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> 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...

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.

In the article it is mentioned but it is worth stressing that N-acetylcysteine is a trivially available antidote of paracetamol overdose.

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.

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.

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.

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.

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

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.

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.

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).

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.

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...

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.

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

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!

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.

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.

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.

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.

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.

"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...

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?

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

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

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.

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.

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.

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

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.

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/

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

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

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

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

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.

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.

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.

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

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/

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?

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

there is an antidote for paracetamol: ACC (Acetylcysteine)

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.

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

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.

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

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

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

Nice, now do Acetminophen vs Dexibuprofen.

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

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”.

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.