It's probably worth mentioning that this drug is called Acetaminophen in the US, and is the active ingredient in Tylenol and other over the counter medicines.
more_corn · 1h ago
Don’t ever take Tylenol.
crmd · 23m ago
I had kidney stone surgery (laser lithotripsy) in Manhattan last Friday morning and literally the first thing I was given after changing into the paper gown was 2 500mg Tylenol pills and a cup of water. I don’t know if you’re a physician but the medical staff in manhattan tend to be at the top of their game, and they are cool with Tylenol.
jeroenhd · 49m ago
It's a cheap and effective drug that has minimal side effects as long as you follow the instructions on the packaging. Pretty much all of the alternatives are worse.
Ibuprofen is usually rated to be on the same level (damaging your kidneys rather than your liver during long term use) but from what I've read I believe the potential side effects are more extreme (i.e. the elevated stroke/heart attack risk).
Using any pain medication for prolonged periods of time without consulting a doctor is dangerous. Many people do it, and most are absolutely fine, but when things go wrong, things go terribly wrong.
The episode shows how even small overdoses of acetaminophen can cause fatal liver damage, while decades of FDA delays and confusing drug labeling left millions of Americans at risk.
astrange · 51m ago
Tylenol is very safe if taken as prescribed. The overdose amount is relatively low, but not uniquely low.
The alternatives are worse - ibuprofen destroys your stomach lining if taken at the regular dose for too long.
yes_man · 38m ago
Ibuprofen also increases risk of strokes and NSAIDs have been linked to increased risk of intracerebral hemorrhage. It’s a question of whether benefits outweigh cons on population level and I am not an expert, but recommending ibuprofen over acetaminophen might be over-simplifying things. It depends on the person (their meds, their pre-existing conditions, their genetics etc)
Lammy · 26m ago
> ibuprofen destroys your stomach lining if taken at the regular dose for too long.
This is how the VA killed my dad :/
KevinMS · 37m ago
Excedrin is the only thing besides morphine that cures my occasional but brutal headaches.
nkmnz · 8m ago
Do you happen to be a heavy coffee drinker? Caffeine withdrawal can cause immense pain, as I can confirm from first hand experience. For me, it starts ~24 hrs after the last coffee and it usually takes a very strong double espresso and a nap to get back to normal. Maybe Exedrin's Caffeine + Aspirin + Paracetamol has the same effect for you?
Ameo · 8m ago
Those have caffeine in them right? I'm sure you know your body well, but that could be part of what's helping you as well; could be constricting blood vessels or something like that
nikolay · 12m ago
I never took Tylenol/Paracetamol/acetaminophen, or anything containing it or given it to my children. We never reduce fever below 39.5/103.1 either - risks of febrile seizures are overstated and if you're a responsible parent, not a lazy one, you can see if things are going South, but there are other traditional means to lower fever. People are just too spoiled nowadays!
I tested positive with COVID-19 on Tuesday and had a pretty high fever (103) with a terrible headache, but I didn't take ibuprofen. First, because it could lower my fever, second, because its anti-inflammatory effect would compromise my immune system response to the pathogen. Most people I know immediately try to lower their fever to reduce their discomfort and would immediately take it for headaches, too.
efnx · 1m ago
I’m not a doctor but I’m pretty sure ibuprofen is _not_ acetaminophen.
littlestymaar · 5m ago
> risks of febrile seizures are overstated and if you're a responsible parent, not a lazy one, you can see if things are going South
Not always. Blaming “lazy” and irresponsible parents is disgusting.
nine_k · 2h ago
Basically, paracetamol turns out to be mildly contraceptive, by meddling with cell division cycle.
I wonder if it might also slow healing of wounds, or wherever else intense cell division happens.
10-1-100 · 2h ago
The authors touch on potential wider implications in the abstract:
> These results suggest that APAP should be used with caution by women attempting to conceive. Given that cell division is fundamental to all development, further investigation is now warranted to substantiate these findings and to elucidate possible implications for other developmental processes, such as gonadal and brain differentiation.
artvandelai · 1h ago
NSAIDs reduce inflammation. Since inflammation is part of healing, they can slow recovery, but they’re useful when inflammation itself is a problem.
e40 · 1h ago
paracetamol is not an NSAID.
artvandelai · 42m ago
Yes, but since the parent was talking about drugs with similar effects slowing healing, I thought it was appropriate to mention.
privacyking · 1h ago
True but one of the proposed mechanisms of action is on the same pathway as NSAIDs
odyssey7 · 1h ago
Unsure if this is related, but I’ve heard that taking painkillers for delayed onset muscle soreness will reduce muscle gains.
cenamus · 1h ago
Same goes for icebaths, they reduce inflammation, which is the whole point of working out.
wiml · 1h ago
Does the opposite hold true as well? If I taunt a wasp nest after hitting the gym will I discover the fast route to mad gains?
rkomorn · 1h ago
You'll certainly get swole.
vanderZwan · 1h ago
What about ginger? Because that apparently only downregulates COX-2 without affection COX-1 (most inflammation-reducing drugs affect both)
antonkochubey · 1h ago
Etoricoxib does just that and is widely available at least in the EU
rkomorn · 1h ago
So, literally "no pain, no gain" ?
15155 · 1h ago
Anti-inflammatories - not all painkillers.
ed · 1h ago
Just NSAID’s - they’re anti-inflammatory and muscle synthesis happens in response to inflammation.
