Bottle or red pills

—Kiernan*, Platteville, Wisconsin

(*Name changed)

Overall, for a healthy, young person, occasional use of ibuprofen (e.g., Advil®) or acetaminophen (e.g., Tylenol®) in recommended doses is likely to provide more benefit than cause harm. For example, controlling pain and fever from a viral sore throat can allow for better sleep and therefore a more rapid recovery. These medicines can also improve quality of life from musculoskeletal injuries such as sprained ankles and low back pain.

Too much ibuprofen, however, can definitely lead to health risks. This is especially true for patients with additional risk factors (see below). The most familiar adverse effect is gastrointestinal injury. Ibuprofen blocks prostaglandin production, which means it’s good for interrupting the process that leads to pain and inflammation, but it has unwanted effects elsewhere in the body. The stomach is protected from digesting itself by a prostaglandin layer that buffers the stomach acid. Overuse of ibuprofen can disrupt this prostaglandin layer, which can contribute to erosion of the stomach lining, leading to gastritis (irritation of the stomach lining) or ulcers. Ibuprofen overuse can also impair kidney function by affecting blood flow to the kidney.

Acetaminophen (aka paracetamol or APAP) is a pain reliever and fever reducer, but it’s a weaker anti-inflammatory than ibuprofen. Long-term use of acetaminophen is less likely to cause adverse effects than ibuprofen is, but there’s a greater risk of overdose, and it can cause profound injury to the liver.

Here are some general guidelines for the use of ibuprofen and acetaminophen

  • Use the lowest effective dose for the shortest time needed. The maximum recommended daily dose of ibuprofen is 2,400 mg per day (actually, it’s 3,200 in the US and 2,400 in Canada; however, I learned that 2,400 in 24 hours is catchier and sensible), and of acetaminophen, it is 4,000 mg per day. Taking either for a few days once every 6–8 weeks is generally safe.
  • Read all medication labels and make sure you aren’t inadvertently doubling up by getting the same, or similar, medication(s) in multiple products. Ask a pharmacist or medical provider if you’re unsure.
  • Talk to a medical provider before using ibuprofen if you have any of these: hypertension, history of gastroesophageal reflux disease (GERD) or ulcers, strong family history of cardiovascular disease (heart attack or stroke), or kidney disease. You should probably also discuss use with a provider if you’re a smoker, have diabetes, are over 65, or regularly consume more than 3–4 alcoholic drinks a day. Also, discuss choice of pain medicine with your prescriber if you take any daily medication.
  • Talk to a medical provider before using acetaminophen if you have liver disease or regularly consume more than 3–4 alcoholic drinks a day.

Guess what? There’s more information out there. Check out these resources from the US National Library of Medicine:

Ibuprofen: MedlinePlus

Acetaminophen: MedlinePlus