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Acetaminophen vs. ibuprofen

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Re: Acetaminophen vs. ibuprofen

#461

Post by AnthonyMouse »

throwaway27448 wrote: post #383
AnthonyMouse wrote: post #220

Earlier quoted context omitted.

> I guess it is much better than the situation before that, where you paid $5000+ and they also gave you an opioid addiction. Having a condition that actually warrants strong opioids and not being able to get them at any price is definitely not an improvement. The problem is fundamentally that we want to pretend doctors can always distinguish two people describing the same symptoms when one person actually has them a…

> and not being able to get them at any price Brother (or sister), you were simply not trying hard enough. I live in a very clean, safe, expensively-policed county, and even I know where to buy fentanyl for much lower cost than a hospital. I would happily turn to that than take 20(!!!) advils in s single day.

Let's review the policy options in light of your suggestion:

1) We make it hard to lawfully acquire pain medications. You pay $$$ to see a doctor and you pay it even if they refuse you. If they do, you then have to pay $$ to get them from Stringer Bell, or start there to begin with if you didn't have $$$, and hope they're not cut with drain cleaner or unevenly mixed so that some days you get 100% corn starch and other days you get a fentanyl overdose.

2) We make it easy. Anyone can get them from Walmart. The people who need them pay the same $ they do for a bottle of Advil/Tylenol instead of paying $$ to murderers or $$$ to waste scarce medical resources that could have saved someone else's life. The bottle from Walmart always has a consistent amount of the drug in it and neither the dental patients nor the addicts get a surprise fentanyl overdose.

The first option is still the bad one, right?

Re: Acetaminophen vs. ibuprofen

#462

Post by Melatonic »

hilbert42 wrote: post #361
Melatonic wrote: post #177

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

"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 h…

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

Re: Acetaminophen vs. ibuprofen

#463

Post by Auracle »

gardnr wrote: post #450
thepryz wrote: post #434

Earlier quoted context omitted.

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 specia…

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; wh…

The fact that there are advertisements for cancer medications make me think a hell of a lot of specialists don’t keep up. It’s one thing to advertise to consumers about a new medication for their chronic condition and they might not have seen their doctor in 3 years. It’s another entirely to have cancer patients need to ask about the new hotness.

Re: Acetaminophen vs. ibuprofen

#464

Post by meew0 »

cue_the_strings wrote: post #285

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 f…

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.

Re: Acetaminophen vs. ibuprofen

#465

Post by atombender »

KaiserPro wrote: post #142
the_sleaze_ wrote: post #7

Earlier quoted context omitted.

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

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…

That combo is naproxen/esomeprazole. The brand name is Vimovo, but they don't have a patent, so you can get it as a generic. To work, though, it has to be taken 30 minutes before food.

Re: Acetaminophen vs. ibuprofen

#466

Post by jcul »

lazzurs wrote: post #249
jcul wrote: post #212

Earlier quoted context omitted.

In Ireland you can buy acetaminophen in stores, gas stations etc. For ibuprofen you need to go to a pharmacy.

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

Yeah, I lived in the UK before and it's a bit mad.

You can't buy antihistamines either, only in pharmacies and they are quite expensive. I remember you could get them in Tesco or Asda for like £2.

Re: Acetaminophen vs. ibuprofen

#467

Post by jcul »

domh wrote: post #252
jcul wrote: post #212

Earlier quoted context omitted.

In Ireland you can buy acetaminophen in stores, gas stations etc. For ibuprofen you need to go to a pharmacy.

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.

I would say 16 tablets would be closer to 6, or even 8 euro here.

Re: Acetaminophen vs. ibuprofen

#468

Post by tshaddox »

Barrin92 wrote: post #432
tshaddox wrote: post #426

Earlier quoted context omitted.

> 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 hubris…

>Presumably the vast majority of OTC painkiller usage is for short-lived and low-severity pain which is far from harmless given how many people use them as a replacement for treating underlying symptoms and changing their life. Case study my dad. Kept taking ibuprofen to get rid of 'harmless' headaches and back pain because he was 'too busy', few years later he couldn't ignore it any more, turns out he had completely…

It's not clear to me that a large portion of people are using them as a replacement for treating underlying symptoms. I suspect in a large portion of cases, treating the underlying symptoms is difficult and/or costly, and thus the choice is merely whether to treat the pain or not.

Re: Acetaminophen vs. ibuprofen

#469

Post by protocolture »

i_think_so wrote: post #117
protocolture wrote: post #47

Earlier quoted context omitted.

I took 2 full packs in a day once while trying to recover from severe pain. Didnt find out until later that it was supposedly a fatal dose.

Did you suffer any liver function damage as a result? I presume your protein intake was adequate and diverse prior to this misadventure....

Not knowingly.

Re: Acetaminophen vs. ibuprofen

#470

Post by booleandilemma »

thepryz wrote: post #434
KacharKhan wrote: post #417

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…

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 specia…

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.

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