VirusNewbie · 1h ago
The studies I saw had people taking a lot, it wasn’t looking at people taking 400mg once a week of their knee or shoulder got sore during the workout.
oh_my_goodness · 2h ago
I think rapid cell division might occur during embryo development. Not a biologist. Just a guess.
bitwize · 2h ago
The vaccine-autism smoking gun that Andrew Wakefield and RFK Jr. heroically tried to find has, so far, failed to turn up. But there was a study recently that showed that autism is correlated with the mother taking acetaminophen during pregnancy.
epgui · 1h ago
> Andrew Wakefield and RFK Jr. heroically tried to find
I'm not sure if that was supposed to be sarcastic, but these two people have done more harm to public health, and are responsible for more health dis/mis-information, than pretty much anyone I can think of. (I am a biochemist, no conflict of interest)
SoftTalker · 1h ago
The general advice is to not take any medication during pregnancy without a physician’s advice. This includes all over the counter medicines.
unsupp0rted · 8m ago
Physicians find it hard, perhaps impossible, to say "do nothing and go home". They always prescribe something or other.
Okay some don't, particularly North American and Northern/Western European ones.
But mostly, on average, physicians always try to prescribe you something.
adaml_623 · 1h ago
Provide a reference please. Which country is that from?
longhaul · 43m ago
Read a paper long time ago, something to do with increase of sulfur in the brain
SoftTalker · 1h ago
USA, what my wife’s OB told her. 20 years ago.
sarchertech · 42m ago
The OB will give you a list of what you can and can’t take. Tylenol is the only pain reliever you can take.
SoftTalker · 37m ago
I’d say that qualifies as physician advice.
No comments yet
adaml_623 · 21m ago
Oh I was hoping for a written down reference from an organisation responsible for giving medical advice rather than an single doctor.
greesil · 1h ago
Or maybe it's genetic. Or whatever. Cite yer sources matey, or it be all hot sargassum.
Terr_ · 2h ago
I've always had an (unreasonable?) dislike of Paracetamol/Tylenol ever since I found out it was the #1 cause of acute liver failure in the US. Liver failure is scary.
The UK started requiring that Tylenol always be sold in blister packs instead of convenient-to-kill-yourself-with whole bottles of pills.
Results: "Suicidal deaths from paracetamol and salicylates were reduced by 22% (95% confidence interval 11% to 32%) in the year after the change in legislation on 16 September 1998, and this reduction persisted in the next two years. Liver unit admissions and liver transplants for paracetamol induced hepatotoxicity were reduced by around 30% in the four years after the legislation. Numbers of paracetamol and salicylate tablets in non-fatal overdoses were reduced in the three years after the legislation. Large overdoses were reduced by 20% (9% to 29%) for paracetamol and by 39% (14% to 57%) for salicylates in the second and third years after the legislation. Ibuprofen overdoses increased after the legislation, but with little or no effect on deaths."[1]
Most, if not all, medication would carry a poisonous symbol, if it were not taken out of regulation for that. Mostly, you kill organs by any overdose.
Roughly:
- Paracetamol overdose can cause severe liver damage and may be fatal.
- Ibuprofen in high doses can lead to kidney injury and stomach bleeding.
- Aspirin overdose may result in salicylate poisoning, causing ringing in the ears, confusion, and metabolic acidosis.
kuschku · 1h ago
That's why it's recommended to combine a half dose of ibuprofen and a half dose of paracetamol at the same time. (Plus some vitamin C)
Together they have higher pain killung effects than each alone, and the side effects are reduced as they affect different body parts. And the vitamin C reduces the damage to the stomach lining.
bryanlarsen · 1h ago
Or if you need stronger painkilling you can take a full dose of paracetomol and either ibuprofen or aspirin. OTOH aspirin and ibuprofen use the same pathways so combining a full dose of ibuprofen and aspirin is not recommended.
jeroenhd · 16m ago
Aspirin and ibuprofen are both NSAIDs with not too dissimilar pathways, so combining them won't be as effective as combining either with paracetamol. They'll both do their jobs, but if the ibuprofen is already doing its job, aspirin won't have much work left to do.
Meanwhile, taking ibuprofen can negate the effect aspirin has when taken against cardiovascular diseases. Not a huge problem if you're just taking it as a painkiller, but not everyone can combine the two. That's another potential reason to take paracetamol over some NSAIDs, though you should obviously consult a doctor if you're taking prescription medicine of any kind.
dark-star · 31m ago
Interesting, then why does Aspirin do almost nothing when I have a headache, while Ibuprofen works very well and very quickly?
basisword · 11m ago
Headaches have different causes.
anjel · 1h ago
Adding to this, its the margin between a therapeutic dose and a harmful dose is most relevant. That margin for aspirin is wide, the same effective vs toxic margin for paracematol is shockingly narrow.
Furthermore, the "aspirin is rough on your stomach whereas Tylenol is gentle" turns out to be McNeil Marketing puffery.
formerly_proven · 15m ago
- Metamizole has a tendency to kill some percentage of native Brits and their descendants. Yet globally it's one of the most popular painkillers, it's even OTC in countries with sufficiently low numbers of British and related people. (Has anyone ever done research to try and figure out why Brits are on the order of 1000x-10000x more sensitive to that side effect?)
Terr_ · 1h ago
"Any medicine can be poison" is kinda missing the point.
There is a rich and varied multidimensional field of danger, from aspects like the safety-margin between regular/dangerous dose levels, the chronology of how it can spike or accumulate, whether there's feedback in advance of damage, etc.
Yeah, I can poison myself drinking clean water, but it's hard.
baxtr · 51m ago
Thank you for this comment
lr4444lr · 1h ago
It's not just that it causes liver failure: it's that the difference between the therapeutic dosing range for pain relief it's prescribed for is dangerously close to the toxicity level.
Other drugs like theophylline have ceased to be prescribed for a similar reason alternatives were available, but due to drug marketing, acetaminophen is touted as the "safe" pain reliever.
littlestymaar · 28m ago
> but due to drug marketing, acetaminophen is touted as the "safe" pain reliever.
