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 or any other field for that matter.
I presume majority of readers here have SE/CS background. Dudes! the artifacts and systems in SE/CS have the following two properties:
1. They are human artifacts. We know exactly how they are build. The theory is all publicly accessible in principle.
2. They are layered logically on top of each other. Machine code, assembly, C, Java ... so on. Firmware, OS, drivers, apps .. etc. Clean layering.
The above two core properties make it possible to more or less reliably reason about bit SE/CS systems from first principles. The complete absence of above two in medicine means you cannot do the same there. Be very very careful when you import thinking habits for daily life , or other fields of expertise, into medicine.
"This video is just for informational purposes. Consult your health care provider for your particular situation" ...is not just a legal precaution. It is a sound life advice. Nothing in life is more crucial to leave it to the experts as health/medical inference and decision making.
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...
[2]: https://nhi.no/for-helsepersonell/nytt-om-legemidler/arkiv-2...
Paracetamol is the safer version Phenacetin. You used to be able to buy aspirin, phenacetin and caffeine..but phenacetin with withdrawn. APC when it was marketed was very popular but soon you were told to never give children aspirin for a fever so we used Paracetamol. Then Phenacetin was withdrawn and paracetamol became part of APC (like Alka selzta XS , or just the popular caffeine paracetamol combos)
Paracetamol came in as safer but similar, yet no where near effective. It captured bith the market feeling of its pros and cons. So we interpreted it as safer than alternatives (especially aspirin for children due to Reye syndrome). But also dangerous which might be why OPs view was that ibuprofen is safer.
The NNT (number of people you'd need to take it) to be headache free after 2 hours is about 20 for paracetamol. But only 14 for ibuprofen.
It's quite surprising that paracetamol became the defacto analgesic given it performs so poorly but it was historical inertia. And plenty of people argue that if we were to start over we would not make paracetamol OTC.
> but it does absolutely nothing with actual pain. It is placebo at best.
This is simply false.
When I took ibuprofen it did actually made an actual real change.
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 a tension headache you're probably going to aim to relax. Turn away from the screen or even have some caffeine and those are more effective than paracetamol!
It works against fewer or maybe mild inflammation and what not ... but it does absolutely nothing with actual pain. It is placebo at best.
Soluble paracetamol literally turned the pain off like a switch - of course I was limited as to how much I could take, which I was careful to stick to but I was almost in tears waiting for the time to come where I could take more paracetamol.
So in some situations paracetamol can be an extremely effective painkiller.
Neither paracetamol nor ibuprofen work by blocking pain. Depending on the type of pain and your physiology it can range from really effective to not at all.
I only take paracetamol, it works better than both ibuprofen and opioids for me. I know other people who have the exact opposite experience. There’s no absolute here.
I always thought a simple over-the-counter supplement (NAC) being the cure for an overdose was so cool. It's a pretty cool substance in a lot of ways, and this is a great spur to myself to research it more thoroughly.
Apparently for some people it also helps with lessening tolerance for their ADHD meds, but I'm not so sure about that.
I'd believe it. I first heard of NAC on the nootropic subreddit in a past lifetime. The benefits vary, but generally it's a safe thing with a low chance of making anything worse, but a possibility to improve things. Many neurodivergent folk have written about how they benefit.
I'd give more info on the exact benefits they found (iirc OCD and rumination loops could be broken more easily), but unfortunately my memory is failing me.
Usually here in Canada it's available in capsule form which I find less effective.
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.
I guess it is much better than the situation before that, where you paid $5000+ and they also gave you an opioid addiction.
20 not-especially-large tablets
edit: https://www.24pharma.nl/paracetamol-eg-1000mg-120-tabletten
Meanwhile, it's funny that it seems like acetaminophen should safer in more scenarios, but the other has a lot of overdoses with typical use, I guess that's why there's a gap between the two, because ODs are apparently a lot more common or at least more legible than problems caused by the other drug.
I arrived in Aus in 2021 and was amazed to be able to buy a pack of 40+, coming from the UK where the limit had been in place for some years.
