Acetaminophen vs. ibuprofen

https://asteriskmag.com/issues/14/the-mystery-in-the-medicine-cabinet

by nkurz • 3 months ago

706 483 3 months ago

_--__--__• 3 months ago

My 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_so6• 3 months ago

If 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....

jeroenhd3• 3 months ago

The expert system relies on training data, and most of the medical data on the internet is either outdated or outright wrong.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.

themanualstates2• 3 months ago

We have this already; the side-effect reporting and post-marketing studies.

seemaze• 3 months ago

I 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.

petesergeant5• 3 months ago

I 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.

kgwgk3• 3 months ago

It’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.

ghosty141• 3 months 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.

mordae3• 3 months ago

Some know that you can combine ibuprofen with paracetamol to get extra pain suppression.

And when you want to be gentle, you alternate between them.

7bit• 3 months ago

If your doctor recommends to take a specific dose, take the specific dose. Don't half it. Taking half of stuff can also cause further damage. Like with antibiotics, where it can lead to bacteria becoming resistant.

So don't be the "smarter" person. Do as your doctor says and if you have doubts, consult another doctor before just doing what you think is safe, but actually isn't.

mordae3• 3 months ago

This. But also don't trust doctors and always remember Richard Feynman's Wife. Science is hard.

nerptastic• 3 months ago

Is this not the case for OTC drugs? Specifically, the two mentioned in the article. I rarely take either of them, but if my doctor tells me to take 1 ibuprofen every 6 hours or so, if I halve that am I actually doing more damage?

pxtail2• 3 months ago

Yes that's correct, but in doing so remember that only person that cares most about you and your health is YOU - doctor cares about you for 10-15min, then next patient is waiting, and the level of doctor's care is inversely proportional to the level of burnout.

NikolaNovak• 3 months ago

Well, 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.

jasperry2• 3 months ago

This 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_• 3 months ago

Same here. Great article.

I avoid both and stick with naproxen sodium. Any issues with that one? Lasts the longest too.

pkaye• 3 months ago

Both 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.

jasperry2• 3 months ago

Looking at the Wikipedia article, it seems naproxen is a NSAID like ibuprofen and can cause all the same gastrointestinal issues.

y1n0• 3 months ago

Some 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• 3 months ago

None 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).

guelo• 3 months ago

All the over the counter NSAIDs have a similar safety profile.

dilyevsky2• 3 months ago

Naproxen sodium has much higher risk of GI damage especially with long term use.

Mars008• 3 months ago

I had to use naproxen for some time as most effective way to control inflammation. Actually the only way, ibuprofen had some effect only in horse dozes. After visiting doctor, analyses, checking available sources was able to eliminate the reason of inflammation. Apparently it was a well known problem/solution. So far so good. Not sure about the long lasting effects of naproxen use.

KaiserPro4• 3 months ago

wait, how are you getting naproxen?

Whenever its prescribed here, its paired with some sort of intestine protection medicine to stop it burning holes in your stomach/intenstines

Ibuprofen is much safer, so long as you eat with it.

Paracetamol is also safer, so long as you don't OD.

BUT! so long as you stay below 4 grams a day, you'll be safe. (yes yes, in some situations you can take double, but unless you are under supervision, thats asking for liver pain.)

makeitdouble• 3 months ago

Still take it with a huge grain of salt. Even official advice usually has severe limitations due to its broadness or straight politics, so medical analysis from random blogs truely isn't the best.

Acetoaminophen also has issues for people with weaker stomachs (I can attest), and will come with additional medication to cover these effects as needed. The whole "Is it safe yes/no" table has many asterixes and might be outright false depending on the how you look at it.

As usual, it's just complicated.

ButlerianJihad3• 3 months ago

Is the salt supposed to offset hyponatremia or something?

dncornholio2• 3 months ago

Never take anything that written on the medications with a grain of salt. Disregard everything that you have read online. The medicine instructions are your single source of truth

dbg314152• 3 months ago

Both 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.

farseer• 3 months ago

Most human medicines would be dangerous to dogs, what is your point?

dbg314152• 3 months ago

Mine was awareness.

Yours is just rudeness. (=

farmeroy2• 3 months ago

I'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• 3 months ago

Unless 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.

farmeroy2• 3 months ago

At least with the folks i hang around, liver damage from years of over-drinking is probably more likely

foobiekr• 3 months ago

Just don't take it on an empty stomach.

burnt-resistor3• 3 months ago

That'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

croes2• 3 months ago

You just might die from taking tylenol if you don't realize your liver is already damaged for other reasons.

If you don’t realize your kidneys are already damaged you might die from kidney failure because of ibuprofen.

JackFr• 3 months ago

My mom fell (88 yo) X-rayed, nothing broken but ignored her history of ulcerative colitis (tough to do, given the colostomy bag she’s worn for 50 years). Sent her home with Motrin. Ended up in the hospital for two weeks with bleeding ulcers.

i_think_so6• 3 months ago

How the hell did the attending physician not see a colostomy bag during the exam?!

wonnage• 3 months ago

This 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• 3 months ago

500mg 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• 3 months ago

Yeah 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• 3 months ago

8g 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.

throwanem• 3 months ago

You should not switch medications based on the uninformed ramblings of [crazy] people.

pugio2• 3 months ago

Really 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• 3 months ago

You 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• 3 months ago

Yes, 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/

epcoa• 3 months ago

No. 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.

perching_aix• 3 months ago

s/idiot-proof/idiot-resistant/g

Also applies to most similar phrases ending in -proof. Should be eye-opening.

Nursie5• 3 months ago

When was this changed?

I arrived in Aus in 2021 and was amazed to be able to buy a pack of 40+, coming from the UK where the limit had been in place for some years.

pugio2• 3 months ago

Jan 2025: https://www.psa.org.au/changes-to-paracetamol-scheduling-wil...

