What are the differences in the way that these NSAIDs work?
Are there drug interaction effects if I take more than one of these at the same time?
Is any of one of them more effective for:
- stress headaches
- fever
- heart conditions
Just a note; acetaminophen isn’t considered an NSAID. More information on NSAIDs can be found at WebMD.
IANADoctor. This is an anecdote, not any kind of medical advice.
Cub Hubby got two aspirin, two acetaminophen and two ibuprofen, each 15 minutes apart in the ER when he was there with cellulitis and a temperature of 104.5 F. If I had given him that combo, he’s have been sure I was trying to kill him. He did ask the nurse if he was sure the ibuprofen were for him, considering the other meds he’d had.
I have no answers to the rest of your questions.
First of all, acetaminophen is not really an NSAID. Aspirin and ibuprofen are, as are naproxen, ketoprofen, sulindac, indomethacin, salicylate, and a few dozen others.
Aspirin is best for prevention of certain types of heart attacks and strokes which involve blood clots forming in key arteries. Aspirin makes platelets less sticky, while other NSAIDS don’t have this particular feature, or at least not to the degree that aspirin does. Whether the risk of regular aspirin (bleeding, mainly) exceeds the benefit (heart attack and stroke prevention) is a topic to explore with your doctor.
Aspirin and other NSAIDS also reduce inflammation, but only when taken very regularly for at least 2 weeks. A dose here or there won’t significantly reduce inflammation. So don’t think aspirin or ibuprofen is better for an injury than acetaminophen because it will make the swelling go down. It won’t.
NSAIDS and acetaminophen both reduce fever and pain. Which class is better for which type of pain? That’s pretty much up to the person taking it. Some people find acetaminophen superior, others find different NSAIDS superior.
One can generally alternate taking NSAIDS with acetaminophen for maximum pain reduction or fever relief. But one shouldn’t really mix NSAIDS. The exception is if one is taking low dose aspirin for blood clot formation. Then one can generally take another NSAID for pain or fever too.
If one’s liver is healthy and one isn’t drinking alcohol, one can generally take up to 4 grams of acetaminophen safely. The safe dose of NSAIDS depends on the type of NSAID. Overdosing on acetaminophen is more dangerous than overdosing on NSAIDS, as in the former case one’s liver may just shut down, causing death. In the latter case, one gets ringing in the ears and upset stomach, but death usually doesn’t occur from sheer large volume of NSAID.
As noted before, any NSAID can cause gastro-intestinal bleeding, even in low dose. So one should be aware of that side-effect if taking an NSAID regularly.
NSAIDS work by inhibiting an enzyme needed to make prostaglandins. Prostaglandins protect the stomach lining, and promote inflammation, pain, and fever. Along with lots of other things. Chronic NSAID use can stress kidneys if they are not entirely healthy to begin with.
Acetaminophen appears to inhibit some prostaglandins but not others. It doesn’t inhibit the prostaglandins involved in blood clotting or stomach protection. It also doesn’t seem to inhibit the prostaglandins which mediate inflammation much at all. Somehow it seems specific mainly for pain and fever. How it does this inhibition is not really known too well.
And that’s about all the info I have on the top of my head at the moment on the subject. Doubtless more could be said, and proper cites could be found, but I’ll leave that to others.
QtM, MD
I’ve heard previously that 4 grams of acetaminophen was the maximum therapeudic dose. I was also told that 7.5 grams was considered a lethal dose. So, what I’d like to know is, what happens if you ingest 5 or 6 grams? Would it kill some people, but not others? Is there an LD50 for acetaminophen for humans?
[hijack]
I recently read an article (ok, just the the conclusion, but hey, I’m retired, I can cheat now and then) that taking NSAIDS taken more often than once a week for pain can interfere with the effects of low dose ASA in clot prevention. I tried to google it, but can’t find it now. It might have been in an old Heart and Lung, but I can’t remember. I was wasting time at the UW med library.[/hijack]
just FYI, most hospital policies regarding acetaminophen limit an adult dose to 4 grams per day. That’s two extra strength Tylenol every six hours.
Yes, I meant to write 4 grams per day. Not at once! My bad.
Seeing as how I just looked it up:
NSAID seems to = Non Steroidal Anti-Inflammatory Drugs
I’m a very big guy - like several hundred lbs overweight…
I generally take 4 Extra Strength Tylenol each time I take the pills.
Lately, I’ve been fighting jaw pain after some dental work. I’ve been taking Tylenol every 4 hours.
Have I been tempting fate?
I’d say I’ve been taking probably 4-5 doses each day, 2000 millegrams each time.
That’s a lot more than you folks are saying is safe…
No ill effects so far…
Should I expect liver failure soon?
How does body mass affect how much dosage of Tylenol you can take?
Liver failure has been seen in adults with doses of 7.5 grams. Body mass may mitigate things a bit, but it may not, also. That’s because the acetaminophen itself is not toxic, but the liver metabolizes it into a toxic substance, when then damages said liver. And the gut is designed to bring the dose of the drug right to the liver before it goes elsewhere, so it’s not like the toxic substance is dispersed thru your body just because you’re larger than average.
So stop taking so much. Now. And discuss pain control with your doctor/dentist.
There is a bit of a debate among ped docs on whether it’s good practive to alternate motrin and tylenol when treating childhood fevers.
Some suggest alternating doses of the two…but the American Academy of Pediatrics says no.
