In my medicine cabinet I have three forms of OTC medications for fever and muscle pain: generic aspirin, Tylenol, and Advil.
Last night I came down with a severe chill and fever. That is, I felt cold to my core, and piled on layers of thermal underwear, sweatpants, sweaters, etc., and ducked under blankets, all while running a 103.2 degree temperature.
I took some Tylenol and fell asleep but two hours later, the fever was running unabated. Then I took some Advil (it’s my understanding that, being different meds, they don’t “stack” and it’s safe to take them within short times of each other), and about an hour later, the fever broke.
Later that night the fever started to come back, and I took the Advil straightaway. Fever dissipated shortly thereafter.
I hadn’t gotten around to trying the Aspirin.
So, what does it mean that Advil seems to have been effective but not Tylenol? Are there different kinds of fever for which one is useful but not the other? How could one tell (without trying them both and seeing what works)?
And Ibuprofen has a warning for people who are sensitive to aspirin. Does that mean it’s somehow chemically related?
Short answer: Acetaminophen is useful for reducing pain and fever. The chemically related class of medicines known as NSAIDS (non-steroidal anti-inflammatory drugs) which includes ibuprofen, aspirin, naproxen, and many other members are useful for reducing pain and fever, and if taken regularly for a few weeks for reducing inflammation. NSAIDS can irritate the stomach and stress out the kidneys in certain folks. Too much acetaminophen can cause liver damage.
Aspirin is slightly special in this class in that in very low doses it inhibits platelet stickiness, thus reducing the risk of clots causing heart attacks in some folks.
No studies have consistently documented any real difference in effectiveness of pain or fever relief between these medications, for large groups of people.
One can alternate doses of acetaminophen with doses of NSAIDS for better pain and fever relief. But one should not mix NSAIDS. That is, don’t alternate ibuprofen with naproxen or (higher dose) aspirin.
So: Use whatever seems to work better for you. Just be aware that the various biological nuances of when and how fever breaks may be unrelated to what meds you just took. Or not.
That phenomenon is still being puzzled out, as far as I can tell. Studies have shown that caffeine is effective as an analgesic adjuvant for both acetaminophen and various NSAIDS.
A number of theories have been put forth: It speeds absorption of the pain reliever, it prolongs the presence of the pain reliever in the system, it is itself somewhat of an analgesic, it raises cyclic GMP levels which makes the pain-killer more effective at inhibiting prostaglandins, etc.
Hah, I knew I wasn’t going to be “the expert” when I got to this post and I was very right from what’s already been posted- so I will only add my personal experience to everything and be content with that.
As a kid I was always given Tylenol, I believe it was marketed as “safer for kids” or something like that so this was the all-in-one remedy whenever my mother was notified of a headache of fever.
As a lifetime headache sufferer of every variety I’ve been through the whole gamut of pain-killers and never passed-up a chance to ask a different doctor about them (something like an on-going poll-question )
Most doctors failed to really answer my questions except one, his advice to me was to take Tylenol for stress-induced headaches (usually indicated by a tight tension on the back of the head; about the size and location one might wear a skullcap). I find it very effective for this kind of headache and since have used the advice over and over. I have found that when I use tylenol to treat a headache that the pain seems to increase for some time and sometimes makes me sleepy thus I don’t usually take it unless it’s tha-t bad or I am around a casual setting where I can relax for a time.
The fever is the body’s natural response to ridding the body of “foreign invaders” in you by elevating the temperature to “cook” the invader and therefore I don’t usually try to inhibit the process (you are sick try to stay in bed if possible).
Motrin (aka this man’s best friend) already stated as an anti-inflammatory has been a God-send to my life as inflammation can be many things besides headaches, so for the "non-skullcap"related pain I usually stay with this painkiller. I’ve never noticed any effects of taking this (besides the pain relieving function) and even use this immediately after I do something strenuous to (possibly) aid in soreness later or for example I banged my leg real bad- that’s inflammation… why not? Yes, some might point out it’s an exaggerated example that a ice pack would do fine for- I’m only stating anti-inflammatory medicines can have many creative applications;)
As for Aspirin I have mostly 2nd-hand knowledge on this as the few times I took it there was nothing else I could use or it was being used by someone else. My wife use Excedrin (Aspirn/Acetaminophen blend) for her migraines and she seems to like it.