It's the usual public health balancing act of help vs harm.
You can overdose on water too, they haven't banned 5-gallon jugs (yet).
Harm reduction is about shifting probability distributions, not guaranteeing outcomes. Kids can still get into pill bottles with childproof medication caps, but accidental ingestion of aspirin by children reduced by 40-55% after they were mandated. [0]
This article is explicitly considering usage as painkiller.
You can’t use Tylenol as an anti-inflammatory so it’s meaningless to compare them for that distinction usage.
I'm aware of acetaminophen's down sides, and yet recently I was taking it combined with 2 other medications at the time.
Why? Because all three medications are recommended for dealing with the issue I had. (Alone and in combination)
The moment it wasn't helping further? Done.
There is this broken idea, particularly apparent in North America, but in western society that more is better for many things. It's not.
More pain killers don't do anything if they max out the relief they can give you, overloading their mechanism doesn't reduce anything, but taxing your liver or your kidneys.
All medications are potentially toxic, your body wants to dispose of them. In appropriate dosages they will benefit you, but more isn't inherently better.
Even water can kill you in sufficient quantity.
We do the same with diet; where someone declares one ingredient in a meal healthier than another; it isn't. A single ingredient isn't better or worse for you in a meal. Your diet however can be good or bad; over time that matters.
Took me 3 months, out of 2 i wasn't able to sit. Luckily I could walk and that give me great relief. So walked for hours.
Keeping the habit, will mostly being coding from my phone & walking from now on.
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 stay under the 3-4g/d limit.
Last year I was diagnosed with a rare headache disease (NDPH). We thought it completely came out of nowhere, but I had logs in my phone recording headaches and acetaminophen use intermittently from a few weeks prior. This proved useful in the diagnosis.
Moral of the story: log when you take it to avoid overdosing. Combine that with some basic symptom logging (like 1 line, 10 words or less). You never know when that might be useful for your doctors later on.
Rationalizations like “they probably put the limit way lower than the real limit so idiots don’t OD themselves, so I can safely take a bit more” become very attractive when you’re in a lot of pain.
Dr. Pasricha adds: "I don’t get too concerned if my patients take one or two doses every now and then. But through regular use, such as several times a month or more, NSAIDs are well-known to increase intestinal permeability. In other words, NSAIDs can damage the lining of our guts. That’s because NSAIDs reduce the blood flow in the tiny vessels feeding our guts and disrupt the intestinal cells forming a barrier between the outside world and your insides. This has been proven over and over again through decades of research."
Conclusion: Acetaminophen is generally safer than ibuprofen, naproxen and aspirin.
https://www.washingtonpost.com/wellness/2024/12/09/ibuprofen...
I've never once thought about taking more than the recommended dosage of acetaminophen, largely because I had no expectation that it would provide additional benefit..
In reality, I try to consume 1/2 doses of anything or nothing at all, unless it's a serious medical treatment being administered by a professional.
An interesting thing with ibuprofen is that at the regular dose of 400mg it inhibits pain but if you take 1600mg it doesn't inhibit much more pain than the 400mg dose, but the inflammatory effect does increase significantly. A lot of people don't know that and take too much thinking it scales linearly.
I'll admit I find ibuprofen to be a bit of a wonder drug. When I have a cold or flu, ibuprofen by itself is the most impactful medicine I take. The anti-inflammatory effects make my whole body better, including my sinuses (my sinuses are a disaster normally anyway, though). I do avoid taking it otherwise because my headache doctor says it causes rebound headaches, though.
But if I need to go out somewhere and am not feeling well? 2 advil and I'm good to go. The only medicine I've found more effective for that is (real) sudafed, but if I take that after like 10am I won't sleep that night.
Also: in Europe everybody normally takes paracetamol and not FANS as a first reach to minimize adverse effects. So this article looks like very US centric. AFAIK liver failure because of paracetamol in Europe is very rare. So here there could be cultural issues at play (medical culture of what is prescribed, and the fact that Europeans in general take lower dosages of everything).