Paracetamol's patents have expired long ago and there's not much profit to be made out of it (nowadays it's mostly not being made in the West, but imported from China, unlike profitable medicine).
The reason why it's still used it's that it's much better than the alternatives, despite the risks (it's only risky if you don't respect the doses by the way).
tobias3 · 1h ago
Also extra damage if the liver is already busy with alcohol. So not good to take for a hangover.
This is why Ibuprofen is perhaps the better default painkiller.
jonkoops · 1h ago
As with all things, the poison is in the dose. A tonne of incredibly useful medicine can kill you if dosed incorrectly.
pjerem · 1h ago
Sure but it’s pretty easy overdose on paracetamol.
Since it’s a mild and really common painkiller, sometimes seen as not dangerous, someone uneducated about it who is really suffering could easily take 3 or 4 times the dose.
Unlike a lot of drugs, you are not going to have a lot of immediate side effects if you overdose on paracetamol. You’ll just horribly die some days after,
basisword · 8m ago
How can you reach adulthood and think it's ok to take 3 or 4x the specific dose of any medication? If you're in that much pain you go to a doctor. Which makes me think maybe the issue is the private health system and not the drug.
littlestymaar · 25m ago
> someone uneducated about it who is really suffering could easily take 3 or 4 times the dose.
And the solution is simple: educate people about that.
And it's not something hard to do, just have pharmacists say “respect the dose as it will kill you if you don't” every time they sell things and it'll work.
XorNot · 48m ago
This is the definition of building a nanny state. Other people not reading the directions is not my problem when the problem is solely personal.
basisword · 12m ago
I'm finding all the 'liver failure' comments on this post fascinating. The dose is on the back on the packet, as is the time interval between doses and the maximum number of pills per day. To overdose you need to ignore that. Given all the mention of 'Tylenol' I'm assuming most of the commenters are American - is this a thing in the US where you just take a random number of pills and ignore the labelling or treat it as a guide? Is it a consequence of the fact you can buy these in bottles by the hundred?
whazor · 1h ago
This send me into a whole rabbit hole. Mostly children get paracetamol overdose. Then I learned that in US/UK kids get paracetamol in liquid form with all kinds of flavours. Which is much harder to dose correctly when the kid spits or drools it out.
Total culture shock for me, as in Europe the default for children is rectal ingestion (which is probably a culture shock as well for Americans). Any how, with pills it is much easier to avoid overdose.
verbify · 27m ago
Recently had a prescription error with my two month old baby. The doctor prescribed 7 times as much iron supplement as they intended (confusing labelling - so while I'm annoyed, I can see how it happened). This went on for a month until we uncovered the error.
We had blood test done (on the doctor's recommendation), and luckily there is no sign of any damage, but prescription errors do happen (even if they are rare) and it's much easier with liquids (you probably wouldn't give 8 pills to a baby, but 8ml doesn't seem so bad).
littlestymaar · 10m ago
> as in Europe the default
There's no “as in Europe”, every European country is different. In France the default is also liquid form, but the pipette is graduated is kilograms of baby weight, which limit the errors you can make (you know your kid doesn't weight 15kg when his weight is around 8).
XorNot · 52m ago
Liquid Panadol flavors were totally useless with my son. He would spit it out or upset himself so much he'd throw it up.
We ended up crushing and diluting tablets in milk, which he would drink (you waste a lot of milk to hit the right factor).
skybrian · 1h ago
It is scary, but I assume caution improves your chances of avoiding an overdose considerably.
WorkerBee28474 · 41m ago
There is mounting talk of a link between Paracetamol/Acetaminophen/Tylenol and autism.
Question: Does acetaminophen use during pregnancy increase children’s risk of neurodevelopmental disorders?
Findings: In this population-based study, models without sibling controls identified marginally increased risks of autism and attention-deficit/hyperactivity disorder (ADHD) associated with acetaminophen use during pregnancy. However, analyses of matched full sibling pairs found no evidence of increased risk of autism (hazard ratio, 0.98), ADHD (hazard ratio, 0.98), or intellectual disability (hazard ratio, 1.01) associated with acetaminophen use.
Meaning: Acetaminophen use during pregnancy was not associated with children’s risk of autism, ADHD, or intellectual disability in sibling control analyses. This suggests that associations observed in other models may have been attributable to confounding.
zoeysmithe · 17m ago
It tends to be poor scholarship imho.
Autistic moms are more likely to have chronic illness, sensory issues, auto immune issues, etc thus are more likely to be taking medications. In the end, the autistic mom just passes her autistic genes to the baby.
oliveiracwb · 1h ago
I live in Brazil. We have broad access to non-steroidal anti-inflammatory drugs. Even the best-known medicines have unexpected and unknown adverse effects: in general and specifically in people with unexpected genetic, enzymatic, and protein variations. This has no solution. The medicine acts differently in each body, which is subtly diverse from the others. I see a lot of research criticizing any "old" general medicine and introducing the "new" one. I don't know if this is the case. Every medicine has its rush, half-life, and side effects, and its actions are not fully mapped. My preference for long-term treatments is: dipyrone. Short term: ibuprofen. Lymphatic pain: paracetamol. It may not make sense, but that's how I use it.
moritzwarhier · 1h ago
Interesting how you put metamizole at #1 for long-term treatment. As far as my experience goes, many doctors do the same in Germany. On the other hand, I've heard that the medication is banned in many other countries.
I guess the safest way is to take up the treatment in a hospital, to check for immediate bad reactions.
On the other hand, like with many medications, severe allergies and individual sensibilities causing side effects often don't show up often in the short term, but rather suddenly after many dose intakes.