Article here
RE: Acetominophen (it’s called Paracetamol here) overdose.
Every Emergency Room in the western world has a chart with time from overdose along the bottom line and serum (blood) acetominophen levels in mg/L going up the side. There is a line that looks sort of like the bottom half of the letter C (parabolic curve? something like that) on the chart. If your results fall on this line or above it, they give you intravenous N-acetylcisteine (an antidote), if not, the overdose isn’t considered severe enough to warrant it.
There is a second line, lower that the first, for people who are at greater risk, such as heavy drinkers (or someone who took alchol with the pills when they overdosed), people on certain medications which affect the liver, people who are malnourished or have a serious illness.
So an alcoholic would get treated with the antidote if his 8hr level was 45mg/L, but the average man in the street would need an 8 hr level of 100mg/L before he got the antidote.
N-acetylcisteine will not prevent liver failure in all cases, it will just decrease the likelihood of it happening. Not odds you want to play with.
Because 12, 500mg tablets, can kill you, and most people have some in the house, Acetominophen is often used in overdose, often by people who don’t actually want to die. Unfortunately these people sometimes end up dying a long and painful death from liver failure, despite everything being done to prevent it. All because of a reckless act that they hadn’t thought through, I’ve seen it and it’s not pretty.
Lips_Obsession if you need to overdose to achieve adequate relief from your pain, you need stronger pain medication. If you lived here I’d suggest a Codeine/Ibuprofen or Codeine/Acetominophen preparation, as they’re available without prescription from any pharmacy. As it is, you’ll need to get a prescription for an appropriate analgaesic from your doctor or dentist.
While you’re overweight, that’s fat. And maybe a bit more muscle than normal. Acetaminophen’s trouble is what it does to the liver as it’s metabolized. You probably don’t have a larger liver than the rest of us, so the damage is not likely to be less.
While some drugs are indeed dosed based on body mass, acetaminophen isn’t really one of them - at least in it’s over-the-counter at home use. There is a lower dose for small children, yes, but that’s because their livers are smaller. Once my kid hit 100 pounds, the pharmacist at the children’s hospital (who’s also my dad, incidently) said to give him the adult dose because his liver’s big enough to handle the load now.
So yes, go see your doctor and get something that can give you pain relief without trashing your liver. Your body mass should not effect the dosing of the drug much, so if it’s not working at regular doses, you need a different drug. (Or, at the very least, you need a doctor to check on your liver and give more educated advice than we can give on a message board.)
I’m under the care of a neurologist for migraines, and he said I can take up to 800 mgs. of Advil (ibuprofen) in one dose when I feel a headache coming on. He recommended the liqui-gel pills, because it gets the medicine into your system faster. He cautioned against too much aspirin (stomach problems) and too much Tylenol (liver problems). He said Advil is best for headaches.
Disclaimer: I am not advocating that you take that much on your own. You should see a doctor before exceeding any package-recommended dosages and for a check-up and always let your personal physician decide what’s best for you.
I’ve heard from a doctor that taking 800mg is not a terribly dangerous prospect - she herself does for headaches (I know as she’s also my aunt.) It seems to be the experience of a lot of folks I know that ibuprofen loses effectiveness if it’s taken frequently. Is there any truth to this? I’m still fine with 400mg myself, and I feel no need to take extra.
It hasn’t lost any effectiveness for me.
I’ll take 400 mgs. for a regular headache, or if it’s a sinus headache (and I’m using Sine-Aid or Sudafed), I’ll take the regular dose, and that works just fine, but when I feel a migraine coming on, if I pop four or five Advil liqui-gels real quick, most of the time, it will work. When they don’t work, and a migraine breaks through, I have Imitrex.
My neuro said the ibuprofen has less side effects than aspirin and Tylenol, and works better for headaches, so that’s why I use it.
Is naproxen a COX-2 inhibitor? For some reason, I thought it was. I know aspirin and ibuprofen are COX-1 and 2 inhibitors. Does acetaminophen work on COX? Both or just one? If it does, why isn’t it considered an NSAID?
Naproxen is COX-1 and 2 inhibitor.
There’s a hypothesis that acetaminophen may act on a not yet understood possible COX-3 inhibitor. It doesn’t seem to act on COX-1 or 2
I was very suprised to read what I did in this thread yesterday. I’ve communicated to my doctor previously that I take large doses of Tylenol or Advil, but I don’t think they knew that I was taking them for extended periods, rather than just a one-time occurance. They always said it wasn’t something I should do, but I just thought that was the typical “tut-tut-tut” you get from a doctor. After reading this thread yesterday, I stopped taking the Tylenol for the day. I was suprised to find that while I did have a few pain “breakthrus” during the day, for the most part, things were tolerable. I experienced a similar suprise a few weeks back when I reduced my Advil dosage from 800 mg every 6 hours around the clock, to 400 mg every 8 hours around the clock.
So far today, I’ve only had 2 doses of Advil (800 mg total for the day so far), and one dose of Tylenol (1000 mg for the day so far) and it’s about 2:30pm.
I don’t think I’ve ever had ibuprophin with codine, but I have had the other, they call it Tylenol 3 here in the states. It usually doesn’t do much for me. Likewise, the doctor when I saw her last prescribed some Vicodin (500) and it didn’t do much either for the pain.
For the time being, I’m surviving… Thanks for the concern everyone.