EDIT: trick, if you very rarely take paracetamol and other pain medications, the next time try to take just 250mg. It works for most people, no need to take 750 or even 1 gram of paracetamol. 500 works for almost everybody, 250 for many folks.
Paracetemol has always been seen as first thing you'd take for pain relief, and you'd "step up" ibuprofen as an escalation, but that might more to do with marketing of Panadol (paracetemol) vs Nurofen (ibuprofen).
We'd look on at the US where you were taking Advil like candy in confusion.
One great thing you learn as a parent, you can alternate acetaminophen and ibuprofen. Both of them are recommended every four hours, but you can stagger one by two hours to maintain consistency of pain-relief taking ibuprofen then paracetemol two hours later
Can confirm this is true in India.
Paracetamol is widely used. Paracetamol + Ibuprofen is more common than Ibuprofen by itself.
Context: I’m t1 diabetic.
I was recovering from an injury, and I switched from ibuprofen to acetaminophen. But the whole time I was on it, my sensor glucose was reading 50-60 mg/dl higher than my blood glucose. This is really bad on a closed loop system as my pump kept trying to lower my blood sugar, but it was pushing me into hypoglycemia (50 mg/dl).
Turns out this is a common effect, but a relatively new discovery that no one told me about.
Having gout, I've also had some pretty severe bouts where the pain level has been in the 8/10 range. Unfortunately nether paracet or ibuprofen worked.
In any case, when I see regular people eating these painkillers as candy, I'm starting to wonder what pain levels they are experiencing. I'm generally very cautious of using this stuff.
So we should not be too quick to dismiss the pain of others.
As far as 10/10 pain goes, I've heard cluster headaches can get so bad it has driven people to suicide during an episode.
I avoid both and stick with naproxen sodium. Any issues with that one? Lasts the longest too.
I would definitely have a chat with a doctor about it.
I'll second the claim that no doctor at any point in his life had told him the risks of doing that, and many encouraged the use of ibuprofen over any other alternative (including the alternative of not using OTC painkillers every single day).
I had a relative with a different story in the same theme. It sucks and I want to see this technology do something truly beneficial for a change....
I have personally never found a use for ibuprofen that ever made any noticeable impact for me. I have tried it for headaches, fever, muscle pain, nerve pain, etc. It never made a noticeable improvement for any of these while acetaminophen works amazingly for all these. Acetaminophen even works better for me for pain than an opioid like Tramadol...
I don't understand it, but it is what it is.
The article mentions this but it’s my answer to “how are laymen supposed to know?” In my case it’s painfully obvious to use ibuprofen with caution
Even then, doctors are usually disapproving of ibuprofen (or some combination of it with paracetamol) unless paracetamol is contraindicated for some reason, and I had always wondered why.
What you describe in an interesting contrast to the situation in The Netherlands. Here, virtually no one is prescribing ibuprofen _without_ also prescribing a baseline of paracetamol.
[1]: https://99percentinvisible.org/episode/579-towers-of-silence...
[1] https://www.thisamericanlife.org/505/use-only-as-directed
[2] https://my.clevelandclinic.org/health/drugs/18080-capsaicin-...
If you don’t realize your kidneys are already damaged you might die from kidney failure because of ibuprofen.
IBU: -stomach -kidneys -bp+ -clotting --NERD --NECD --NEUD --SNIUAA --SNIDR --DRESS
APAP: -liver --DRESS
-- extreme, rare side-effects
Needless to say we had covid at least 12 times at this point, all with positive tests so no mistake there. Plus few other questionable cases without tests. Some were brutal, like first and second one, that was before vaccines, and then a recent one when we seem to have lost most of immunity. Back then I lost taste for few weeks completely and smell didn't fully come back till 6 months after (sniffing bottle of vodka did smell like forest air, even later my perfume smelled rotten). Weird times, eating nice looking gunk and trying to imagine how it tasted before.
