New Model For Differences Between Ibuprofen And Paracetamol
Differences Between Ibuprofen And Paracetamol are two of the most widely used drugs by the population and are sometimes used interchangeably to treat all kinds of pain. Although they have things in common, these drugs are not the same and their misuse can cause health problems, especially in those patients in which any of these drugs is contraindicated.
To overcome doubts about when to use one or the other, which doses are the safest, who cannot take them or which is the most suitable for the coronavirus, CuídatePlus has spoken with experts who give us the keys to differentiate them and opt for the more indicated in each case.
The first thing to know is that “ibuprofen is an analgesic, anti-inflammatory and antipyretic, that is, it serves to treat pain, reduce inflammation and lower fever,” reports Luis Arranz, emergency physician at Vithas Vitoria. For its part, paracetamol “is only analgesic and antipyretic, so it does not reduce inflammation.”
Neus Calles, a pharmacist and member of the Spanish Society of Family and Community Pharmacy (Sefac), gives more detail on the indications of each: “Ibuprofen is indicated for the treatment of pain of mild to moderate intensity, including migraine; of fever and for the symptomatic relief of pathologies that cause inflammation, such as arthritis, ankylosing spondylitis and non-rheumatic inflammation, as well as the relief of the symptoms of primary dysmenorrhea ”.
As for paracetamol, it would be used for “the symptomatic treatment of pain of moderate intensity and feverish states”. Another important difference that must be taken into account when using one or the other is the way it is metabolized in the body: “Paracetamol does it through the liver, while ibuprofen does it through the kidney.” Hence the contraindications: “Paracetamol is contraindicated in patients with hepatology (liver disease) and ibuprofen, like other anti-inflammatory drugs, in patients with kidney disease (kidney disease),” reports Arranz.
Furthermore, the absorption pathway also changes. “While ibuprofen is gastroenteroerosive, paracetamol is not, so patients with a history of gastric ulcer or bleeding as well as patients with inflammatory bowel disease should avoid drugs that contain anti-inflammatory drugs,” advises the Vithas expert.
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Regarding safety, the profile is also different, “ibuprofen has a gastrointestinal risk and should not be used in patients with an active ulcer and, depending on the patient, should be used together with a gastrointestinal protector. Also, it should not be used in patients with kidney or liver dysfunction. ” For his part, “paracetamol is more related to liver damage.”
According to Caelles, “for headaches, both ibuprofen and acetaminophen are the choice.” Both, says Arranz, “can be used for headaches due to having an analgesic effect, although the use of ibuprofen may be more effective in certain types of migraines, as it has an anti-inflammatory effect.”
Caelles summarizes it this way: “In feverish processes or in mild or moderate pain, both can be used, but, as an anti-inflammatory, only ibuprofen.” The patient will know that he is going through an inflammatory process when he has any of these symptoms: “Erythema, heat, swelling, pain and functional loss.” Thus, the perfect formula to use one or the other in the absence of any contraindication would be, according to Arrranz: “Paracetamol in processes with pain and ibuprofen in inflammatory processes that cause pain.”
These types of medications, like many others, are found in different formats and at different doses depending on the type of illness you want to treat. According to Caelles, “the safe doses for ibuprofen at cardiovascular risk would be 400 mg three times a day.” Taking 600 mg three times a day, adds the pharmacist, “it can increase cardiovascular risk” and would be discouraged, especially considering that “this higher dose has not been shown to be more effective in patients over 40 kg ”, According to Arranz.
For pain, Caelles advises “the use of ibuprofen preparations together with arginine or liquid preparations with a faster absorption pharmacokinetics since they better control pain due to its speed of action”. As for paracetamol, “650 mg doses are safer three or four times a day, since 1g doses every 6 hours can produce hepatotoxicity,” says Caelles. These 650 mg doses “are usually enough for many of the processes that occur with self-limited symptoms over time,” says the pharmacist.
Despite this, “in 2019 50 million containers of paracetamol were sold, the most frequent being 1g, and 37 million ibuprofen, the most frequent being 600mg,” according to data provided by Arranz. The positive fact is that “the latter has decreased with an increase in sales of ibuprofen from 400mg to 9 million units sold, when years before it was hardly used.”
Sometimes doctors advise to alternate its use in certain processes, such as fever. According to Arranz, “they are used interchangeably through the concept of rescue medication, that is, in symptoms such as high fever or inflammation or significant pain (fractures).”
As the expert explains, “they are two good drugs that make synergy, that is, the two together add and potentiate the analgesic and antothermal effect of the other”, therefore, “when we have a fever and it does not subside in 3 or 4 hours or pain It does not remit, we can take them alternately and without waiting for time to pass so that it has completely metabolized and repeat doses. ” The half-life of both drugs is also different and therefore “you can use ibuprofen every 6 or 8 hours and paracetamol every 4 or 6 hours,” says the emergency expert.
On the other hand, it would not be advisable to use them to treat the same pain chronically due to the tolerance phenomenon, that is: “Continued and chronic use of these drugs would entail higher doses to achieve the same effect,” warns Arranz.
With the coronavirus crisis, many conflicting messages have been released about the use of ibuprofen to treat COVID-19 infected patients. In relation to this, the Spanish Agency of Medicines and Health Products reports that “there is currently no data that would allow us to confirm an aggravation of infection by COVID-19 with ibuprofen or other non-steroidal anti-inflammatory drugs, so there are no reasons why patients who are on chronic treatment with these drugs interrupt them. ”
The possible relationship between the exacerbation of infections with ibuprofen or ketoprofen, they continue to report, “is a sign that is being evaluated by the entire European Union in the Pharmacovigilance Risk Assessment Committee at the request of the French drug agency (ASNM) ”
This analysis is expected to end in May 2020, but with the information currently available, “it is complex to determine if this association exists, since ibuprofen is used to treat the initial symptoms of infections and, therefore, the cause- effect is not easy to establish ”.
The datasheets of the medicines that contain ibuprofen already indicate that this medicine “can mask the symptoms of infections, which could delay their diagnosis and cause them to be diagnosed in more flowery stages, although this refers to infections in in general, not specifically to the infection by COVID 19 ”, they point out from the agency.
Finally, they recommend, however, “the use of paracetamol for the symptomatic treatment of fever as the first alternative.” However, “there is also no evidence to contraindicate the use of ibuprofen in the treatment of minor symptoms. In both cases, the drugs should be used based on the technical sheet and at the lowest dose capable of controlling symptoms, “they conclude.