So I'm back where I started. Not disagreeing with what you say. It seems like these non-steroidal pain relief medications are poorly understood regarding their interaction with the whole body though.
Many OTC medications and even some prescribed ones (especially psychiatric medications) suffer from a very poor understanding and apparent lack of effort in improving the understanding of their mechanisms of action.
davikr · 1h ago
Metamizole is safe to take on the long-term, which is not the case for NSAIDs (nephrotoxic) and corticosteroids.
moritzwarhier · 24m ago
I guess that's why they are part of the standard medical treatment for many procedures involving pain here.
Not addictive, not hepatotoxic, not nephrotoxic.
Seems the reason for the ban / harder regulation in some countries is about the disturbance of blood-forming in some individuals (which can also be deadly, but I have no idea of the quantified risk here).
moi2388 · 1h ago
“ APAP could contribute to early embryonic loss by impairing initial cell divisions. These results suggest that APAP should be used with caution by women attempting to conceive. Given that cell division is fundamental to all development, further investigation is now warranted”
By the same logic it would now be effective against cancer, no?
Noe2097 · 56m ago
Isn't paracetamol forbidden in the US for pregnant women already? It is in other countries
jeroenhd · 35m ago
As far as I can tell from my local health organisations, paracetamol is one of the safest painkillers for pregnant women.
That doesn't make it very safe, but NSAIDs carry well known risks during later stages of pregnancy, and opiods aren't exactly harmless either. Even aspirin carries risk (and aspirin doesn't even work as well compared to other drugs).
As far as I can tell paracetamol is still the first choice for painkillers while pregnant, but only because none of them are completely safe to use. It's probably fine for short term usage, but that also goes for non-pregnant people to be honest.
sarchertech · 38m ago
No it’s the only allowed pain reliever for pregnant women in the US. It’s also allowed in the UK and the EU from what I can tell. What countries are you talking abou?
de6u99er · 2h ago
Can the effects of a drug on the body be reversed after a person stops taking it?
thisislife2 · 1h ago
Yes, in most cases. Or are you specifically asking about Paracetamol?
davikr · 1h ago
For paracetamol intoxication, there is n-acetylcysteine.
epgui · 1h ago
Sometimes yes, sometimes no.
mythrwy · 1h ago
I won't take acetaminophen (usually) learning of the liver toxicity and low overdose potential. And I have a friend that destroyed his kidneys with ibuprofen and is on a transplant list.
But from what I understand acetaminophen also dulls emotional pain like from being fired or breaking up with a girlfriend which is interesting.
I still prefer to take neither if I can avoid it and I'll hurt a little bit instead. Hurt a lot and I'd probably change my mind though.
latchkey · 2h ago
> "Smoking and alcohol are established risk factors for spontaneous abortion, underscoring the importance of the chemical environment during embryonic development."
Both of my parents are/were heavy smokers drinkers from their teenage years. Mom died of lung cancer from smoking. Kind of wild to think that the odds were really stacked against my birth.
roughly · 2h ago
Nature really, really, really wants you to have kids. It took us collectively as a species most of our existence to find genuinely effective methods to alter our biology sufficient to block this process, and we still have a hard time doing it without dramatically impacting the host organism.
bena · 2h ago
This is probably one of those things where the risk is normally small, so small increases cause large changes in percentage.
For instance, if spontaneous abortion is normally 1% and smoking increases it to 2%, then that’s a 100% increase. Now, I don’t know the actual numbers, and smoking is just generally not good for one’s health, but I wouldn’t go as far to say things were stacked against you.
docfort · 1h ago
The article says that implantation fails in humans 10-40% of the time. Your point is still valid, but the scale in reality is very significant.
SoftTalker · 1h ago
Millions of kids have been born to parents who smoked and drank all the way through their pregnancies, especially before the 1970s or so. It raises risks, but doesn’t guarantee bad outcomes.
rendx · 37m ago
Many, many more but here's a few you might want to start with:
"The meta-analysis showed a significant association between maternal tobacco smoking during pregnancy and increased risk of ADHD in offspring."
Mohammadian M, Khachatryan LG, Vadiyan FV, Maleki M, Fatahian F, et al. (2025) The association between maternal tobacco smoking during pregnancy and the risk of attention-deficit/hyperactivity disorder (ADHD) in offspring: A systematic review and meta-analysis. PLOS ONE 20(2): e0317112. https://doi.org/10.1371/journal.pone.0317112
"Compared with unexposed controls, individuals with PAE reported significantly higher frequencies of problems with hearing, dentition, heart, cancer, gastritis, kidney stones, bladder, diabetes, thyroid, skin, and seizures."
Coles, C.D., Shapiro, Z.R., Kable, J.A., Stoner, S.A., Ritfeld, G.J. & Grant, T.M. (2024) Prenatal alcohol exposure and health at midlife: Self-reported health outcomes in two cohorts. Alcohol: Clinical and Experimental Research, 48, 2045–2059. https://doi.org/10.1111/acer.15441
"Our results indicate that perinatal exposure to maternal smoking is associated with increased risks of CVD events, and such relations are modified by adulthood smoking behaviors."
H., Liang, Z., Wang, H., Cardoso, M. A., Heianza, Y., & Qi, L. (2021). Perinatal exposure to maternal smoking and adulthood smoking behaviors in predicting cardiovascular diseases: A prospective cohort study. Atherosclerosis, 328, 52–59. https://doi.org/10.1016/j.atherosclerosis.2021.05.009
"Our findings support previous findings suggesting the detrimental effects of prenatal binge drinking on child cognition. Prenatal alcohol exposure at levels less than daily drinking might be detrimentally associated with child behavior. The results of this review highlight the importance of abstaining from binge drinking during pregnancy and provide evidence that there is no known safe amount of alcohol to consume while pregnant."