I don't think I had flu that many times over my whole life, hate that shit with fiery passion and having small kids in creche/school is just a 24/7 virus importing service. None of our peers had it as bad as we did, no idea why the 'luck'.
FDA FAERS is the official dataset for reporting Adverse events from taking a drug. FDA adverse event reports about 2 million cases and 4,067 unique drugs
I agree the results are not easy for non medical professionals to interpret correctly. For example DEATH is very strong with Parecetemol and so is DEPENDECE. The latter because from AI it is a confounding factor. Acetaminophen/parecetemol is frequently co-formulated with opioids (like Hydrocodone or Codeine). The "Dependence" signal is likely attributed to the opioid, not the Acetaminophen itself...
Adverse Event Acetaminophen PRR (95% CI) Acetaminophen n ibuprofen PRR (95% CI) ibuprofen n ACUTE KIDNEY INJURY 0.87 (0.80-0.96) 498 4.27 (3.91-4.67) * 483 ANAPHYLACTIC REACTION 0.61 (0.51-0.72) 122 9.85 (8.90-10.90) * 382 ANGIOEDEMA 1.31 (1.13-1.53) 170 15.26 (13.77-16.92) * 378 DEATH 1.44 (1.40-1.49) 3958 0.07 (0.06-0.10) 42 DEPENDENCE 237.12 (231.51-242.88) * 39679 0.02 (0.01-0.05) 4 DEPRESSION 2.18 (2.05-2.31) * 1157 0.39 (0.29-0.52) 43 DRUG EFFECTIVE FOR UNAPPROVED INDICATION 16.77 (16.11-17.46) * 3180 44.17 (42.18-46.25) * 1921 DRUG HYPERSENSITIVITY 0.57 (0.51-0.64) 327 3.30 (2.98-3.65) * 372
I've had doctors prescribing short runs of opioids (2 weeks for surgery recovery) but they always said "try Tylenol first and if the pain is too much you can fill the prescription". I liked having the option but never really used it up to this point.
Also, possible blood clotting or stomach issues sound scary, but Aspirin has similar (opposite) issues. Pharmacists regularly push its combinations with Acetominophen (which has, of course, synergetic bonuses, but is not the reason) under multitude of brands with a hefty premium when people ask for either one. So in many situations you need to consider the added risks from Aspirin too.
Ideally, I'd like to have an optimized strategies of using all three of the aforementioned substances for common situations. Like, is rotating ibuprofen/acetominophen during the day safer than consuming just one?
Have gotten into a habit of keeping a note of which med when on the fridge.
it seems to happen more when i'm overweight, making me think it's blood pressure (BP) related, but then doing the valsalva maneuvre, which spikes BP, doesn't cause any problems at all.
i've tried acetaminophen, even 1.2g of it, to no avail. it doesn't help.
i've also tried every other remedy, such as curcumin, fire/ice locally, hot and cold showers, neck massages, working out muscles that may be involved in it, everything. nothing helps.
except for ibuprofen. 400-600mg kills it every time.
at least for me, there seems to be a definite difference, as ibuprofen can anecdotally help in some situations that acetaminophen can't. i wonder what exactly it can / can't treat and why.
I didn't know about this acetaminophen risk. So I'll be looking for alternatives. Ibuprofen is for inflammation and not headaches. Naproxen is a candidate.
Ibuprofen is very well supported as a treatment for migraines. Not necessarily headaches generally, but definitely migraines.
But there are multiple classes of abort drugs now that a doctor might be able to prescribe you, like triptans and CGRP inhibitors, that work much better than either NSAIDs or acetaminophen.
But yet in some countries pediatricians will libreally prescribe it to toddlers
[1] https://www.bmj.com/content/368/bmj.m1086
Also from [2] "In this systematic review of NSAID use during acute lower respiratory tract infections in adults, we found that the existing evidence for mortality, pleuro-pulmonary complications and rates of mechanical ventilation or organ failure is of extremely poor quality, very low certainty and should be interpreted with caution."
https://bpspubs.onlinelibrary.wiley.com/doi/10.1111/bcp.1451...