OTC, Tylenol always worked better for my childhood migraines (I don’t have them anymore). My father loves it for it’s “heart-healthy” qualities.
There has always been some debate over the amount of “unfelt damage” these medicines inflict to your stomach and surrounding areas, but as it stands I take Motrin liberally (within recommended doses) and are more wary of the other two painkillers usually but not always- taking them with something for these to “chew on” a “buffer” if you will.
I hope this input helps you in some way. Thanks for posting something I feel a little more comforatble with subject-wise
Just a little additional information in the interest of fighting ignorance.
Ibuprofen and all other NSAIDs, including aspirin, block the COX enzyme. This enzyme is part of the pathway that converts arachidonic acid to a variety of inflammatory and pyretic compounds (eg prostaglandin E2). It also is involved in activating platelet aggregation (hence the use of aspirin for heart attacks and strokes).
The exact mechanism of action for acetominophen (paracetamol for the Brits) is not exactly known, but it does have action on the COX enzyme as well.
How this affects fever is that all those fever causing compounds that are produced while your body is fighting infection are blocked. Additionally acetaminophen may have some central action (within the hypothalamus) that reduces fever as well.
And now a little bit more about Fever in general. The body’s temperature is regulated by the hypothalamus (within the brain). It has a ‘set point’ which is approximately 37C (98.6F) in most people that are not sick. During an illness, prostaglandin E2 is formed and this causes the ‘set point’ to be increased. When your body temp is less than the ‘set point’ you feel cold, you shiver, you cover up with blankets etc until you reach your new ‘set point’ which is now a fever.
When the fever breaks, that is the ‘set point’ returning to normal. At that point you feel hot, you get sweaty, you take off layers, etc as your body cools itself back to the normal temp.
Your body’s ability to fight infection is greatly enhanced by a higher than normal temperature; the enzymes and reactions the immune cells use are more effecient at febrile temperatures than normal temperatures. The take home point is that fever in and of itself is NOT harmful (within reason, hyperpyrexia can be harmful, but that is a very high temp, like 105F or higher). Although you may feel better with your fever down, you will not be able to fight off your infection as well. So keep that in mind the next time you get a fever.
And one last point. NEVER take aspirin for anything that might be a fever or viral infection due to the risk of Reye’s syndrome. There are other medications (discussed above) that have the same mechanism and no risk of this rare but deadly condition.
Worth noting. I generally won’t take fever medication until I hit 102. I thought that “very” high fevers, where one begins to risk brain damage after some period of time, started at around 103-104 degrees? Or maybe that is only for small children? I remember my wife was literally put on ice at the hospital to bring her body temperature down when she had meningitis while six months pregnant, and was running a 104-105 degree fever. So I figure if 105 = emergency room ice treatment, 103 = better take that Advil.
Oh yeah – Advil and Motrin both have Ibuprofen as the active ingredient. Any difference other than brand name?
:dubious: Can I get a cite on that? I was of the understading that the fever is a byproduct of your antibodies working to kill off whatever is making you sick. They work harder, they produce heat, you get a fever. I don’t think the fever itself is getting rid of the ‘invader.’ That’s like saying the warm exhaust pipe propels the car foward. No, it’s just a byproduct of internal combustion.
Now, wheather or not breaking the fever via medication prolongs healing time, I don’t know.
I recommend reading the excellent post by USCDiver in this thread. He directly explains what causes fever, and what its effects are. And it isn’t just the heat from antibodies working to kill of the infectious agent.
Is it not correct that this precaution is generally for children and adolescents? If I’m not mistaken, adults don’t risk developing Reye’s Syndrome by taking aspirin for viral infections. Wikipedia seems to confirm this, iwith the usual caveats about WP not being an authoritative source.