It's the usual public health balancing act of help vs harm.

brainwad4• 3 months ago

You can still buy 100 packs, they are just behind the counter at chemists. TBH it's a rather stupid restriction - do they think people only ever own 1 packet of paracetamol at a time? In my household we have at least half a dozen, including a 100-pack from Oz and a 500-pack from America.

throwaway274485• 3 months ago

What does ingesting 10g of acetaminophen even look like? I've got to imagine the fatal dose is far, far, far lower with chronic usage. Finding out that people are ingesting grams is profoundly disturbing.

petesergeant5• 3 months ago

What does ingesting 10g of acetaminophen even look like?

20 not-especially-large tablets

colechristensen• 3 months ago

Taking too much acetaminophen is bad for you but 10g is 20 extra strength pills and that much isn't likely at all to kill you but damage your organs is quite possible. Reading this might make someone in a bad place think that much will do the job and it won't. Tylenol poisoning's most likely outcome is permanent organ damage and pain, don't try it.

devmor• 3 months ago

I have taken 4-5g in a day while suffering from intense pain before.

There is a limit to the amount of opioids they will prescribe you, even if you are in mind shattering pain. For instance while attempting to get your dental insurance to actually cover a treatment you may find yourself between risking organ damage or risking $5000+ in ER visit bills only to have them refuse to give you anything but Tramadol.

mzl• 3 months ago

I've been prescribed slightly more than 5g per day (2 x 650mg tablets every 6 hours) for pain after an operation jointly with ibuprofen, which is scarily close to the limits.

hannob• 3 months ago

Buy a pack of 20x500mg (just checked, common size in Germany), take 2-3 every half hour for a while.

Sure, that's extreme. But if you're unaware of the risks, you feel sick, and you believe it's helping you.

I mean, people aren't killing themselves in masses with it, but it happens every now and then. Easily imaginable that one in a few million people will have enough tendency to take more pills and is unaware of the overdose danger.

simplicio• 3 months ago

Extra strength tylenol is 500mg a tablet, so 20 pills. Think most of the accidental ODs are due to people not realizing its included in other cold meds, and also being loopy from whatever illness they're trying to manage, and so end up forgetting when they last took the meds.

Its also a pretty popular choice for people trying to kill themselves, though, so I suspect a non-trival chunk of ODs in the statistics given in the article were intentional.

rao-v2• 3 months ago

Could somebody package Tylenol with a sufficient amount of NAC to de-risk it? I suspect such a formulation would not require trials?

djsavvy• 3 months ago

See superscript 6 on the article. Apparently NAC might has side effects of its own.

986aignan• 3 months ago

Certain esters have been found to be much safer (in mice, at least):

The glutathione hepatic values in mice obtained by intraperitoneal injection of the ester are superimposable on controls and the oral LD50 was found to be greater than 2000 mg kg^-1 and the intraperitoneal LD50 was 1900 mg kg^-1 ...

That's for pyroglutamic and glutamic acid esters of paracetamol: https://pubmed.ncbi.nlm.nih.gov/8799871/

and more general analogs apparently can also be designed to not produce NAPQI:

Thus, in 2020, N-sulpharyl-APAP prodrugs 39–40 (Fig. 11) were developed. [...] They are not hepatotoxic because they do not generate toxic metabolite NAPQI, even in concentrations equal to a toxic dose of APAP (600 mg kg^−1 in mice).

https://pubs.rsc.org/zh-tw/content/articlepdf/2024/ra/d4ra00... p. 9702.

These would probably require trials, though.

Natsu• 3 months ago

I've heard it suggested that acetaminophen just come with a small dose of NAC alongside it to make it safer. I guess this would require a lot of regulatory work to approve, but given that 500 people a year OD, it seems like a thing we should at least consider.

Meanwhile, it's funny that it seems like acetaminophen should safer in more scenarios, but the other has a lot of overdoses with typical use, I guess that's why there's a gap between the two, because ODs are apparently a lot more common or at least more legible than problems caused by the other drug.

eru2• 3 months ago

Here in Singapore NAC is sold to make muckus more liquid to alleviate coughs.

Apparently for some people it also helps with lessening tolerance for their ADHD meds, but I'm not so sure about that.

user_78323• 3 months ago

Apparently for some people it also helps with lessening tolerance for their ADHD meds, but I'm not so sure about that.

I'd believe it. I first heard of NAC on the nootropic subreddit in a past lifetime. The benefits vary, but generally it's a safe thing with a low chance of making anything worse, but a possibility to improve things. Many neurodivergent folk have written about how they benefit.

I'd give more info on the exact benefits they found (iirc OCD and rumination loops could be broken more easily), but unfortunately my memory is failing me.

CalRobert2• 3 months ago

How is nac (acetylcysteine) delivered there? I can buy dissolvable tablets here in Europe but from what I see that’s less helpful for mucous, things like mucomyst require inhalation, which isn’t in otc products I know of.

