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Acetaminophen vs. ibuprofen

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Re: Acetaminophen vs. ibuprofen

#231

Post by freehorse »

rustyhancock wrote: post #191
watwut wrote: post #166

Earlier quoted context omitted.

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.

You're partially right compared to placebo only about 5% of people are painfree over the effect of a placebo when taking paracetamol. Paracetamol got it's start as replacing the more effective but much more dangerous and withdrawn drug Phenacetin. Why don't people notice that it's such a small benefit over nothing? Well because placebo effect is quite good for pain and pain is usually transitory anywhere..if you have…

Where did you pull this 5% from? There are gazillions of studies showing higher or lower efficacies for different kinds of pain. Along with the inaccuracies about Phenacetin (whose MOA is metabolising into paracetamol).

Re: Acetaminophen vs. ibuprofen

#232

Post by cmiles8 »

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.

Re: Acetaminophen vs. ibuprofen

#233

Post by AnthonyMouse »

kakacik wrote: post #132
devmor wrote: post #52

Earlier quoted context omitted.

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.

Whenever people here mention to my critique of US healthcare how its now mostly solved problem now, its 'good' to see the other side and reality. It certainly doesn't seem solved unless you have a million or two just laying around on the account, while mortgages and kids tuitions are paid. And I can easily imagine a long term condition or 10 which, if unlucky in terms of treatment cost coverage can wipe out that sum…

The problem with the US system is that it doesn't know what it's trying to be.

If you did a socialist system then everything is "free" but possibly slow and expensive on the back end when the government isn't efficient.

If you did a libertarian system then everything is cheap but it's caveat emptor because nobody is stopping you from buying morphine for $10 from Amazon.

The US system isn't either one. It pretends to be a market sometimes but then has a bunch of rules to thwart competition. Doctors are required by law to do residency but the government limits the number of residency slots in response to lobbying from the AMA so there aren't enough doctors. "Certificate of need" laws explicitly prohibit new competitors for various services. Insurance is tied to employment to make it hard for individuals to shop around. Laws encourage, require or have the government provide "prescription drug coverage" to make patients price insensitive so drug companies can charge a huge premium for patenting a minor improvement or simple combination of existing drugs and have the patient will something which is marginally if at all better even if it's dramatically more expensive because they don't see the cost when the insurance/government is required to pay for it.

It's a big pile of corruption, because all that money is going to places. But then if you try to fix it, half the population insists on doing the first one and the other half is only willing to do the second one, and the industry capitalizes on this to prevent either one.

Maybe instead we should do both rather than neither. Have the government provide a threshold level of services, like emergency rooms and free clinics and anything more than that the local government wants to fund, and then have a minimally regulated private system that anyone can use if the government system doesn't satisfy them.

Re: Acetaminophen vs. ibuprofen

#234

Post by lloydatkinson »

gregoryyy wrote: post #131
magicalhippo wrote: post #110

> 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.…

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.

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

Re: Acetaminophen vs. ibuprofen

#235

Post by rustyhancock »

freehorse wrote: post #231
rustyhancock wrote: post #191

Earlier quoted context omitted.

You're partially right compared to placebo only about 5% of people are painfree over the effect of a placebo when taking paracetamol. Paracetamol got it's start as replacing the more effective but much more dangerous and withdrawn drug Phenacetin. Why don't people notice that it's such a small benefit over nothing? Well because placebo effect is quite good for pain and pain is usually transitory anywhere..if you have…

Where did you pull this 5% from? There are gazillions of studies showing higher or lower efficacies for different kinds of pain. Along with the inaccuracies about Phenacetin (whose MOA is metabolising into paracetamol).

You will indeed find various figures for various pain types all are far worse than ibuprofen.

Here is an example from the Cochrane library

> For the IHS preferred outcome of being pain free at two hours the NNT for paracetamol 1000 mg compared with placebo was 22 (95% confidence interval (CI) 15 to 40) in eight studies (5890 participants; high quality evidence), with no significant difference from placebo at one hour.

A NNT of 22 means that in absolute terms 1/22 people met the positive endpoint criteria more than placebo. This figure is usually quoted as 20% for placebo and 25% for paracetamol giving NNT of 20.

The NNT of 22 gives 1/22= 4.5%.

https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD...

Re: Acetaminophen vs. ibuprofen

#236

Post by oblio »

petesergeant wrote: post #40
vasco wrote: post #35

Earlier quoted context omitted.

Or 10 slightly larger ones edit: https://www.24pharma.nl/paracetamol-eg-1000mg-120-tabletten

I’ve pretty much only ever seen them sold at 500mg; are you regularly seeing them where you are sold in 1g form?

In Europe for sure they're also sold in 1g dosing. I think the packages don't contain lots of pills, though. Definitely not US style buckets of pills.

Re: Acetaminophen vs. ibuprofen

#237

Post by salex89 »

wonnage wrote: post #11

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”.

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.

Re: Acetaminophen vs. ibuprofen

#238

Post by Sammi »

elric wrote: post #189
CalRobert wrote: post #71

Earlier quoted context omitted.

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.

Dissolvable tablets & powders are still useful for getting rid of mucus. Maybe inhaling is better, but anecdotally the tablets seem to work.

The dissolvable tablets completely fix a runny nose for me. Much better than any nose spray, which tend to irritate the nose and lead to chronic runny nose if taken for too long.

Re: Acetaminophen vs. ibuprofen

#239

Post by SpaceNugget »

petesergeant wrote: post #40
vasco wrote: post #35

Earlier quoted context omitted.

Or 10 slightly larger ones edit: https://www.24pharma.nl/paracetamol-eg-1000mg-120-tabletten

I’ve pretty much only ever seen them sold at 500mg; are you regularly seeing them where you are sold in 1g form?

The .nl indicates the netherlands. Many people in the netherlands vent/joke about how the doctors here only ever tell you to take paracetamol and come back in two weeks if it's still a problem (recursive solution).

However the last time I went to my GP she scoffed at me taking the maximum and suggested I take literally double the maximum recommended dose 4-5 times a day which totaled I think 2.5x the daily maximum on the package. I am very much a "believer" in science and reasonable medical authority but this experience sowed the seeds of doubt, because from what I have always heard, that can actually kill you or cause permanent liver issues. I was also taking diclofenac simultaenously, and when I told her how many mg, she asked "where can you even buy such small doses, that's what I would give a small child" =/

Re: Acetaminophen vs. ibuprofen

#240

Post by eru »

Sammi wrote: post #238
elric wrote: post #189

Earlier quoted context omitted.

Dissolvable tablets & powders are still useful for getting rid of mucus. Maybe inhaling is better, but anecdotally the tablets seem to work.

The dissolvable tablets completely fix a runny nose for me. Much better than any nose spray, which tend to irritate the nose and lead to chronic runny nose if taken for too long.

Have you tried a neti pot or similar?
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