One of the articles posted here last week focused on when to use Tylenol versus ibuprofen in adults. Guidelines for using the pediatric versions of these over-the-counter medications in children should be considered when we’ve got sick children, and especially when these medications are in short supply.
Fevers
I really wanted to be able to write here that one drug was better than the other for reducing fever. Unfortunately, the fact of the matter is that there are numerous studies indicating that Tylenol is better, and just as many showing that ibuprofen is more effective. They both act equally quickly to reduce fevers, though ibuprofen lasts longer.[1] Pediatricians in general assert that they are equally safe though ibuprofen is not recommended for infants under six months of age in the US. (In Italy the threshold is three months of age.[2]) And because they are equally effective, doctors usually just recommend one or the other without offering any further information. It’s easier that way and it gets parents and children out the door faster so the doctor can see the next patient more quickly.
Unfortunately, they often don’t take the time to share a more effective treatment for bringing fevers down when using these medications. And that is to alternate them. Following the dosage directions provided with the medication, administer one dose of ibuprofen. Two to three hours later, administer a dose of the other drug, Tylenol in this case. And then back to the first drug after the requisite amount of time has passed. (Four hours after the previous dose of acetaminophen; six hours after the previous dose of ibuprofen.)[3]
Because ibuprofen and Tylenol are cleared through different organs (ibuprofen by the kidneys and Tylenol by the liver), there’s no danger of overdosing when combining the two. The only concern is ensuring that doses of the same drug are correctly timed. Alternating and combining the two medications is frequently recommended by physicians to achieve maximum pain relief and has been previously discussed (link below).
In the course of researching for this article, it was interesting to find that studies also show that children over six years of age or those who have higher fevers do not respond as well to fever-reducing medications as younger children or those with lower fevers do.[4] It may be that alternating the two drugs would be more effective in these situations.
Pain Relief
Tylenol (acetaminophen) is an analgesic, meaning it functions on pain signals within the nervous system itself.[5] It basically masks the pain while not really addressing the reason for the pain. It does nothing to reduce inflammation and is thus not really effective against inflammatory pain. Tylenol is a good choice for pain due to headaches and sore throats.[6]
Ibuprofen is an NSAID—non-steroid anti-inflammatory drug. As the name suggests, it works well against inflammation—earache, toothache, sinus infections. It is definitely preferred over Tylenol in relieving pain due to inflammation.[7]
Ibuprofen should also not be used:
- When there is diarrhea or vomiting (because ibuprofen is cleared through the kidneys, and the risk of dehydration due to diarrhea or vomiting increases stress on the kidneys and the potential for renal damage)[8]
- For treating chickenpox[9]
- If there is wheezing or persistent asthma[10]
- If there is stomach upset[11]
Tylenol should not be used:
- In infants under three months of age except on advice of physician
- Without checking ingredients if other medications are being used at the same time. A significant number of drug overdoses in the US occur as a result of combining medications without realizing that the other medications also contain Tylenol.
[1] https://www.thriveap.com/blog/tylenol-vs-ibuprofen-which-better-fever
[2] https://link.springer.com/article/10.1007/s40265-017-0751-z
[3] https://www.bmj.com/content/337/bmj.a1302
[4] https://www.thriveap.com/blog/tylenol-vs-ibuprofen-which-better-fever
[5] https://health.clevelandclinic.org/acetaminophen-vs-ibuprofen-which-works-better/
[6] https://health.clevelandclinic.org/acetaminophen-vs-ibuprofen-which-works-better/
[7] https://link.springer.com/article/10.1007/s40265-017-0751-z
[8] https://link.springer.com/article/10.1007/s40265-017-0751-z
[9] https://link.springer.com/article/10.1007/s40265-017-0751-z
[10] https://link.springer.com/article/10.1007/s40265-017-0751-z
[11] https://health.clevelandclinic.org/acetaminophen-vs-ibuprofen-which-works-better/
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