Acetaminophen = Paracetamol
That being said I weirdly find Naproxen the most effective of all of these. Everyone is different though
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 has the same side effects profile as the latter.
I'd also recommended you watch the YouTube video in the link on Vioxx, it demonstrates the dangers of COX-2 drugs shouldn't be underestimated.
56,000 emergency room visits is the key here, because "the mortality associated with acetaminophen overdose is low if recognized and treated within the first 8 hours after an acute ingestion."
So I guess it depends on if you think 56,000 is low or not.
Source: "Acetaminophen Toxicity", David H. Schaffer; Brian P. Murray; Babak Khazaeni. 2026/02/19. https://www.ncbi.nlm.nih.gov/books/NBK441917/
Acetaminophen is the only medication of its kind approved for infants under six months because the liver develops faster than the kidneys.
Acetaminophen is part of ECA stack weight loss formula, while article says not OK with fasting. Either way, more safe solutions are known these days.
Since I've had a fair share of it in my life so far (more than 1kg of it so far, in total), and I investigated the disparaging studies and they are definitely not convincing at all; more recent ones somewhat absolve it (check the Wikipedia page).
I've never had any side effects from it, and I don't know anyone who did, unlike for any other painkiller (diclofenac, ketoprofen, ibuprofen, acetaminophen / paracetamol).
It is a medicine where I'm almost 100% sure the studies against it are intentional sabotage by pharma companies, and the vigor and persistence this is done with is really telling (lots of doctors and pharmacists in my extended family, including in regulatory bodies). The campaign against it never ends.
That said, I've found great relief at times taking a moderately large dose of ibuprofen for several days to break what seems to be a cycle of persistent inflammation. YMMV I guess.
Not only you can't take more than 4 grams of paracetamol per day, you must not take it for more than 3 days straight, it says so on the leaflet.
Biochemistry and medicine are hard and complex, all the quacks out there that preach snake oil treatments went down the path of thinking their domain specific knowledge in random domains somehow transfers to medicine it does not.
[1] https://pubmed.ncbi.nlm.nih.gov/40819833/
[2] https://ddeacademy.dk/ddea/what-new-research-reveals-about-p...
Unrelated, but it feels like an oversight that this article said nothing about how both acetaminophen and ibuprofen reduce fevers. They aren't used solely for reducing pain.
I find it interesting that people take these as fever reduction mechanisms. Fevers are a defence mechanism, not just an inconvenience. Maybe it makes more sense in places without decent workers' rights (like having a limited amount of sick days you need to manage), but it feels weird for me to actively harm your body's defence mechanisms unless you're in "you should see a doctor" territory already.
1g of Paracetamol with 400mg of Ibuprofen gives similar pain relief as 2mg of IV morphine.[1]
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.
This is semi recent research on how it might be blocking pain
Ibuprofen is mostly for inflammation and Acetaminophen for fever and pain. Now there's overlap in that both work on headaches and some other kinds of pain but the main use case for each is different.
Max dose combination (IBU/APAP FDC) can be useful as a substitute in emergency therapeutic situations compared to opiates. Not recommended ordinarily because of liver, kidney, and stomach impairment.[0]
Taking ibuprofen with questionable stomach condition may want to consider taking a famotidine adjuvant or duexis [1] or acetaminophen instead.
Overdose treatment of acetaminophen poisoning is the stinky N-acetylcysteine (NAC), so that maybe worth stocking whenever Tylenol is kept in a house with kids. Overdose of ibuprofen is palliative, requiring IV fluids and dialysis.
0. https://www.researchgate.net/publication/382639515_Ibuprofen...
Ibuprofen damages the kidneys -- and that damage is often permanent. The little filtering devices inside the kidneys don't grow back once they're destroyed. A dog who survives the poisoning can end up with lifelong kidney disease, which means special diets, more frequent vet visits, and a shorter life than she should have had.
(I watched this happen to my own dog after a house sitter stepped on her paw and gave her ibuprofen to "help." My dog lived, but she needed a special diet for the rest of her life.)