Gareth3212• 3 months ago

My anecdotal experience is that NAC makes me much more tolerant to alcohol. As in, I can drink a lot more without feeling the effects. Since I don't get the same buzz, I care less about reaching for a beer.

triage8004• 3 months ago

NAC is so amazing for us in terribly polluted areas. Also great before drinking

garyclarke27• 3 months ago

Glycine + NAC even better, both precursors for Glutathione, Glycine also great for sleeping.

harmonics• 3 months ago

I am blessed with living in one of the most polluted areas in the world (PM2.5 going into thousands of µg/m³ in winter; summers are not much better due to dense chemical smog). Can you say more about how you're using it to combat that? Thanks!

dgan2• 3 months ago

I randomly bought NAC just to try it. I dont know about the chemical interactions, but going out with collegues at that time taught me that it's basically impossible to get drunk. Usually a pint of beer is enough to make le feel at least a little dizzy, but when taking NAC, it was all like drinking water

elric2• 3 months ago

When I go out drinking with my pharmacist buddy, we take NAC before going out. He swears it makes hangovers less likely. I can't say I've noticed that particular effect, but I do seem to sleep a bit better on those nights.

jcynix2• 3 months ago

NAC taken before consuming alcohol has a positive effect apparently, but taken afterwards it's detrimental as mentioned here: https://en.wikipedia.org/wiki/Acetylcysteine

keane2• 3 months ago

Just a note: “research about the safety of taking NAC every day for the long term is limited.” cf. a concerning 2019 animal study regarding higher risks of cancer https://doi.org/10.1172/jci.insight.127647 also discussed at https://www.science.org/content/blog-post/n-acetyl-cysteine-...

Gareth3212• 3 months ago

Same! I thought I was going crazy but the effect is clear and reproducible. My hangovers are also less bad.

ericd• 3 months ago

If you all think NAC is great, wait till you try liposomal glutathione (glutathione is one of the things NAC is a precursor for, one of the general take-out-the-trash compounds for your cells). Of all the supplements I’ve tried, it has probably the most immediately noticeable positive effect (maybe because you take it by leaving it under your tongue to be absorbed sublingually for a bit before swallowing). Generally leaves me feeling great, even if I was kind of dragging and tired beforehand.

ncruces2• 3 months ago

Similar rules in Europe, or at least, Portugal.

rramadass2• 3 months ago

The 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-...

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

croes2• 3 months 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?

rramadass2• 3 months ago

What? Read the article fully; it has to do with "negative empathy" different from "positive empathy".

Dominik Mischkowski is a Pain Researcher at Ohio University who has been studying this for a while. The word "suspects" here is statistical research-speak meaning there is a correlation (w.r.t. positive empathy) but more studies are warranted (w.r.t. negative empathy). That is all.

Fnoord• 3 months ago

After 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.

kazinator5• 3 months ago

You 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• 3 months ago

As 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)

kazinator5• 3 months ago

The 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.

Melatonic3• 3 months ago

I weirdly always found Naproxen much more effective than ibuprofen but also find Celebrex great which seems to further confuse the whole COX 1 vs 2 situation

chermi2• 3 months ago

No. There is no one solution. For some things Naproxen simply doesn't work.

kazinator5• 3 months ago

Do you mean, compared to drugs in the same family that work via the same mechanism?

KnuthIsGod• 3 months ago

This is why asking for medications based on the last thing you saw on social media is a really bad idea.

pupppet• 3 months ago

If you don't make a habit of taking either, what actually performs better?

petesergeant5• 3 months ago

Depends 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_spool3• 3 months 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.

ButlerianJihad3• 3 months 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.

SpicyLemonZest• 3 months ago

For non-habitual pain relief, combinations outperform either in isolation. Studies show a significant effect, and anecdotally for me it's often the difference between dampening and outright curing a headache. Combo pills are widely available in most countries (branded as Advil Dual Action and Motrin Dual Action in the US), but they're pretty new so consumer awareness isn't yet super high.

rubatuga• 3 months ago

If you take either of these medications regularly talk to your doctor.

burnt-resistor3• 3 months ago

IANADATINMA.

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_Ibuprofen...

1. https://pubmed.ncbi.nlm.nih.gov/25516006/

klausa• 3 months ago

For those who struggled similarly to me:

I Am Not A Doctor And This Is Not Medical Advice.

(I think?).

DANmode• 3 months ago

Should definitely hold up in whatever court they’re trying to avoid being in, lol

alok-g• 3 months ago

OMG! 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• 3 months ago

This is a repost from an article that was posted last week: https://news.ycombinator.com/item?id=47799088

justinc86875• 3 months ago

I 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.

justinc86875• 3 months ago

P.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.

vidarh2• 3 months ago

It 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)

isoprophlex2• 3 months ago

I'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!

skrebbel• 3 months ago

People who are in a lot of pain and don’t know the risks.

Rationalizations like “they probably put the limit way lower than the real limit so idiots don’t OD themselves, so I can safely take a bit more” become very attractive when you’re in a lot of pain.

vidarh2• 3 months ago

If you take 2 on average every 4 hours, you're at 12. If you're feverish or otherwise feeling ill enough and sleep deprived enough, forgetting when you took them last is easy. Personally I write down the time I took the last one.

brainwad4• 3 months ago

It often happens when people take the max dose of straight paracetamol, and then also take another drug that has paracetamol in it without knowing that (e.g. a codeine/paracetamol or ibuprofen/paracetamol combination).

mordae3• 3 months ago

Hot Coldrex (Tylenol) + Pills. People don't read.

ufo• 3 months ago

It can also happen if the person has some disease that affects the liver, which in turns lowers how much of the drug they can take.

justinc86875• 3 months ago

You are running a high fever or have a massive headache, so know you are going to max out at 4g/day. At that point, it's kind of hard to keep track of the clock.

"My head is pounding. Shit...did I take this at 3PM or 5PM? I know I took it and then fell asleep, but I can't remember when. It is now 9PM, can I take more or not?"

e404• 3 months ago

If you're taking a lot of pills, which ill people often do (e.g., cancer patients), it's easy to forget.

Also, people with memory issues...

