Acetaminophen versus ibuprofen which works better and when?

In most cases, pain and fever relief is as simple as a visit to the local supermarket for some paracetamol or ibuprofen.

While both are effective at reducing pain, they work in different ways. So deciding which one you should choose depends on the type of pain you are experiencing. Sometimes it may be appropriate to take a medication that contains both drugs.

In Australia, paracetamol is branded as Panadol, Herron Paracetamol, Panamax, Chemist Own or Dymadon, also there are generic drug brands. Nurofen is the common brand name for ibuprofen, which is also sold under generic brand names.

So how do you know which one to pick and when?

Different blocking actions

While ibuprofen and acetaminophen may be taken for similar reasons (pain relief), each works a little differently.

Ibuprofen is a nonsteroidal anti-inflammatory drug, which means it works by blocking enzymes that produce a group of chemicals called prostaglandins. These chemicals are important for normal body functions such as relaxing blood vessels, preventing blood from clotting, secreting protective mucus in the intestines, and helping the uterus contract. They are also involved in inflammation, pain and fever.

It is not yet fully understood how paracetamol works. Like ibuprofen, it is thought to work by blocking enzymes that produce prostaglandins, although by a different mechanism than ibuprofen. There is also good evidence that acetaminophen interacts with the brain’s endocannabinoid system and the descending pain pathway, which inhibits pain perception.

Read more: Why does my back get so sore when I’m sick? The connection between immunity and pain

Is one drug better than the other?

Because they each provide pain relief in different ways, acetaminophen may be better at treating some types of pain, while ibuprofen is better at treating other types. But beware of packaging that claims that a drug is helpful in targeting pain associated with a specific condition as these claims are not true.

Because it reduces inflammation, Australian medication guidelines state that ibuprofen is the best choice for pain associated with osteo- and rheumatoid arthritis, menstrual pain, some types of headaches, and for pain that results from ‘operation. Acetaminophen doesn’t reduce inflammation, but it’s a better choice when fever is associated with pain, such as when you have a cold or the flu.

The Australian government recommends paracetamol or ibuprofen if you suffer from pain associated with COVID.

Read more: I’m at home with COVID. When should I see a doctor? And what treatments are available?

How about taking them both or carrying them on your shoulders at intervals?

Sometimes we may get better relief when we take both types of medicine at the same time, as each targets a different cause or pathway of pain. If one pathway does not fully control pain, targeting the other may be helpful. The effects of each drug can add up for a greater effect.

Combination products that contain both acetaminophen and ibuprofen in a single tablet include Nuromol and Maxigesic.

Using a combination product means you can take fewer tablets. However, the doses in these combined products are sometimes lower than the maximum recommended dose, which means they may not work as well as taking the tablets individually.

Other times, you can get the best effect by alternating doses of ibuprofen and acetaminophen. This keeps the levels of the drug in the body more constant and helps provide more constant pain relief. This can be especially helpful in treating pain and fever in children. To do this, one drug is given, then a dose of the other drug is given a few hours later, continuing to alternate between the two throughout the day.

If you’re alternating between different pain relievers, be sure to leave time (at least an hour) between dosing each product to get the most effective and consistent relief. Administer only the recommended dose of each medicine as directed on the package. And do not give more than the recommended maximum number of doses of any medicine per day.

Read more: Be careful with acetaminophen during pregnancy, but don’t let your pain or fever go uncontrolled

How do the side effects compare?

Side effects from both drugs are rare and usually mild.

Ibuprofen has a reputation for causing stomach problems. These can manifest as nausea, indigestion, bleeding in the stomach and diarrhea. For this reason, people with a history of bleeding or ulcers in the intestines shouldn’t take ibuprofen. Ibuprofen has also been known to sometimes cause headaches, dizziness, and increased blood pressure.

Because ibuprofen thins the blood, it should also not be taken by people who are taking other blood-thinning medicines; such as aspirin, warfarin and clopidogrel. Ibuprofen should also be avoided by pregnant women and people with asthma. In these cases, paracetamol is the best choice.

However, you need to be careful when using these medicines to make sure you don’t use more than recommended. This is especially important for paracetamol.

Acetaminophen in recommended doses is non-toxic but too much can lead to liver failure.

Because acetaminophen is found in many different products, it can be difficult to keep track of exactly how much acetaminophen you’ve taken, and this increases the risk of taking too much.

Read more: The TGA is considering restrictions on paracetamol due to poisonings, but what does this mean for consumers?

Both work, both must be used safely

Acetaminophen and ibuprofen are effective medicines for relieving both pain and fever; however, care must be taken to use them safely.

Always read the label so you know exactly which products you’re using and how much. Take only the recommended dose and, if necessary, write down the time you take each dose. Your pharmacist or doctor can also recommend the best medicine for pain and fever and how to use the selected medicine safely.