Flak, A. L., Su, S., Bertrand, J., Denny, C. H., Kesmodel, U. S., & Cogswell, M. E. (2014). The association of mild, moderate, and binge prenatal alcohol exposure and child neuropsychological outcomes: a meta-analysis. Alcoholism, clinical and experimental research, 38(1), 214–226. https://doi.org/10.1111/acer.12214
You may not not want to hear this, but let's put it plainly: Prenatal smoking and alcohol is clear and obvious child maltreatment.
scns · 3m ago
> "The meta-analysis showed a significant association between maternal tobacco smoking during pregnancy and increased risk of ADHD in offspring."
The implied causation annoys me. ADHD is hereditary, even if if the mother does not smoke. People with ADHD smoke ten times more often.
SoftTalker · 33m ago
Don’t misunderstand that I’m advocating it.
ck2 · 2h ago
Acetaminophen/Paracetamol is a cox3 inhibitor
it also messes with bone formation so be careful using it for any length of time
especially after athletic activity
thrance · 1h ago
I'm sure an untreated infection might be more upsetting.
hollerith · 1h ago
Except that paracetamol does not treat infections.
propter_hoc · 2h ago
Acetaminophen is actually a terrible drug. It is barely effective as an analgesic, and the liver-failure dose is so close to its effective dose (about double) that it's very easy to accidentally overdose. Now this too.
Nobody should ever take it, ibuprofen is better in every way.
I won't get into the history of why people take so much acetaminophen despite how crappy a drug it is.
Edit: I appreciate everyone's anecdata about their kids, but studies show it's no more effective than placebo:
> Nobody should ever take it, ibuprofen is better in every way.
Please don't give health advice on the internet. I'm not a doctor but I'm a biochemist, and there are MANY situations where ibuprofen is less safe.
tylerhou · 2h ago
> ibuprofen is better in every way.
Taking ibuprofen (or other NSAIDs) long-term can wear away the stomach lining, causing ulcers. Acetaminophen is generally better tolerated to manage mild long-term pain than NSAIDs, as long as you don't overdose / take with alcohol.
propter_hoc · 1h ago
Yes, you need to take it with food, but it won't cause liver failure.
epgui · 1h ago
> take it with food
That's not helpful for the various categories of people who are more prone to gastrointestinal bleeding.
davikr · 1h ago
Yeah, but on the long-term it will cause kidney injury.
Rebellos · 1h ago
Not denying that acetaminophen/paracetamol has a horrible therapeutic index, but there are reasons why it is still so widely used. Despite potential hepatoxicity, it is considered the safest pain relief drug (this emerging research notwithstanding)
Ibuprofen is not better in every way. For instance ibuprofen, as well as other NSAIDs, is much less gentle on gastrointestinal tract and puts much more strain on kidneys.
Some people (e.g. with inflammatory bowel diseases or renal diseases) do not tolerate NSAIDs well, which is why acetaminophen is on the same step of analgesic ladder - it is still considered better in some cases.
Both are also used complementary to each other in pediatrics.
propter_hoc · 1h ago
Your comment is fair; obviously I wrote a pretty flippant comment, but the message is largely useful for most people.
The fact is that (largely due to the incredible marketing of Johnson & Johnson's Tylenol brand in the US) way too many people think acetaminophen is "safe and effective" when it's actually both pretty unsafe and pretty ineffective. Most people just "pop a Tylenol" by default without realizing it's not much better than placebo.
Sure there are cases where people have unique risks and should avoid NSAIDs. But for the vast majority of the public, if they or their kid are dealing with a headache, fever, menstrual cramp, or other transient pain or fever, they should reach for ibuprofen (with a snack) over acetaminophen. It's not remotely a close call.
I'm frankly pleased that people are becoming more aware of this and I don't mind taking a couple correction comments for presenting the info in a superficial way.
sarchertech · 31m ago
NSAIDs can cause GI issues if taken with or without a snack.
They reduce production of the stomach’s protective mucous lining. Snacks don’t help with that.
They can also cause kidney damage.
Occasional use for an otherwise healthy person is fine. But Tylenol as long as you are careful not to take too much is generally safer.
naijaboiler · 1h ago
This is a dangerous advice. Please folks. disregard this OPs comment. I doubt he is a doctor.
Ibuprofen is not better in every way. Ibuprofen is active in so many different parts of the body at the same time that inevitably it has unintended effects which is more pronounced especially in the elderly. It's bad for stomach, bad for kidneys, bad for mental status. and very bad with long-term use.
TLDR. Both aren't great for different reasons. Tylenol can be acutely OD'd and evidence is starting to show it isn't great embryos. Outside of those 2 situations that can be easily avoided, it is overall less bad than ibuprofen.
fredley · 2h ago
Barely effective? The difference 20 minutes after my toddler takes a dose is astonishing.
dreamcompiler · 16m ago
It's also a very effective drug for reducing high fevers in infants and children.
There are legitimate reasons to complain about APAP but calling it a placebo is nonsense.
nly · 2h ago
Barely effective? Seems to work well for me
soVeryTired · 2h ago
> I won't get into the history of why people take so much acetaminophen despite how crappy a drug it is.
I'd love if you did. What's the story there?
propter_hoc · 1h ago
Basically, the pharma industry's most successful marketing campaign ever. Here's an article from 1982:
Give me paracetamol over ibuprofen in most cases. Ibuprofen is much more likely to cause stomach issues than I am to miscalculate "take 2 paracetamol every 4-6 hours".