Salgat• 3 months ago

My mother in law did this. There are a lot of ignorant and uneducated people out there. They think "take this for pain" = "take more for more pain", popping one an hour not really understanding how insanely dangerous it is since acetaminophen has such a subtle effect until it's too late.

alphager• 3 months ago

It's in all kinds of medicine. People take some pills and then add a cough syrup, not noticing that the syrup also contains it as an active ingredient.

e404• 3 months ago

Agreed!! Here’s my trick: take 1g and set an alarm for +6 hours. If I don’t need it, fine. If I do, repeat.

marcogarces2• 3 months ago

In mozambique i was committed to the hospital with my liver failing after spending two weeks taking acetaminophen daily because everyone at work got sick and someone had to keep the business up (it was a bank, our IT department was very specific and only 6 people knew that job and everyone got extremely hill). After two weeks, i finally went to the hospital and I couldn't leave; spent the next two weeks fighting for my life and at some point I was told I was not going to make it. All due a simple over the counter medicine... crazy. This was 2016. To this day I still get extremely tired if I take it, so I have to choose it carefully when to take it.

molf• 3 months ago

That sounds terrible! Glad you made it out alive and hopefully recovered well! Out of curiosity: how much did you take per day?

jmalicki• 3 months ago

In my wilderness first responder class they emphasized taking a cocktail of ibuprofen and acetaminophen - both are effective pain relievers, each with different dangerous side effects.

The benefits stack, the side effects don't.

So if you are going to be loading up on higher doses of pain relief, take half acetaminophen and half ibuprofen.

alexcpn• 3 months ago

I created this open-source application (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• 3 months ago

I 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.

jeroenhd3• 3 months ago

I 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• 3 months ago

You 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/

Phui3ferubus2• 3 months ago

Plus 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• 3 months ago

For 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• 3 months 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.

dilyevsky2• 3 months ago

High 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• 3 months ago

https://www.eurekalert.org/news-releases/1086746

This is semi recent research on how it might be blocking pain

topham3• 3 months ago

The 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.

wouldbecouldbe4• 3 months ago

Try dealing with a herniated disc, more ibu is definitely better. Too little wont do anything, proper dose and you feel healed

e404• 3 months ago

Spine issues are the single thing that pish me to ibuprofen or naproxen over acetaminophen. The latter does nothing for my issues.

shankr2• 3 months ago

Yeah can confirm. I try to keep it low but then pain lingers for days and cumulatively over the days most probably I took as much as I should have taken in stating few days already.

SirMaster6• 3 months ago

I had a herniated disc and severe nerve pain. I took 16 ibuprofen a day, 4 200mg pills every 6 hours, it did nothing that I could tell. I also used a methylprednisolone dose pack, also didn't seem to help. I also tried prescribed opioid (tramadol), didn't seem to help much.

Acetaminophen worked far, far better than all these. It worked so well, but i wanted to be careful to limit myself to 3000mg a day, so I took 1 500mg pill every 4 hours for a few days while awaiting surgery. It's the only thing that got me through it. Even a epidural lumbar steroid injection didn't help...

teiferer• 3 months ago

I agree with your overall sentiment. But allow me some objections:

There is this broken idea, particularly apparent in North America, but in western society that more is better for many things. It's not.

But it is. The faster I go, the earlier I arrive at a destination. The more I eat, the later I'll be hungry again. The more I pay, the more I can buy. The more I smile, the more people smile back. It's all-pervasive in life, and "more is better for many things" is just obviously true. Not for all things and there are limits of course.

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.

A higher dose gets broken down slower, as in, the threshold below which the effect is reduced is reached later. Not a reason to damage your kidneys and better take smaller doses more often, but it's not fully accurate to say there is a limit and anything above has zero effect.

cybersol• 3 months ago

I 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• 3 months ago

The 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• 3 months ago

I 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?

Eisenstein2• 3 months 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/

robocat2• 3 months ago

About 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.

georgeburdell• 3 months ago

I 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.

kakacik3• 3 months ago

Yeah 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• 3 months ago

I’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• 3 months ago

Nice, now do Acetminophen vs Dexibuprofen.

blueblisters• 3 months ago

Acetaminophen (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• 3 months ago

I 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...

magicalhippo2• 3 months 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-ve...

[2] https://nhi.no/for-helsepersonell/nytt-om-legemidler/arkiv-2...

schnitzelstoat• 3 months ago

It’s the same in the UK - paracetamol is the default. Ibuprofen is better for reducing swelling, inflammation etc.

rustyhancock7• 3 months ago

Ibuprofen is better are reducing fever and managing headaches.

Paracetamol is the safer version Phenacetin. You used to be able to buy aspirin, phenacetin and caffeine..but phenacetin with withdrawn. APC when it was marketed was very popular but soon you were told to never give children aspirin for a fever so we used Paracetamol. Then Phenacetin was withdrawn and paracetamol became part of APC (like Alka selzta XS , or just the popular caffeine paracetamol combos)

Paracetamol came in as safer but similar, yet no where near effective. It captured bith the market feeling of its pros and cons. So we interpreted it as safer than alternatives (especially aspirin for children due to Reye syndrome). But also dangerous which might be why OPs view was that ibuprofen is safer.

The NNT (number of people you'd need to take it) to be headache free after 2 hours is about 12-20 for paracetamol. But only 7-10 for ibuprofen.

It's quite surprising that paracetamol became the defacto analgesic given it performs so poorly but it was historical inertia. And plenty of people argue that if we were to start over we would not make paracetamol OTC.

ncruces2• 3 months ago

Same in Portugal.

watwut4• 3 months ago

The only issue with treating pain with paracetamol is that it does not work at all against the pain.

It works against fewer or maybe mild inflammation and what not ... but it does absolutely nothing with actual pain. It is placebo at best.

sitharus2• 3 months ago

but it does absolutely nothing with actual pain

Neither paracetamol nor ibuprofen work by blocking pain. Depending on the type of pain and your physiology it can range from really effective to not at all.

