat about low dose aspirin?
- pikminguy 6mo agoSomething I'm surprised this article didn't mention is that sometimes the anti-inflammatory is the point. If you have swelling along with the pain then ibuprofen or any other NSAID is going to be much more effective. That would be the main reason to go with ibuprofen in my opinion. But again if you take medical advice from an internet comment you're already doing it wrong.
- thenthenthen 6mo agoI had a swelling and even mild fever from an infection and what really helped was Loxoprofen, Ibuprofen did not do anything.
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- theptip 6mo ago> if I needed a painkiller, I’d try to take ibuprofen rather than acetaminophen. My logic was that if eight grams of acetaminophen could kill my liver, then one gram was probably still hard on it. This article is explicitly considering usage as painkiller. You can’t use Tylenol as an anti-inflammatory so it’s meaningless to compare them for that distinction usage.
- pikminguy 6mo agoIf you need a painkiller it's worth considering the source of pain you are trying to kill. This is an article with a chart considering 11 different situations you might be in and which pill is better for each. A 12th line for "there is also some swelling in the part of you that hurts" would make sense to me.
- thisisauserid 6mo agoSort of mentioned in one of the side notes: Acetaminophen is the only medication of its kind approved for infants under six months because the liver develops faster than the kidneys.
- merlindru 6mo agoabout once a month since my childhood i get an awful, slowly ramping headache that makes it unable for me to think or function. it seems to happen more when i'm overweight, making me think it's blood pressure (BP) related, but then doing the valsalva maneuvre, which spikes BP, doesn't cause any problems at all. i've tried acetaminophen, even 1.2g of it, to no avail. it doesn't help. i've also tried every other remedy, such as curcumin, fire/ice locally, hot and cold showers, neck massages, working out muscles that may be involved in it, everything. nothing helps. except for ibuprofen. 400-600mg kills it every time. at least for me, there seems to be a definite difference, as ibuprofen can anecdotally help in some situations that acetaminophen can't. i wonder what exactly it can / can't treat and why.
- MeteorMarc 6mo agoIf you have serious pain, you probably need both of them.
- eth0up 6mo agoUnfortunately, both of these medicines have substantially adverse effects on me. Ibuprofen destroys my stomach, often affecting me for days after a single dose. Acetaminophen leaves my stomach fine, but has subtle, but noticeably negative affects on my cognition and general energy levels. Both are often ineffective for bouts of significant pain, which is frequent for me. To mitigate this, I supplement with NAC (N-Acetyl-L-Cysteine) anytime I'm forced to take acetaminophen. I will also sometimes take Betaine Anhydrous. I do the same for ibuprofen, but sans betaine and instead take aloe, probiotics (bacillus subtilis/coagulans, Mastic Gum and experiment with other things. For acute pain, neither does anything. And though I'll get attacked for this here, I find a stout dose of quality, lab tested Kratom (red strain) to be far more effective than both acetaminophen and ibuprofen combined. However, for regular pain, this is not a good plan, as the withdrawals can exceed the nature of the problem itself. I sure do wish we'd get over the anti opiate [1] craze someday, or at least discover and make available an effective alternative. 1. Aside from constipation and obvious risks of dependency (or abuse), opiates have none of the deleterious effects of ibuprofen or acetaminophen, and the constipation is easily mitigated, and a bit of agmatine sulfate for saying adios when the pain subsides.
- arijun 6mo agoWhy don't we package Acetaminophen with NAC? The reason I can think of is it will be delivered earlier than it normally is in cases of overdose. That would mean there will be less NAC in your system than at the peak dosage when the body starts using the pathway that needs it. But every little bit must help, no?
- aeturnum 6mo agoThis American Life had a good 2013 episode on the tricky dosing of acetaminophen [1]. It's also worth saying that capsaicin is used for pain relief[2]! Especially for things like muscle and joint pain. [1] https://www.thisamericanlife.org/505/use-only-as-directed https://www.thisamericanlife.org/505/use-only-as-directed [2] https://my.clevelandclinic.org/health/drugs/18080-capsaicin-cream-lotion-or-solution https://my.clevelandclinic.org/health/drugs/18080-capsaicin-...
- drewg123 6mo agoAt least in the US, its hard to find single-purpose over the counter medicines. Most "cold" remedies now also include acetaminophen. So that makes it easier to OD on acetaminophen if you take some by itself and then don't realize that your cough syrup also includes it. I think this (bundling acetaminophen) should be banned for safety reasons.
- guzfip 6mo agoI thought this was partly intentional to discourage DXM tripping. Same reason the only opioid they seem to give anyone now is the shitty hydrocodone/acetaminophen mix.
- kenjackson 6mo agoThis was a masterclass in science writing for laypeople. Going to find more from this author.