Analemma_ · 2h ago
Naproxen sodium is also a lot better, and is slightly safer than ibuprofen to take for extended periods. I had severe sciatica for the better part of a year, and the only thing that kept me somewhat functional was ~1000mg/day of naproxen, which isn’t great for you but would’ve been a lot worse if it had been ibuprofen (never mind opiates or something).
opan · 1h ago
Did your sciatica go away on its own or did you introduce some new exercises to your routine? I've had some pain in my left leg for a few months now that is likely sciatica. I did go to the doctor, but it wasn't a particularly helpful visit.
init2null · 1h ago
It's also even worse at gastrointestinal problems, for those affected. That's why it's less commonly used.
__alexs · 1h ago
I have an emergency Naproxen stash for the occasional gout flare-up and it's so much more effective than Ibuprofen it's amazing.
propter_hoc · 1h ago
That's fair, but naproxen is OTC or prescription-only in many jurisdictions.
Xenoamorphous · 1h ago
I think Paracetamol is better for fever, but for other pain I always prefer Ibuprofen.
propter_hoc · 1h ago
From wikipedia:
At a standard dose, paracetamol slightly reduces fever,[13][17][18] though it is inferior to ibuprofen in that respect[19]
[13] Warwick C (November 2008). "Paracetamol and fever management". J R Soc Promot Health. 128 (6): 320–323. doi:10.1177/1466424008092794. PMID 19058473. S2CID 25702228.
[17] Chiumello D, Gotti M, Vergani G (April 2017). "Paracetamol in fever in critically ill patients-an update". J Crit Care. 38: 245–252. doi:10.1016/j.jcrc.2016.10.021. PMID 27992852. S2CID 5815020.
[18] de Martino M, Chiarugi A (December 2015). "Recent Advances in Pediatric Use of Oral Paracetamol in Fever and Pain Management". Pain Ther. 4 (2): 149–68. doi:10.1007/s40122-015-0040-z. PMC 4676765. PMID 26518691.
[19] Pierce CA, Voss B (March 2010). "Efficacy and safety of ibuprofen and acetaminophen in children and adults: a meta-analysis and qualitative review". Ann Pharmacother. 44 (3): 489–506. doi:10.1345/aph.1M332. PMID 20150507. S2CID 44669940.
beejiu · 1h ago
> At a standard dose, paracetamol slightly reduces fever,[13][17][18] though it is inferior to ibuprofen in that respect[19]
It's good you can take both at the same time then! (For adults.)
Ibuprofen is usually rated to be on the same level (damaging your kidneys rather than your liver during long term use) but from what I've read I believe the potential side effects are more extreme (i.e. the elevated stroke/heart attack risk).
Using any pain medication for prolonged periods of time without consulting a doctor is dangerous. Many people do it, and most are absolutely fine, but when things go wrong, things go terribly wrong.
The episode shows how even small overdoses of acetaminophen can cause fatal liver damage, while decades of FDA delays and confusing drug labeling left millions of Americans at risk.
The alternatives are worse - ibuprofen destroys your stomach lining if taken at the regular dose for too long.
This is how the VA killed my dad :/
I tested positive with COVID-19 on Tuesday and had a pretty high fever (103) with a terrible headache, but I didn't take ibuprofen. First, because it could lower my fever, second, because its anti-inflammatory effect would compromise my immune system response to the pathogen. Most people I know immediately try to lower their fever to reduce their discomfort and would immediately take it for headaches, too.
Not always. Blaming “lazy” and irresponsible parents is disgusting.
I wonder if it might also slow healing of wounds, or wherever else intense cell division happens.
> These results suggest that APAP should be used with caution by women attempting to conceive. Given that cell division is fundamental to all development, further investigation is now warranted to substantiate these findings and to elucidate possible implications for other developmental processes, such as gonadal and brain differentiation.
I'm not sure if that was supposed to be sarcastic, but these two people have done more harm to public health, and are responsible for more health dis/mis-information, than pretty much anyone I can think of. (I am a biochemist, no conflict of interest)
Okay some don't, particularly North American and Northern/Western European ones.
But mostly, on average, physicians always try to prescribe you something.
No comments yet
https://en.wikipedia.org/wiki/Paracetamol_poisoning
Results: "Suicidal deaths from paracetamol and salicylates were reduced by 22% (95% confidence interval 11% to 32%) in the year after the change in legislation on 16 September 1998, and this reduction persisted in the next two years. Liver unit admissions and liver transplants for paracetamol induced hepatotoxicity were reduced by around 30% in the four years after the legislation. Numbers of paracetamol and salicylate tablets in non-fatal overdoses were reduced in the three years after the legislation. Large overdoses were reduced by 20% (9% to 29%) for paracetamol and by 39% (14% to 57%) for salicylates in the second and third years after the legislation. Ibuprofen overdoses increased after the legislation, but with little or no effect on deaths."[1]
[1] https://pmc.ncbi.nlm.nih.gov/articles/PMC526120/
Roughly:
- Paracetamol overdose can cause severe liver damage and may be fatal.
- Ibuprofen in high doses can lead to kidney injury and stomach bleeding.
- Aspirin overdose may result in salicylate poisoning, causing ringing in the ears, confusion, and metabolic acidosis.
Together they have higher pain killung effects than each alone, and the side effects are reduced as they affect different body parts. And the vitamin C reduces the damage to the stomach lining.
Meanwhile, taking ibuprofen can negate the effect aspirin has when taken against cardiovascular diseases. Not a huge problem if you're just taking it as a painkiller, but not everyone can combine the two. That's another potential reason to take paracetamol over some NSAIDs, though you should obviously consult a doctor if you're taking prescription medicine of any kind.
