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Comment by propter_hoc | Hacker News Reader

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> Nobody should ever take it, ibuprofen is better in every way.

Please don't give health advice on the internet. I'm not a doctor but I'm a biochemist, and there are MANY situations where ibuprofen is less safe.

Not denying that acetaminophen/paracetamol has a horrible therapeutic index, but there are reasons why it is still so widely used. Despite potential hepatoxicity, it is considered the safest pain relief drug (this emerging research notwithstanding)

Ibuprofen is not better in every way. For instance ibuprofen, as well as other NSAIDs, is much less gentle on gastrointestinal tract and puts much more strain on kidneys.

Some people (e.g. with inflammatory bowel diseases or renal diseases) do not tolerate NSAIDs well, which is why acetaminophen is on the same step of analgesic ladder - it is still considered better in some cases. Both are also used complementary to each other in pediatrics.

Your comment is fair; obviously I wrote a pretty flippant comment, but the message is largely useful for most people.

The fact is that (largely due to the incredible marketing of Johnson & Johnson's Tylenol brand in the US) way too many people think acetaminophen is "safe and effective" when it's actually both pretty unsafe and pretty ineffective. Most people just "pop a Tylenol" by default without realizing it's not much better than placebo.

Sure there are cases where people have unique risks and should avoid NSAIDs. But for the vast majority of the public, if they or their kid are dealing with a headache, fever, menstrual cramp, or other transient pain or fever, they should reach for ibuprofen (with a snack) over acetaminophen. It's not remotely a close call.

I'm frankly pleased that people are becoming more aware of this and I don't mind taking a couple correction comments for presenting the info in a superficial way.

NSAIDs can cause GI issues if taken with or without a snack.

They reduce production of the stomach’s protective mucous lining. Snacks don’t help with that.

They can also cause kidney damage.

Occasional use for an otherwise healthy person is fine. But Tylenol as long as you are careful not to take too much is generally safer.

> ibuprofen is better in every way.

Taking ibuprofen (or other NSAIDs) long-term can wear away the stomach lining, causing ulcers. Acetaminophen is generally better tolerated to manage mild long-term pain than NSAIDs, as long as you don't overdose / take with alcohol.

Yes, you need to take it with food, but it won't cause liver failure.

> take it with food

That's not helpful for the various categories of people who are more prone to gastrointestinal bleeding.

Yeah, but on the long-term it will cause kidney injury.

This is a dangerous advice. Please folks. disregard this OPs comment. I doubt he is a doctor.

Ibuprofen is not better in every way. Ibuprofen is active in so many different parts of the body at the same time that inevitably it has unintended effects which is more pronounced especially in the elderly. It's bad for stomach, bad for kidneys, bad for mental status. and very bad with long-term use.

TLDR. Both aren't great for different reasons. Tylenol can be acutely OD'd and evidence is starting to show it isn't great embryos. Outside of those 2 situations that can be easily avoided, it is overall less bad than ibuprofen.

Barely effective? The difference 20 minutes after my toddler takes a dose is astonishing.

It's also a very effective drug for reducing high fevers in infants and children.

There are legitimate reasons to complain about APAP but calling it a placebo is nonsense.

> I won't get into the history of why people take so much acetaminophen despite how crappy a drug it is.

I'd love if you did. What's the story there?

Basically, the pharma industry's most successful marketing campaign ever. Here's an article from 1982:

https://www.washingtonpost.com/archive/politics/1982/10/02/h...

https://archive.md/rssPI

Barely effective? Seems to work well for me

>> ibuprofen is better in every way

Give me paracetamol over ibuprofen in most cases. Ibuprofen is much more likely to cause stomach issues than I am to miscalculate "take 2 paracetamol every 4-6 hours".

Naproxen sodium is also a lot better, and is slightly safer than ibuprofen to take for extended periods. I had severe sciatica for the better part of a year, and the only thing that kept me somewhat functional was ~1000mg/day of naproxen, which isn’t great for you but would’ve been a lot worse if it had been ibuprofen (never mind opiates or something).

Did your sciatica go away on its own or did you introduce some new exercises to your routine? I've had some pain in my left leg for a few months now that is likely sciatica. I did go to the doctor, but it wasn't a particularly helpful visit.

I did physical therapy which mostly involved strengthening core muscles - if the cause is a herniated disc, which it usually is, this can slightly speed up the recovery process because a stronger core can push the disc back into place. But this is a speedup in the sense of "8-10 months instead of 10-12". Welcome, certainly, but not a silver bullet.

The other thing the PT taught me was nerve glides (also called nerve flosses). These don't seem to make recovery any faster, but help a decent amount with pain and tightness .

Sadly, that plus loading up on NSAIDs appears to be about all you can do for most cases of sciatica. I got a consult with a back surgeon who basically said, "I can operate if you want, but it probably won't help much, you just have to wait".

Good luck: it can be a pretty miserable time, but the good news is that most cases of sciatica do in fact clear up on their own even without PT. It can just take a while and you'll be hurting in the meantime.

I have an emergency Naproxen stash for the occasional gout flare-up and it's so much more effective than Ibuprofen it's amazing.

It's also even worse at gastrointestinal problems, for those affected. That's why it's less commonly used.

That's fair, but naproxen is OTC or prescription-only in many jurisdictions.

I think Paracetamol is better for fever, but for other pain I always prefer Ibuprofen.

From wikipedia:

At a standard dose, paracetamol slightly reduces fever,[13][17][18] though it is inferior to ibuprofen in that respect[19]

[13] Warwick C (November 2008). "Paracetamol and fever management". J R Soc Promot Health. 128 (6): 320–323. doi:10.1177/1466424008092794. PMID 19058473. S2CID 25702228.

[17] Chiumello D, Gotti M, Vergani G (April 2017). "Paracetamol in fever in critically ill patients-an update". J Crit Care. 38: 245–252. doi:10.1016/j.jcrc.2016.10.021. PMID 27992852. S2CID 5815020.

[18] de Martino M, Chiarugi A (December 2015). "Recent Advances in Pediatric Use of Oral Paracetamol in Fever and Pain Management". Pain Ther. 4 (2): 149–68. doi:10.1007/s40122-015-0040-z. PMC 4676765. PMID 26518691.

[19] Pierce CA, Voss B (March 2010). "Efficacy and safety of ibuprofen and acetaminophen in children and adults: a meta-analysis and qualitative review". Ann Pharmacother. 44 (3): 489–506. doi:10.1345/aph.1M332. PMID 20150507. S2CID 44669940.

> At a standard dose, paracetamol slightly reduces fever,[13][17][18] though it is inferior to ibuprofen in that respect[19]

It's good you can take both at the same time then! (For adults.)

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