I only take paracetamol, it works better than both ibuprofen and opioids for me. I know other people who have the exact opposite experience. There’s no absolute here.

postexitus2• 3 months ago

What is actual pain?

arethuza• 3 months ago

Many years ago I had 4 surgical procedures done around my nose/throat at the same time - straightening a deviated septum, turbinectomy, enlarging the openings into my sinuses and removing my tonsils. This meant I couldn't breath through my nose for about a month - and breathing through your mouth when you've just had tonsils removed is quite painful.

Soluble paracetamol literally turned the pain off like a switch - of course I was limited as to how much I could take, which I was careful to stick to but I was almost in tears waiting for the time to come where I could take more paracetamol.

So in some situations paracetamol can be an extremely effective painkiller.

danlitt• 3 months ago

It may not work for you, I don't know. But it absolutely does work in general!

ViktorRay2• 3 months ago

Your statements are factually incorrect.

Double blind placebo controlled trials have shown that acetaminophen/paracetamol is superior to a placebo at controlling pain.

iamniels• 3 months ago

In Western Europe too.

but it does absolutely nothing with actual pain. It is placebo at best.

This is simply false.

shlant• 3 months ago

you responded to the wrong comment. I assume this want mean for https://news.ycombinator.com/item?id=47860061

watwut4• 3 months ago

It is not false. It does nothing. Head hurts, you take paracetamol ... head still hurts. The belly hurts, you take paracetamol ... nothing change.

When I took ibuprofen it did actually made an actual real change.

gregoryyy• 3 months ago

Yup - in the UK, paracetamol is usually recommended for general pain relief before Ibuprofen. Additionally, Ibuprofen and NSAIDs have a lot of interactions which can make them unsafe - SSRIs or blood thinners for example.

lloydatkinson• 3 months ago

Where does Aspirin fit into this? I only use paracetemol and ibuprofen. The one time I tried asprin I got a stomach pain.

mghackerlady• 3 months ago

Ibuprofen interacts with SSRIs? Anecdotally I've never had any problems with my Escitalopram and the Wikipedia page doesn't mention any interactions

oulipo2• 3 months ago

Same in France

apatheticonion• 3 months ago

Really? I get headaches semi-frequently and my first line of defense is ibuprofen, I use acetaminophen sporadically as a last resort

sfn42• 3 months ago

I take both. 500-1000mg acetaminophen, 200-400mg ibuprofen. Usually helps for headaches which I get frequently. I only take them for the worst headaches though, so probably once every couple of weeks on average.

dncornholio2• 3 months ago

Why? Does ibuprofen work better? It's bad for your stomach walls.

jcul3• 3 months ago

In Ireland you can buy acetaminophen in stores, gas stations etc.

For ibuprofen you need to go to a pharmacy.

lazzurs• 3 months ago

I couldn't get over this after moving here from the UK where you can pick up a pack for 10p in a supermarket.

domh• 3 months ago

That is interesting. In the UK they're both available pretty much everywhere, and they're some of the cheapest drug prices I've seen anywhere in the world... ~20p for 16 tablets or something.

socalgal2• 3 months ago

Here in my body, it tells me acetaminophen does absolutely nothing for pain where as ibuprofen does. I wouldn't take ibuprofen for fever

bluGill• 3 months ago

I 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• 3 months ago

This 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.

vanderZwan13• 3 months ago

I feel like this is one of those things where Europe and the US are very different, culturally speaking - I've lived in the Netherlands, Germany and now Sweden, and the amount of painkillers used and prescribed here seems much lower than what Americans tell me is normal in the US.

Pain a warning signal from the body. It's something one should listen to, not just try to ignore and overrule. If I sprain my ankle it only hurts when I lean on it. Because it's healing. So I don't. Why would headaches or other "inconvenient" pains be different?

In my case headaches are usually caused by sleep deprivation causing high sensitivity to external stimuli, muscle tension, dehydration, or some combination of that. So I'll first try to take a nap and/or stick to low-stimuli environments, have a good stretch and/or heated up massage pillow for the neck, and make a quick home-made oral rehydration solution with some salt and sugar. That usually alleviates most if not all of the pain.

And I'm not saying painkillers should always be avoided. If I have insomnia-induced headaches in the morning and a long day ahead with many social interactions, then I know that headaches will make me a grumpy asshole, so I'll obviously will take a painkiller for everyone's sake. And sometimes I can only fall asleep if I take a painkiller to get rid of the headache first, so I need it to break the vicious cycle. I'm not saying people should "walk it off" here, just to focus on trying to figure out the actual cause first before medicating the symptom way. That's also healthier in the long run, no?

vanderZwan13• 3 months ago

That's also healthier in the long run, no?

Long-winding tangential anecdote (which is why I'm replying to myself in a separate comment), but I have pretty extreme example of this: I managed to avoid nearly all suffering after getting a tonsillectomy in my mid-thirties, while using almost no painkillers.

My ENT surgeons warned that me "I'd hate him for about a month, then I'd love him for never having to deal with [serious medical condition that justified the removal of tonsils] again". He prescribed all kinds of stuff to alleviate the expected suffering, and advised me to try to take the weakest options I was comfortable with, because the heavier ones might have some unpleasant side effects. It's the only time in my life I've been prescribed painkillers at all, actually (this was in Sweden, btw).

I got codeine/paracetamol as a coughing suppressor and mild painkiller, a couple of heavier painkillers for if it got worse (I forgot the name but some kind of heavy-duty variation of diclophenac that you can only get with a prescription), and some kind of nasty solution to gargle with that supposedly would numb my throat if it got really bad. I've been told this is nothing compared to what you can expect in the US.