There is a rich and varied multidimensional field of danger, from aspects like the safety-margin between regular/dangerous dose levels, the chronology of how it can spike or accumulate, whether there's feedback in advance of damage, etc.
Yeah, I can poison myself drinking clean water, but it's hard.
Other drugs like theophylline have ceased to be prescribed for a similar reason alternatives were available, but due to drug marketing, acetaminophen is touted as the "safe" pain reliever.
Paracetamol's patents have expired long ago and there's not much profit to be made out of it (nowadays it's mostly not being made in the West, but imported from China, unlike profitable medicine).
The reason why it's still used it's that it's much better than the alternatives, despite the risks (it's only risky if you don't respect the doses by the way).
This is why Ibuprofen is perhaps the better default painkiller.
Since it’s a mild and really common painkiller, sometimes seen as not dangerous, someone uneducated about it who is really suffering could easily take 3 or 4 times the dose.
Unlike a lot of drugs, you are not going to have a lot of immediate side effects if you overdose on paracetamol. You’ll just horribly die some days after,
And the solution is simple: educate people about that.
And it's not something hard to do, just have pharmacists say “respect the dose as it will kill you if you don't” every time they sell things and it'll work.
Total culture shock for me, as in Europe the default for children is rectal ingestion (which is probably a culture shock as well for Americans). Any how, with pills it is much easier to avoid overdose.
We had blood test done (on the doctor's recommendation), and luckily there is no sign of any damage, but prescription errors do happen (even if they are rare) and it's much easier with liquids (you probably wouldn't give 8 pills to a baby, but 8ml doesn't seem so bad).
There's no “as in Europe”, every European country is different. In France the default is also liquid form, but the pipette is graduated is kilograms of baby weight, which limit the errors you can make (you know your kid doesn't weight 15kg when his weight is around 8).
We ended up crushing and diluting tablets in milk, which he would drink (you waste a lot of milk to hit the right factor).
Some links:
https://hsph.harvard.edu/news/using-acetaminophen-during-pre...
https://jennifermargulis.substack.com/p/why-this-doctor-is-c...
Question: Does acetaminophen use during pregnancy increase children’s risk of neurodevelopmental disorders?
Findings: In this population-based study, models without sibling controls identified marginally increased risks of autism and attention-deficit/hyperactivity disorder (ADHD) associated with acetaminophen use during pregnancy. However, analyses of matched full sibling pairs found no evidence of increased risk of autism (hazard ratio, 0.98), ADHD (hazard ratio, 0.98), or intellectual disability (hazard ratio, 1.01) associated with acetaminophen use.
Meaning: Acetaminophen use during pregnancy was not associated with children’s risk of autism, ADHD, or intellectual disability in sibling control analyses. This suggests that associations observed in other models may have been attributable to confounding.
Autistic moms are more likely to have chronic illness, sensory issues, auto immune issues, etc thus are more likely to be taking medications. In the end, the autistic mom just passes her autistic genes to the baby.
I guess the safest way is to take up the treatment in a hospital, to check for immediate bad reactions.
On the other hand, like with many medications, severe allergies and individual sensibilities causing side effects often don't show up often in the short term, but rather suddenly after many dose intakes.
So I'm back where I started. Not disagreeing with what you say. It seems like these non-steroidal pain relief medications are poorly understood regarding their interaction with the whole body though.
Many OTC medications and even some prescribed ones (especially psychiatric medications) suffer from a very poor understanding and apparent lack of effort in improving the understanding of their mechanisms of action.
Not addictive, not hepatotoxic, not nephrotoxic.
Seems the reason for the ban / harder regulation in some countries is about the disturbance of blood-forming in some individuals (which can also be deadly, but I have no idea of the quantified risk here).
By the same logic it would now be effective against cancer, no?
That doesn't make it very safe, but NSAIDs carry well known risks during later stages of pregnancy, and opiods aren't exactly harmless either. Even aspirin carries risk (and aspirin doesn't even work as well compared to other drugs).
As far as I can tell paracetamol is still the first choice for painkillers while pregnant, but only because none of them are completely safe to use. It's probably fine for short term usage, but that also goes for non-pregnant people to be honest.
But from what I understand acetaminophen also dulls emotional pain like from being fired or breaking up with a girlfriend which is interesting.
I still prefer to take neither if I can avoid it and I'll hurt a little bit instead. Hurt a lot and I'd probably change my mind though.
Both of my parents are/were heavy smokers drinkers from their teenage years. Mom died of lung cancer from smoking. Kind of wild to think that the odds were really stacked against my birth.
For instance, if spontaneous abortion is normally 1% and smoking increases it to 2%, then that’s a 100% increase. Now, I don’t know the actual numbers, and smoking is just generally not good for one’s health, but I wouldn’t go as far to say things were stacked against you.
"The meta-analysis showed a significant association between maternal tobacco smoking during pregnancy and increased risk of ADHD in offspring."
Mohammadian M, Khachatryan LG, Vadiyan FV, Maleki M, Fatahian F, et al. (2025) The association between maternal tobacco smoking during pregnancy and the risk of attention-deficit/hyperactivity disorder (ADHD) in offspring: A systematic review and meta-analysis. PLOS ONE 20(2): e0317112. https://doi.org/10.1371/journal.pone.0317112
"Compared with unexposed controls, individuals with PAE reported significantly higher frequencies of problems with hearing, dentition, heart, cancer, gastritis, kidney stones, bladder, diabetes, thyroid, skin, and seizures."
Coles, C.D., Shapiro, Z.R., Kable, J.A., Stoner, S.A., Ritfeld, G.J. & Grant, T.M. (2024) Prenatal alcohol exposure and health at midlife: Self-reported health outcomes in two cohorts. Alcohol: Clinical and Experimental Research, 48, 2045–2059. https://doi.org/10.1111/acer.15441
"Our results indicate that perinatal exposure to maternal smoking is associated with increased risks of CVD events, and such relations are modified by adulthood smoking behaviors."
