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Acetaminophen vs. ibuprofen

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Re: Acetaminophen vs. ibuprofen

#271
post #104

Earlier quoted context omitted.

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.

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?

> Is this not the case for OTC drugs?

In general, taking a lower dose than recommended can cause problems, but aside from antibiotics, the problems are probably going to be from insufficiently treating the underlying condition, rather than the medication itself. Most OTC drugs give a single recommended dosage for all adults, so some people will necessarily get a lower "effective" dose than others (eg. a 200 lb man compared to a 90 lb woman).

> Specifically, the two mentioned in the article. [...] 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?

With the caveat that I'm not a doctor, you should be fine: the only effect of acetaminophen is pain suppression, so if the pain is tolerable, then you should be fine. Ibuprofen has some anti-inflammatory effects that could be important here, but realistically, if the anti-inflammatory effects are the primary reason for the prescription, then your doctor is more likely to prescribe naproxen or celecoxib.

But if this ever comes up for you again, probably the best solution would be to tell your doctor/pharmacist "I have a high pain tolerance, would it be okay if I take less?", since in my experience, medical practitioners are generally pretty happy to hear when you want to take less drugs.

Re: Acetaminophen vs. ibuprofen

#272

Earlier quoted context omitted.

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 onl…

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.

I agree that Purdue Pharma was probably the most significant factor, maybe enhanced by the relative ease of granular lobbying of private doctors as compared to the challenges it may face in universal healthcare systems. However, I do suspect that the limited rights of most US workers to take sick leave served as one more cultural advantage in favour of Purdue's campaign.

In many countries if a doctor believes you're too sick to work you have a right to take leave until you recover, without risking your job and without expending limited "sick days". In those circumstances the doctor will of course prescribe something for your pain, but as a patient you have no incentive to insist the painkiller is strong enough to allow you to continue working.

Re: Acetaminophen vs. ibuprofen

#274
post #36
post #17

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-co…

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

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.

Re: Acetaminophen vs. ibuprofen

#276

> 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.…

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 onl…

> home-made oral rehydration solution

water?

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

Re: Acetaminophen vs. ibuprofen

#277

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

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.

Re: Acetaminophen vs. ibuprofen

#279

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'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!

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.

Re: Acetaminophen vs. ibuprofen

#280

> 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.…

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 onl…

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