Then in the evening after the surgery, when I was trying to eat a soup with my mom, I realized soup didn't hurt as much as drinking plain tap water. And then I thought: isn't it odd that drinking plain water feels like a thousand paper-cuts in the open wound in my throat, but whenever the coughing made the wounds open and bleed, the blood doesn't hurt at all? Blood is mostly water, so what is the difference? Could it be the salt? Is this similar to why drinking demineralized water is bad for you? What's the opposite of demineralized water? Oral rehydration solution. Ok, trivial to make, let's try that. I'll drink it luke-warm to be close to body temperature too.

Turns out that that works. Oral rehydration solution is almost painless to drink after a tonsillectomy. I know this is anecdata, but sample size three: I've since shared this information with two friends who got a tonsillectomy, and they've been extremely grateful for this tip.

It even seemed to speed up my recovery, probably due to a lack of irritation triggering inflammation. I was eating solid food within days. DAYS. My mom, a retired family physician herself, couldn't believe her eyes.

I ended up only needing the codeine/paracemtal in the evening to suppress coughing in my sleep, and brought back all the other pain-killers without opening them.

markovs_gun• 3 months ago

Perdue Pharma/The Sacklers went on a huge campaign in the 90s convincing doctors and the general public that pain was bad and worth stopping at any cost and even though they were pushing opioids, I can imagine this also increased the cultural tendency to use NSAIDs as well.

spzb• 3 months ago

AIUI one of the many quirks of the US health insurance system is that a lot of people have only minimal cover which doesn't include things like physiotherapy and rehabilitation treatment. That means that they often can't treat a painful condition at source so their only option is to mask the pain with painkillers.

beAbU3• 3 months ago

the amount of painkillers used and prescribed here seems much lower than what Americans tell me is normal in the US.

Americans' relationship with painkillers is absolutely unhinged.

huhkerrf2• 3 months ago

Since we're talking about acetaminophen and ibuprofen, in France you're liable to end up with a medicine cabinet full of acetaminophen, because almost anytime you go to the doctor with any type of pain, they add it to the prescription.

internet_points2• 3 months ago

home-made oral rehydration solution

water?

EDIT: I see it's a thing. Salt, water and sugar.

lapcat8• 3 months ago

Pain a warning signal from the body. It's something one should listen to, not just try to ignore and overrule.

This is vastly overstating the rationality of the human body. It's no more rational than the human mind, which is often quite irrational. Your body isn't the product of medical school, nor intelligent design, but rather random natural selection, which is decent but demonstrably far from perfect.

brazzy2• 3 months ago

Pain a warning signal from the body. It's something one should listen to, not just try to ignore and overrule. If I sprain my ankle it only hurts when I lean on it. Because it's healing. So I don't. Why would headaches or other "inconvenient" pains be different?

Pain is also suffering, and there is no virtue in suffering needlessly.

Even more importantly, there's also chronic pain, which can severely affect quality of file permanently and is essentially an illness all of its own. Research supports the concept of "pain memory", where chronic pain develops as the result of leaving the pain from a temporary condition untreated.

kryogen1c• 3 months ago

Pain a warning signal from the body

Hard agree, same with fevers. Heat helps kill many diseases, dont blunt your body's defenses.

There are exceptions to both rules, but many people forget which part is the exception and which part is the rule.

nbaugh12• 3 months ago

Well for one thing, in America, you gotta get back to work.

Work a manual labor job or one where you're on your feet all day and sprained your ankle? Would you rather miss a week of pay (or worse lose your job) or take some pain killers and work through it?

AshamedBadger56• 3 months ago

You're forgetting that when you're sick and hurt yourself in the US you very likely still have to go to work. Doing some quick research, roughly 25% of the US workers don't have any sick time whatsoever, so you gotta take some painkillers and get back to work. If you need to take time off to go to the doctor, you're no longer getting paid, so...a lot of people don't do that and instead hide the pain with painkillers.

brightball3• 3 months ago

I've taken so much Advil/Ibuprofen in my life it would be impossible to count at this point.

I always got headaches when I was younger and it didn't really stop until I went to college at a higher altitude. When I go back to my hometown, after a couple of days they come back. Some headaches will go away on their own with water or rest, but others that seem to go from one side of my forehead all the way down the same side of my neck seem to only go away with medicine.

I used to have to take Advil what seemed like every other day to get them to go away. Tylenol never seemed to help at all. Aleve actually works better than anything for me.

wat100002• 3 months ago

If pain is a signal, then it's often a car alarm that won't shut up. Even if someone is actually trying to steal the car, I only need to be told once.

Sometimes I get headaches. I don't know why. Maybe there's a cause. I do try things to fix the underlying problem. But it's not instant. While I wait for it, why should I continue to be in pain when the pain medicine is pretty much risk free if I'm not reckless with it?

It's strange that you'll take a painkiller for the sake of others, so you don't bother them by being grumpy, but you wouldn't do the same for yourself. Surely you also don't enjoy being a grumpy asshole even when you're alone.

duzer65657• 3 months ago

This is talking about ibuprofen and acetaminophen, not prescription drugs. Also controlling inflamation and swelling is a very important part of an injury recovery plan; it's not all about Americans complaining about pain.

nkrisc2• 3 months ago

It is a cultural difference.

In my case headaches are usually caused by sleep deprivation causing high sensitivity to external stimuli, muscle tension, dehydration, or some combination of that. So I'll first try to take a nap and/or stick to low-stimuli environments, have a good stretch and/or heated up massage pillow for the neck, and make a quick home-made oral rehydration solution with some salt and sugar. That usually alleviates most if not all of the pain.

Most Americans aren’t allowed to take naps at work or leave for some low-stimuli environment while on the clock. If they take time off to do those things, they aren’t getting paid. So why do Americans take more painkillers? Because they can’t afford to not do so.

So what’s the cultural aspect? That for some reason Americans find this preferable to socialized healthcare.

tshaddox2• 3 months ago

Pain a warning signal from the body. It's something one should listen to, not just try to ignore and overrule.