Acetaminophen wrecks the liver, and it also can damage red blood cells so they can't carry oxygen properly. A poisoned dog may get lethargic, vomit, start to breathe heavily... This is especially dangerous for older dogs, or any dog whose red blood cells are already compromised, by conditions like IMHA.
You take too much and it can give you a fever, which might entice you to take more aspirin. Nasty.
Obligatory Reye's mention:
https://www.uspharmacist.com/article/reyes-syndrome-a-rare-b...
and my own editorializing -- this is not just a problem for little kids. As various articles explain, if you've had flu-like symptoms (from whatever cause) you should be wary of aspirin. Will one standard dosage kill you? Unlikely. But if you've got better options, particularly pre-loading NAC before Tylenol, why not consider them first?
Further reading:
https://www.nhs.uk/medicines/low-dose-aspirin/who-can-and-ca...
And for those of you with kids: https://www.nhs.uk/conditions/kawasaki-disease/
Of course it's not all bad. There's even some discussion of anti-cancer potential. How might this work? One hypothesis: https://www.nature.com/articles/srep45184
This topic is a bit personal for me and I'm glad it's getting some attention here. Bravo, hackers.
Tylenol/acetaminophen is good for fever which NSAIDs won't help. Otherwise, take both and alternate their dosing times for better pain coverage.
A fever is not dangerous within normal parameters, except for being dangerous to the virus and bacteria that threaten the body. Your body runs a fever because it engages in a battle to the death with these microbes.
If you defeat the body's own defenses by lowering the fever, for example if you are a nervous mother who hates her baby's fussing, or if you're hospitalized and the nurses are laser-focused on "number go down" treatments, then you can expect to be ravaged by the contagion for much longer than expected.
Yes, ignorant consumers and physicians across the world.
You can't just 'vibe medicine' or 'vibe biology' - please don't comment if you don't know what you're talking about.
To mitigate this, I supplement with NAC (N-Acetyl-L-Cysteine) anytime I'm forced to take acetaminophen. I will also sometimes take Betaine Anhydrous.
I do the same for ibuprofen, but sans betaine and instead take aloe, probiotics (bacillus subtilis/coagulans, Mastic Gum and experiment with other things.
For acute pain, neither does anything. And though I'll get attacked for this here, I find a stout dose of quality, lab tested Kratom (red strain) to be far more effective than both acetaminophen and ibuprofen combined. However, for regular pain, this is not a good plan, as the withdrawals can exceed the nature of the problem itself.
I sure do wish we'd get over the anti opiate [1] craze someday, or at least discover and make available an effective alternative.
1. Aside from constipation and obvious risks of dependency (or abuse), opiates have none of the deleterious effects of ibuprofen or acetaminophen, and the constipation is easily mitigated, and a bit of agmatine sulfate for saying adios when the pain subsides.
I wish people would stop saying "drinking" to mean alcohol consumption. I genuinely thought it meant after drinking any fluid until I read the description and realised it meant alcohol. I also don't like how alcohol is singled out as a "special" drug. What about other drugs? Is alcohol special in this regard?
The medications that change who we are - https://www.bbc.com/future/article/20200108-the-medications-...
Excerpt:
Mischkowski’s own research has uncovered a sinister side-effect of paracetamol. For a long time, scientists have known that the drug blunts physical pain by reducing activity in certain brain areas, such as the insular cortex, which plays an important role in our emotions. These areas are involved in our experience of social pain, too – and intriguingly, paracetamol can make us feel better after a rejection.
Mischkowski wondered whether painkillers might be making it harder to experience empathy
And recent research has revealed that this patch of cerebral real-estate is more crowded than anyone previously thought, because it turns out the brain’s pain centres also share their home with empathy.
For example, fMRI (functional magnetic resonance imaging) scans have shown that the same areas of our brain become active when we’re experiencing “positive empathy” –pleasure on other people’s behalf – as when we’re experiencing pain.
