# Paracetamol/Acetaminophen vs NSAIDs as first choice analgesics **URL:** \ **Category:** Factual Questions\ **Created:** [June 7, 2016, 6:08am UTC](https://boards.straightdope.com/t/paracetamol-acetaminophen-vs-nsaids-as-first-choice-analgesics/756718 "2016-06-07T06:08:28Z")\ **Posts on this page:** 5\ **Page:** 2
**Author:** ![Flocculencio](https://avatars.discourse-cdn.com/v4/letter/f/9dc877/32.png) [@Flocculencio](https://boards.straightdope.com/u/Flocculencio)\ **Post date:** [June 8, 2016, 5:37am UTC](https://boards.straightdope.com/t/paracetamol-acetaminophen-vs-nsaids-as-first-choice-analgesics/756718/21 "2016-06-08T05:37:55Z")
> [@DrDeth](#): > > No. Acetaminophen is a very common source of liver failure: > [Paracetamol - Wikipedia](https://en.wikipedia.org/wiki/Paracetamol#Adverse_effects) > \*Liver damage[edit] > Acute overdoses of paracetamol can cause potentially fatal liver damage. In 2011 the US Food and Drug Administration launched a public education program to help consumers avoid overdose, warning: “Acetaminophen can cause serious liver damage if more than directed is used.”[40][41][42] In a 2011 Safety Warning the FDA immediately required manufacturers to update labels of all prescription combination acetaminophen products to warn of the potential risk for severe liver injury and required such combinations contain no more than 325 mg of acetaminophen (within 3 years).[43][44] FDA has likewise requested prescribers limit combination opioids to 325 mg of acetaminophen. Such overdoses are frequently related to high dose recreational use of prescription opioids as these opioids are most often combined with acetaminophen.[45] The overdose risk may be heightened by frequent consumption of alcohol. > > Paracetamol toxicity is the foremost cause of acute liver failure in the Western world, and accounts for most drug overdoses in the United States, the United Kingdom, Australia and New Zealand.[46][47][48][49] According to the FDA, in the United States there were “56,000 emergency room visits, 26,000 hospitalizations, and 458 deaths per year related to acetaminophen-associated overdoses during the 1990s. Within these estimates, unintentional acetaminophen overdose accounted for nearly 25 percent of the emergency department visits, 10 percent of the hospitalizations, and 25 percent of the deaths.”[50] > > Paracetamol is metabolised by the liver and is hepatotoxic; side effects are multiplied when combined with alcoholic drinks, and are very likely in chronic alcoholics or patients with liver damage.[51][52] Some studies have suggested the possibility of a moderately increased risk of upper gastrointestinal complications such as stomach bleeding when high doses are taken chronically.[53] Kidney damage is seen in rare cases, most commonly in overdose.[54] > \* > > The main reason is that Tylenol/Acetaminophen/Paracetamol is hidden in many OTC drug concoctions. It’s really easy to get a overdose by chugging your Nyquil and also taking 3 Extra Strength Tylenol- and some booze. It’s also really common in narcotic prescription pain pills, and of course those are very commonly abused. > > Aspirin has a number of common adverse effects, yes- but most are quite minor and not gonna send you to the ER: > [http://www.webmd.com/drugs/2/drug-1082-3/aspirin-oral/aspirin---oral/details/list-sideeffects](http://www.webmd.com/drugs/2/drug-1082-3/aspirin-oral/aspirin---oral/details/list-sideeffects) Actually I’m visiting the US right now and I did notice this “hidden” paracetamol trend. (Yes I like wandering around pharmacies and looking at medications). In Singapore paracetamol tends to be much more clearly indicated (and we don’t have the dayquil/nyquil type concoctions that you guys have in the US). ---