That's a pretty apt explanation for why pain probably evolved via natural selection, but you can't therefore conclude that all or even most pain is a genuinely actionable warning sign.

Presumably the vast majority of OTC painkiller usage is for short-lived and low-severity pain. I don't think it's a hubristic affront to biology to feel a bit of soreness, note it, then take the painkillers.

smcleod2• 3 months ago

They do in NZ. Paracetamol is promoted as the safest, most well studied pain relief for short and chronic conditions. In Australia however they have just started limiting how many you can buy at a time for some reason while ibuprofen covers the chemist shelves without any such controls despite the risks.

ikr678• 3 months ago

IIRC it's because Paracetamol has low threshold for overdose, and is often blended in with other cold and flu medicines in Aus so it is easy to exceed daily dose if you are say, taking some conbination of paracetamol + Sudafed (paracetamol+decongestant) + drinking a Lemsip (lemony vitamin powder with more paracetamol).

It is only packet size restricted in supermarkets, you can still buy bulk packs from chemists.

acidtechno303• 3 months ago

perhaps it's got to do with packaging sizes. i think an acetominophen od is much worse. most of these countries regulate package size for these drugs, yes? US does not

ubercore• 3 months ago

American in Norway, it's always amusing when I buy some Ibux at the pharmacy, and get questioned about it and steered towards Paracet instead.

raverbashing• 3 months ago

Honestly 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

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• 3 months ago

The 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• 3 months ago

It'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

unmole• 3 months 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.

niek_pas• 3 months ago

Australians (and I presume other Commonwealth countries) default to paracetamol

The same is the case in the Netherlands.

carlsborg• 3 months 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

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.1451...

KaiserPro4• 3 months ago

One 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• 3 months ago

Cool, 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• 3 months ago

why they don't make pills with ibuprofen + nac?

i_think_so6• 3 months ago

Don't forget ye olde aspirin. It has a cheat mechanic: 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-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-ca...

And for those of you with kids: 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

This topic is a bit personal for me and I'm glad it's getting some attention here. Bravo, hackers.

wolfi12• 3 months ago

there is an antidote for paracetamol: ACC (Acetylcysteine)

phonon• 3 months ago

Acetylcysteine

That's NAC (N-acetylcysteine, C5H9NO3S), mentioned in the article many times.

wolfi12• 3 months ago

my bad

globular-toast• 3 months ago

Interesting! 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• 3 months ago

Don’t anyone mentioning this, but alternating acetaminophen and ibuprofen every 6 hours as needed works well

Melatonic3• 3 months ago

Why 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

hilbert424• 3 months 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

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.

Melatonic3• 3 months ago

Wouldn't the other non selective NSAIDs also have this risk ? Or is Celebrex unique ?

d--b• 3 months ago

To 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.

fulafel• 3 months ago

Could they safer and/or higher dose acetaminophen pills if they included NAC?

m12k• 3 months ago

I 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/

[2] https://ddeacademy.dk/ddea/what-new-research-reveals-about-p...

rXwubXUGAm• 3 months ago

In 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.

antirez2• 3 months ago

In 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• 3 months 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).

antirez2• 3 months ago

Didn'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• 3 months ago

If 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.

throwawayffffas2• 3 months ago

To 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• 3 months ago

Is 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.

throwawayffffas2• 3 months ago

He 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.

beAbU3• 3 months ago

For the rest of the world:

Acetaminophen = Paracetamol

nmeofthestate• 3 months ago

Reminds 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.

TrackerFF• 3 months ago

Only 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.

vanderZwan13• 3 months ago

Pain 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• 3 months ago

After reading this, I wonder whether maybe low doses of morphine over a short period are safer than either.

Mordisquitos2• 3 months ago

No, 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.

cue_the_strings• 3 months ago

It is a damn shame bordering conspiracy that 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• 3 months ago

Metamizole 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• 3 months ago

My 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• 3 months ago

Frankly, 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• 3 months ago

Considering 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?

benj111• 3 months ago

For those wondering why it's acetaminophen and paracetamol, the name difference is because they both took different random letters from an even longer name.

FigurativeVoid• 3 months ago

Acetaminophen 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• 3 months ago

Anectdotally, 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• 3 months ago

Without 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• 3 months ago

Scattered 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...

https://archive.is/XRZEU

squidbang• 3 months ago

Anecdotal, 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• 3 months ago

What about low dose aspirin?

pikminguy2• 3 months ago

Something 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• 3 months ago

I had a swelling and even mild fever from an infection and what really helped was Loxoprofen, Ibuprofen did not do anything.

theptip• 3 months 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.

pikminguy2• 3 months ago

If 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• 3 months ago

Sort 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• 3 months ago

about 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• 3 months ago

If you have serious pain, you probably need both of them.

eth0up• 3 months ago

Unfortunately, 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• 3 months ago

Why 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• 3 months ago

This 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

[2] https://my.clevelandclinic.org/health/drugs/18080-capsaicin-...

drewg123• 3 months ago

At 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• 3 months ago

I 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• 3 months ago

This was a masterclass in science writing for laypeople. Going to find more from this author.

dismalaf• 3 months ago

Acetaminophen 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.

chermi2• 3 months ago

What about cox-2 like celoxib? Chronic pain for 15 years checking in.

Carioca• 3 months ago

One 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

SirMaster6• 3 months ago

I 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• 3 months ago

Ibuprofen 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• 3 months ago

Doc 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• 3 months ago

One 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• 3 months ago

Oddly 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.

tedd4u• 3 months ago

"Billionaires Want You To Know They Could Have Done Physics" - Angela Collier (actually has a Physics PhD)

https://www.youtube.com/watch?v=GmJI6qIqURA

thepryz• 3 months ago

While I don’t disagree, the problem I often have with medical professionals is that they tend to be arrogant and unable to take in new information to adapt and evolve their frameworks.