- dismalaf 6mo agoAcetaminophen and Ibuprofen are taken for different things and can be taken together as well, it's not a versus... Ibuprofen is mostly for inflammation and Acetaminophen for fever and pain. Now there's overlap in that both work on headaches and some other kinds of pain but the main use case for each is different.
- chermi 6mo agoWhat about cox-2 like celoxib? Chronic pain for 15 years checking in.
- Carioca 6mo agoOne weird analgesic/antipyretic is metamizole/dipyrone[1]. It's banned in the US and some of Western Europe (and prescription-only in other countries). Yet it's by far the most used medication here in Brazil and I have actually never heard of adverse effects, except some allergies [1] https://en.wikipedia.org/wiki/Metamizole https://en.wikipedia.org/wiki/Metamizole
- SirMaster 6mo agoI always use acetaminophen as ibuprofen doesn't seem to do anything for me... I have personally never found a use for ibuprofen that ever made any noticeable impact for me. I have tried it for headaches, fever, muscle pain, nerve pain, etc. It never made a noticeable improvement for any of these while acetaminophen works amazingly for all these. Acetaminophen even works better for me for pain than an opioid like Tramadol... I don't understand it, but it is what it is.
- conductr 6mo agoIbuprofen works for me about the same as acetaminophen but it tears my stomach up. If I use it for more than a two or three days at labeled usage rates, I’ll feel like I have an ulcer. The article mentions this but it’s my answer to “how are laymen supposed to know?” In my case it’s painfully obvious to use ibuprofen with caution
- KacharKhan 6mo agoDoc here. One thing every single member of the general public needs to get drilled into them: Medical science is NOT intuitive. You cannot just read the mechanism of action of a drug and infer a dozen things from it. A drug's mechanism of action, its indication (when it ought to be used) and its adverse effects CANNOT simply be inferred logically from each other. Biology is orders of magnitude more complex than SE/CS or any other field for that matter. I presume majority of readers here have SE/CS background. Dudes! the artifacts and systems in SE/CS have the following two properties: 1. They are human artifacts. We know exactly how they are build. The theory is all publicly accessible in principle. 2. They are layered logically on top of each other. Machine code, assembly, C, Java ... so on. Firmware, OS, drivers, apps .. etc. Clean layering. The above two core properties make it possible to more or less reliably reason about bit SE/CS systems from first principles. The complete absence of above two in medicine means you cannot do the same there. Be very very careful when you import thinking habits for daily life , or other fields of expertise, into medicine. "This video is just for informational purposes. Consult your health care provider for your particular situation" ...is not just a legal precaution. It is a sound life advice. Nothing in life is more crucial to leave it to the experts as health/medical inference and decision making.
- pavlov 6mo agoOne of the greatest Silicon Valley tropes is when boring software guys get rich, lose the plot, and start reinventing physics from first principles because they think the universe is like computer science. The solace of made-up physics is there for every mediocre dude, from Uber founder Travis Kalanick down to any random guy who made $10M as the CTO of a third-rate video conferencing app and immediately broke up with his girlfriend.
- mcoliver 6mo agoOddly specific. The interactions and variables in biology and physics create way more permutations than many (perhaps all?) people can wrap their heads around but that doesn't mean the possibility of reasoning from first principles doesn't exist. There are very well defined pathways in both medicine and physics. The ones we haven't discovered are most likely much more complex and may contain recursive loops that make tradeoffs inevitable. Or not. The rapid improvement in pattern recognition and processing leads me to believe we are in for a wild time over the next 10 years with a ton of breakthroughs in both physics and medicine.
- larrik 6mo agoThis article was eye opening. I'll admit I find ibuprofen to be a bit of a wonder drug. When I have a cold or flu, ibuprofen by itself is the most impactful medicine I take. The anti-inflammatory effects make my whole body better, including my sinuses (my sinuses are a disaster normally anyway, though). I do avoid taking it otherwise because my headache doctor says it causes rebound headaches, though. But if I need to go out somewhere and am not feeling well? 2 advil and I'm good to go. The only medicine I've found more effective for that is (real) sudafed, but if I take that after like 10am I won't sleep that night.
- tristor 6mo agoInteresting, I've always preferenced ibuprofen because I was concerned with long-term liver effects from acetaminophen as a casual drinker and someone who is a bit overweight (both things negatively impact the liver). I think one thing that's hard to understand as someone with no medical background is the long-term impacts of medications, it sounds like once it's processed there's no long-term negative impact for acetaminophen, where-as alcohol does have long-term negative impacts on the liver even after processing. Also, there's not enough information placed on the label or known how important not being dehydrated is to having good outcomes with ibuprofen. Obviously dehydration is bad, but it's also very commonplace.