Given these facts, Mischkowski wondered whether painkillers might be making it harder to experience empathy. Earlier this year, together with colleagues from Ohio University and Ohio State University, he recruited some students and spilt them into two groups. One received a standard 1,000mg dose of paracetamol, while the other was given a placebo. Then he asked them to read scenarios about uplifting experiences that had happened to other people, such as the good fortune of “Alex”, who finally plucked up the courage to ask a girl on a date (she said yes).
The results revealed that paracetamol significantly reduces our ability to feel positive empathy – a result with implications for how the drug is shaping the social relationships of millions of people every day. Though the experiment didn’t look at negative empathy – where we experience and relate to other people’s pain – Mischkowski suspects that this would also be more difficult to summon after taking the drug.
Also see the previous thread; A social analgesic? Acetaminophen (paracetamol) reduces positive empathy - https://news.ycombinator.com/item?id=31263305
Why should I trust someone who doesn’t test properly but just suspects?
Dominik Mischkowski is a Pain Researcher at Ohio University who has been studying this for a while. The word "suspects" here is statistical research-speak meaning there is a correlation (w.r.t. positive empathy) but more studies are warranted (w.r.t. negative empathy). That is all.
I take acetaminophen for fever, and those kind of full-body diffuse ill-feeling.
I take ibuprofen for localized intense pain.
I take aspirin for headaches and sore muscles.
> Acetaminophen has a scarily narrow therapeutic window. The instructions on the package say it's okay to take up to four grams per day. If you take eight grams, your liver could fail and you could die.
Gee I don't know, I think this is a wide enough window to not miss it. That difference is 8 500mg pills
> that for most people in most circumstances, acetaminophen is safer than ibuprofen, provided you use it as directed. I think most doctors agree with this.
Could be but I think a lot of doctors underestimate the dangers of paracetamol as well
All of the factors the author mentions about IBP are true. But it's all about the details. Safer? Safer in which condition?
"Dehydrated" ok take a glass of water. Active bleeding? Most NSAIDs interfere with that, and no you won't become a hemophiliac by taking one Ibuprofen
Also, some countries do add a notice for kidney problems for Paracetamol as well (e.g.) https://www.medicines.org.uk/emc/product/5164/pil
An as a conclusion, I find it "funny" that nobody considers how healty/safe it is to take paracetamol and have mild analgesia (translation - you're still in pain) and taking ibp and having better analgesia
If you’re taking more meds than that without clinical supervision Id say something is wrong in the system or your medicine practices.
Where I’m from it’s common to walk to the nearest pharmacy and get meds when needed. Even over the counter stuff like paracetamols. And talking to the pharmacist. They’ll ask what you’re already taking and tell you what else to get.
Of course, we could press the fix this immediately button by requiring acetaminophen to be sold mixed with NAC but that would be too easy.
It works similarly, but stays a lot longer (half life is cited as being anywhere from 12 to 17 hours).
Acetaminophen and ibuprofen are just for temporary problems, like a headache that would go away on its own in a couple of hours.
They are uneconomic and inconvenient if you have something more persistent to keep at bay. Four ibuprofens or one naproxen? No brainer.
The main disadvantage of naproxen is that it's not approved for kids. So there is no naproxen syrup for infants or anything of the sort. Thus, you still need acetaminophen for that.
Convenience vs ibuprofen is a thing given the longer half life, but it still generally comes with similar risks. If you are taking anything for more than just an occasional headache, definitely discuss with a doctor, COX2 selectives like celecoxib may be a better risk profile and even more convenient.
(COX1 and COX2 selectivity loosely separate which systems get the brunt of the side effects)
There are also slow release forms of naproxen. (Which make sense given its long action: lets people fade in the next one while the previous dose slowly fades out). That could also help make it easier on the GI tract.
Unless I am missing something, the data really doesn't back that up. naproxen is much more longer lasting and has a higher chance of causing ulcers. Hence why its not over the counter in the UK and is prescribed with omeprazole to reduce the risk of issues.