H., Liang, Z., Wang, H., Cardoso, M. A., Heianza, Y., & Qi, L. (2021). Perinatal exposure to maternal smoking and adulthood smoking behaviors in predicting cardiovascular diseases: A prospective cohort study. Atherosclerosis, 328, 52–59. https://doi.org/10.1016/j.atherosclerosis.2021.05.009
"Our findings support previous findings suggesting the detrimental effects of prenatal binge drinking on child cognition. Prenatal alcohol exposure at levels less than daily drinking might be detrimentally associated with child behavior. The results of this review highlight the importance of abstaining from binge drinking during pregnancy and provide evidence that there is no known safe amount of alcohol to consume while pregnant."
Flak, A. L., Su, S., Bertrand, J., Denny, C. H., Kesmodel, U. S., & Cogswell, M. E. (2014). The association of mild, moderate, and binge prenatal alcohol exposure and child neuropsychological outcomes: a meta-analysis. Alcoholism, clinical and experimental research, 38(1), 214–226. https://doi.org/10.1111/acer.12214
You may not not want to hear this, but let's put it plainly: Prenatal smoking and alcohol is clear and obvious child maltreatment.
The implied causation annoys me. ADHD is hereditary, even if if the mother does not smoke. People with ADHD smoke ten times more often.
it also messes with bone formation so be careful using it for any length of time
especially after athletic activity
Nobody should ever take it, ibuprofen is better in every way.
I won't get into the history of why people take so much acetaminophen despite how crappy a drug it is.
Edit: I appreciate everyone's anecdata about their kids, but studies show it's no more effective than placebo:
https://www.news.com.au/lifestyle/health/health-problems/med...
Please don't give health advice on the internet. I'm not a doctor but I'm a biochemist, and there are MANY situations where ibuprofen is less safe.
Taking ibuprofen (or other NSAIDs) long-term can wear away the stomach lining, causing ulcers. Acetaminophen is generally better tolerated to manage mild long-term pain than NSAIDs, as long as you don't overdose / take with alcohol.
That's not helpful for the various categories of people who are more prone to gastrointestinal bleeding.
Ibuprofen is not better in every way. For instance ibuprofen, as well as other NSAIDs, is much less gentle on gastrointestinal tract and puts much more strain on kidneys.
Some people (e.g. with inflammatory bowel diseases or renal diseases) do not tolerate NSAIDs well, which is why acetaminophen is on the same step of analgesic ladder - it is still considered better in some cases. Both are also used complementary to each other in pediatrics.
The fact is that (largely due to the incredible marketing of Johnson & Johnson's Tylenol brand in the US) way too many people think acetaminophen is "safe and effective" when it's actually both pretty unsafe and pretty ineffective. Most people just "pop a Tylenol" by default without realizing it's not much better than placebo.
Sure there are cases where people have unique risks and should avoid NSAIDs. But for the vast majority of the public, if they or their kid are dealing with a headache, fever, menstrual cramp, or other transient pain or fever, they should reach for ibuprofen (with a snack) over acetaminophen. It's not remotely a close call.
I'm frankly pleased that people are becoming more aware of this and I don't mind taking a couple correction comments for presenting the info in a superficial way.
They reduce production of the stomach’s protective mucous lining. Snacks don’t help with that.
They can also cause kidney damage.
Occasional use for an otherwise healthy person is fine. But Tylenol as long as you are careful not to take too much is generally safer.
Ibuprofen is not better in every way. Ibuprofen is active in so many different parts of the body at the same time that inevitably it has unintended effects which is more pronounced especially in the elderly. It's bad for stomach, bad for kidneys, bad for mental status. and very bad with long-term use.
TLDR. Both aren't great for different reasons. Tylenol can be acutely OD'd and evidence is starting to show it isn't great embryos. Outside of those 2 situations that can be easily avoided, it is overall less bad than ibuprofen.
There are legitimate reasons to complain about APAP but calling it a placebo is nonsense.
I'd love if you did. What's the story there?
https://www.washingtonpost.com/archive/politics/1982/10/02/h...
https://archive.md/rssPI
Give me paracetamol over ibuprofen in most cases. Ibuprofen is much more likely to cause stomach issues than I am to miscalculate "take 2 paracetamol every 4-6 hours".
At a standard dose, paracetamol slightly reduces fever,[13][17][18] though it is inferior to ibuprofen in that respect[19]
[13] Warwick C (November 2008). "Paracetamol and fever management". J R Soc Promot Health. 128 (6): 320–323. doi:10.1177/1466424008092794. PMID 19058473. S2CID 25702228.
[17] Chiumello D, Gotti M, Vergani G (April 2017). "Paracetamol in fever in critically ill patients-an update". J Crit Care. 38: 245–252. doi:10.1016/j.jcrc.2016.10.021. PMID 27992852. S2CID 5815020.
[18] de Martino M, Chiarugi A (December 2015). "Recent Advances in Pediatric Use of Oral Paracetamol in Fever and Pain Management". Pain Ther. 4 (2): 149–68. doi:10.1007/s40122-015-0040-z. PMC 4676765. PMID 26518691.
[19] Pierce CA, Voss B (March 2010). "Efficacy and safety of ibuprofen and acetaminophen in children and adults: a meta-analysis and qualitative review". Ann Pharmacother. 44 (3): 489–506. doi:10.1345/aph.1M332. PMID 20150507. S2CID 44669940.
It's good you can take both at the same time then! (For adults.)