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Posted by nkurz 2 days ago

Acetaminophen vs. ibuprofen(asteriskmag.com)
610 points | 394 commentspage 4
yumraj 11 hours 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.

rubatuga 13 hours ago||
If you take either of these medications regularly talk to your doctor.
CalChris 12 hours 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 11 hours ago||
> Ibuprofen is for inflammation and not headaches

Ibuprofen is very well supported as a treatment for migraines. Not necessarily headaches generally, but definitely migraines.

But there are multiple classes of abort drugs now that a doctor might be able to prescribe you, like triptans and CGRP inhibitors, that work much better than either NSAIDs or acetaminophen.

dilyevsky 11 hours 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...
carlsborg 11 hours 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...

KaiserPro 11 hours 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.
thisisauserid 4 hours 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.

beAbU 7 hours ago||
For the rest of the world:

Acetaminophen = Paracetamol

nmeofthestate 5 hours 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.
Melatonic 10 hours 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

hilbert42 3 hours 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.

cowlby 11 hours 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?
Eisenstein 11 hours 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/

robocat 9 hours 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.

Eisenstein 4 hours ago||
For all accidental acute poisonings leading to hospitalizations from OTC drugs amongst adults and adolescents, the top culprits are:

1. Acetaminophen: Dangers noted in article, and stats given in my parent comment

2. NSAIDs: "NSAIDs are ingested commonly in overdose, however severe toxicity is rare"

3. Salicylates "Severe salicylate poisoning follows ingestion of greater than 500 mg/kg". For an adult weighing 150lbs that is 68kg, which means severe poisoning requires 34g of aspirin, which at 325mg per pill is 104 pills total. Hardly easy to do this accidentally.

[1] "Acute poisoning: understanding 90% of cases in a nutshell", S L Greene, P I Dargan, A L Jones, Postgrad Med J 2005;81:204–216

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