The febrile response is a critical host defense mechanism that favors the host and is only detrimental to the infecting pathogen. The height of the fever elevation, the fever pattern, and pulse-temperature relationships have important diagnostic implications which are eliminated if antipyretics are employed. Similarly, in many cases, the only way to assess the efficacy of antimicrobial therapy in a septic patient is the febrile response to appropriate antimicrobial therapy. If a febrile response is removed by antipyretics, the clinician has no way to assess the adequacy or inadequacy of antimicrobial therapy. Because there are no data or reason to employ antipyretics, this practice should be eliminated. Fever has survival value to the host, and confers great advantages to the host, and should not be blunted or eliminated except under relatively few circumstances. The many benefits of fever should not be denied to the septic patient by administering antipyretics [1,34,35].
“Why, the fever itself is Nature’s instrument.” “Fever is the great engine that nature brings to the field to fight disease.” “While acetylsalicylic acid decreases the temperature in fever, we are not convinced that this has any beneficial effect.”*
It’s not quite that simple, of course; but on average those of us geezers who have been in medicine awhile are not convinced that the rush to treat the average fever is anything more than the need to do something, as opposed to just standing there–even when the latter is more appropriate.
The arguments and studies for the beneficial role of fever are not hard to come by.
The arguments for treating fever boil down to two:
First, a direct empiric argument that says a high prolonged fever is directly bad for you. This is true, but it has to be high and prolonged. A sudden spike in temperature in a kid might produce convulsions, but these types of febrile seizures are fairly benign, and outcome is more related to the underlying cause than the fact that a febrile seizure occurred. In cases where there is a very high and prolonged fever, the underlying cause is hard to sort out from the direct effect of the fever itself although there are certainly hyperthermic syndromes where you more or less cook the brain to encephalopathy.
Second, an indirect argument says that pyrogenic cytokines are themselves harmful and contribute to the physiologic burden of the illness. This is a little tougher to prove, since the underlying pathophysiology is a titchy bit hard to sort out from the fever itself. If you have a specific badness producing pyrogens, how do you sort out the underlying badness from the fever? Want a cite to help here, too? I don’t do literature searches for a single SDMB post, but you could start here for a nice discussion: http://www.annals.org/cgi/content/full/120/12/1037 Don’t make the medical student mistake of pulling out only comments favorable to your bias. It’s hard to read that article and decide fever should be treated aggressively. One of the conclusions this author seems to suggest is that when fever is detrimental, it’s detrimental because the cause is lost, and nature likes to weed out the dying. OK…but it’s really the presence of pyrogenic cytokines that are the putative enemy, and not fever per se (in this article).
As a practicing clinician I treated fevers aggressively if they wanted to stay over 103F and for comfort if they were below that. Kids, for instance, will sometimes be perkier and more inclined to take fluids if they don’t stay in a prolonged hot state (plus their insensible fluid losses are less at lower temps). Nevertheless I think fever is way over-treated. It’s the result, and not the cause, of the illness most of the time, and if Mother Nature has given us a febrile response when we are ill, I need a lot of persuading to say she screwed it up.
Not at all. First of all, fever is a very crude guideline to how serious an illness is and second, 103 is a fairly arbitrary guideline that needs to be put in a clinical context, such as duration, frequency, rapidity of rise and the appearance of the patient along with a presumptive diagnosis.
There is no hard and fast rule and a temp of 103, in and of itself, is neither dangerous nor a dangerous sign.
This is from the Wikipedia entry on fever, but the original “cite” was from the same doctor that helped me understand painkillers better. Which is why I really don’t have a “official cite”.
But if you think how organisms adapt to all kinds of “solutions” we come up with to fight infection or whatnot it really is sound theory… UV lamps work in a similar fashion. Especially in relation to not allowing infectious agents to adapt to this method of purification.
I guess it’s just coincedence that I just finished watching the “Andromeda Strain” for the first time =7
As far as an acceptable point for fever treatment… from what I see it’s how you say “no hard and fast rule” there are many different opinions on dangerous fever… personally, I’d get nervous around 103 and probably do something about it.
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