I was married to a doctor, helped them study for board exams, etc and was surrounded by other doctors within our social circle. What most people don’t realize, and most doctors themselves refuse to acknowledge, is how limited by specialization their knowledge can be and how the education of most doctors stops after med school and residency. Nutrition, for example, is barely covered at all.

Yes, there are continuing education requirements and countless journals but most doctors do the bare minimum and don’t keep up. I’d even argue that most physician knowledge tends to be updated more often through drug and instrumentation reps promoting their products by taking them out to dinner and entering them into referral programs, etc.

gardnr• 3 months ago

I wouldn't label that arrogance. In my experience outside the USA, my GP has been unaware of new research / advice / guidelines published by the MoH. They generally respond to new info from reputable sources when you print it out and bring it to them.

I would expect specialists to be subscribed to journals and reading the latest articles in their field. When I saw a specialist at UCSF this was definitely the case; while my GP still has gaps where their current knowledge on a specific subject is from their time at med school.

An equivalence would be a front-end engineer being naive to the happenings on the Linux kernel mailing list. They could likely understand what's going on if they took the time to read it, but that is not their focus.

booleandilemma• 3 months ago

they tend to be arrogant

Yeah I can't with the "biology is orders of magnitude more complex than SE/CS or any other field for that matter" and then thinking he can explain to the techies how technology works. Just put the pills in the bag bro. Oh wait, we need to go to a pharmacist for that.

The med students I've known have been some of the most insufferable people I've met.

tstrimple• 3 months ago

Having built software distributed in clinics and troubleshooting with doctors has absolutely confirmed this for me. They are some of the worst clients to deal with. It’s not all that different from many “technologists” though when they casually suggest “easy solutions” outside their domain of expertise. How many ignorant HN posts have started with “why don’t they just”?

ViktorRay2• 3 months ago

I'm a doctor as well and I think your statement here is too broad. Plenty of specialists such as cardiologists, orthopedic surgeons, radiologists, etc are able to reason things from first principles. The issue is that many non-doctors may not know several key details about these systems that would let you reason through them. And even many doctors well versed in one specialty would be unable to reason about another specialty since they may not know in detail several key pieces of information from that other speciality.

naijaboiler2• 3 months ago

I'm a doctor who used to be an engineer. Deriving things from first principles in medicine is a lie we doctors tell ourselves.the truth is this.we have some really good understanding of syne things at molecular levels that we then correlates to things that happen clinically at a macro level, that correlation is very very handwavy. But we teach it as if we know for sure. We don't. The few things that we think we have a somwhat good correlation for, we often test on our exams, but even for most of those things, it's some handwavy link

I recall being an engineering classes, armed with just calculus and linear algebra and newton laws, I could attack just about every problem from first principles from my entire undergrad. Every. I didn't have to take into consideration real life presentation of the problem. First principles were enough to get me nearly there

Medicine is fundamentally not that way. Yes we learn the biology, but if you reason solely from biology, you will quickly end up in the wrong places. to become a doctor, I had to learn that hard way that yeah a disease doesn't just present this way just because the underlying physics and biology suggests it should. You separately have to learn how the disease presents, then try to tie it back to our extensive but still very very limited understanding of the possible biology.

I have problems with doctors that don't acknowledge how tenous that link is and despite how much we know, we still know so so little. We are far more useful than what we know.

I understand to biology majors, the few things that seem to follow physiologically from moelculqr biology dupes us into thinking medicine currebtly derives from first pricinples. But it doesnt.

ahepp• 3 months ago

This seems like a classic "rationalism vs empiricism" issue, and it was interesting for me to learn that Galen (famous / influential ancient Roman physician) wrote a lot about that.

0: https://plato.stanford.edu/archives/win2021/entries/galen/#M...

the_real_cher• 3 months ago

I dont know if that tracks. Medicine is a science after all.

drdaeman• 3 months ago

Clean layering.

We’d all wish it’d be so, doctor. Sometimes it’s as clean as biological systems - touch something somewhere, a different seemingly completely unrelated thing elsewhere breaks.

Even in the dawn of the era, where accumulated complexity was a while lot lower, we have tales of 500-mile emails and “magic/more magic” switch ;-)

Inferring things in a legacy codebase old enough to drink can be quite a challenge. And the way I get it, you folks are dealing with a multimillenia-old mess of layering violations - so no surprise first principles are tricky.

naijaboiler2• 3 months ago

Good analogy except a human is several orders in magnitude more complex than that

nfw2• 3 months ago

It seems both true that 1. intuitive-sounding explanations about medicine can be extremely misleading for laypeople and 2. reasoning about mechanisms of action, supplemented with empirical science, is important and useful in medical science.

I'm not sure saying to not try to reason at all about mechanisms of actions is a good idea. If someone knows Tylenol is metabolized into chemicals that are toxic to liver, that is simple enough to understand and reason about

belviewreview• 3 months ago

Was the article flat out wrong or at least misleading in any way that might lead people to make poor decisions regarding which drug to take?

pxtail2• 3 months ago

Yes, that's another issue - CS/IT seems to be unique that sharing knowledge and openly discussing problems is the norm, in other professions you can get finger wagging and some general "advice"

foxyv• 3 months ago

I don't know how you MDs/DOs do it. You give a dude medication knowing that it has a small chance to turn his stomach into goo because it will stop his brain arteries from popping like a stress ball in a hydraulic press. Sometimes without knowing how the medication does either thing.

larrik• 3 months ago

This 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• 3 months ago

Interesting, 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.

Acetaminophen vs. ibuprofen

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