**Author:** ![Hermitian](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/hermitian/32/470_2.png) [@Hermitian](https://boards.straightdope.com/u/Hermitian)\ **Post date:** [June 9, 2016, 2:52pm UTC](https://boards.straightdope.com/t/paracetamol-acetaminophen-vs-nsaids-as-first-choice-analgesics/756718/22 "2016-06-09T14:52:53Z")
> [@NeonMadman](#): > > This is anecdotal, but I find that acetaminophen just doesn’t work as well for me as ibuprofen. With ibuprofen, I get significant relief from my aches and pains; the result from acetaminophen is negligible. This became an issue a while back when I was in chemotherapy and was told to avoid NSAIDs because the chemo was suppressing my platelet counts and bleeding became a potential issue. At times, it seemed there was just no relief from pain at all. Same here. For me, Acetaminophen is like child’s play compared to ibuprofen in terms of pain relief, but it does seem to be the go-to drug to mix with hydrocodone for post operative pain (maybe because of the blood clotting thing mentioned above). ---
**Author:** ![Blue\_Blistering\_Barnacle](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/blue_blistering_barnacle/32/3386_2.png) [@Blue\_Blistering\_Barnacle](https://boards.straightdope.com/u/Blue_Blistering_Barnacle)\ **Post date:** [June 9, 2016, 3:17pm UTC](https://boards.straightdope.com/t/paracetamol-acetaminophen-vs-nsaids-as-first-choice-analgesics/756718/23 "2016-06-09T15:17:14Z")
Acetaminophen is supposed to potentiate narcotics. I don’t know if the same or similar mechanism applies to NSAID’s or not. IIRC, acetaminophen is better at treating fever than pain, when considered alongside NSAID’s. ---
**Author:** ![robby](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/robby/32/11048_2.png) [@robby](https://boards.straightdope.com/u/robby)\ **Post date:** [June 9, 2016, 3:20pm UTC](https://boards.straightdope.com/t/paracetamol-acetaminophen-vs-nsaids-as-first-choice-analgesics/756718/24 "2016-06-09T15:20:03Z")
In my household, ibuprofen has always been our primary drug of choice for treating pain, fever, and inflammation. When my son was very young, we gave him [Children’s Motrin](https://www.motrin.com/products/childrens-motrin). My wife is a registered nurse, and has always disdained acetaminophen. While it does reduce fever (though not as well as ibuprofen), it doesn’t do much for pain, nor does it reduce inflammation. Then there’s the chance of liver damage in the event of an overdose. ([Apparently](https://en.wikipedia.org/wiki/Paracetamol#Liver_damage), it is “the foremost cause of acute liver failure in the Western world, and accounts for most drug overdoses in the United States, the United Kingdom, Australia and New Zealand.”) The only thing it has going for it is that it is less irritating to the GI tract than NSAIDs. I refer to acetaminophen as a “placebo with the chance of liver damage.” 😉 ---
**Author:** ![WhyNot](https://avatars.discourse-cdn.com/v4/letter/w/c77e96/32.png) [@WhyNot](https://boards.straightdope.com/u/WhyNot)\ **Post date:** [June 9, 2016, 6:57pm UTC](https://boards.straightdope.com/t/paracetamol-acetaminophen-vs-nsaids-as-first-choice-analgesics/756718/25 "2016-06-09T18:57:34Z")
Acetaminophen does have the “potentiates” thing going for it, though. And no, ibuprofen doesn’t seem to do that. Acetaminophen makes other painkillers work better than would be guessed by the effect of each drug additively. My personal choice for post op pain after the IV narcotics are stopped, and I’m cleared for bleeding risk, is ibuprofen AND acetaminophen. But because ibuprofen is dosed every 4 hours, and acetaminophen every 6, it can get confusing. So that’s not usually recommended, because it has a higher risk of dangerous errors than using one or the other. But it was very effective for me after my c- section, when my then husband lost my Vicodin prescription. [Previous page](https://boards.straightdope.com/t/paracetamol-acetaminophen-vs-nsaids-as-first-choice-analgesics/756718.md?page=1)