This is certainly one of the questions we pediatricians hear most frequently from parents with sick children, whether they have a fever, pharyngitis, or a cold.
But first, let me make some important points, also in light of recent “American controversies” (if you don’t know what I’m talking about, read this article about Tylenol and autism).
How to choose between Ibuprofen or Tylenol?
Here are the use cases for both of these medications.
Acetaminophen (paracetamol) is the safest pain reliever and fever reducer available, the only one indicated at any stage of pregnancy and from the first day of life (ibuprofen is not – why?). It works on fever and pain, but not on inflammation;
At the therapeutic dose (the one you find on the package or in the package insert), glutathione will not be depleted, so you can rest easy;
Ibuprofen is contraindicated at certain stages of pregnancy (unless otherwise indicated by a doctor) and, in pediatrics, is only indicated from 3 months of age onwards (though we generally avoid giving it even in the immediately following months).
In addition to having fever-reducing and pain-relieving action like acetaminophen, it also acts on inflammation, bringing with it side effects that acetaminophen does not have.
But rather than asking ourselves what is better BETWEEN ibuprofen or tylenol, we should ask ourselves: WHEN to administer one or the other?
In which cases should we intervene with medications?
In case of:
- discomfort
- suffering
- moaning
- crying
- restlessness
In other words, when the child is in PAIN.
And NOT in case of “fever above X” since fever is a weapon deployed by the body to fight infections.
It should be lowered ONLY if it creates discomfort, as it poses no danger except in specific underlying conditions well known to parents, such as epilepsy.
And just as fever is generated to fight infection, the same applies to inflammation which, within certain limits, should therefore be preserved and not suppressed.
So then, WHICH one should I choose?
Acetaminophen or Ibuprofen?
Always and without exception, acetaminophen first.
At therapeutic dosage, it can be repeated with complete safety every 6 hours in children, every 8 hours in pregnant women, adults, and the elderly (who take 1 g regardless of body weight).
In case of specific conditions where the pain is of inflammatory origin (e.g., acute otitis media, pharyngitis, transient synovitis), ibuprofen will be preferable (can be repeated maximum every 8 hours).
In case of difficult-to-manage pain and before resorting to stronger pain relievers (e.g., tramadol), it will be possible to alternate the 2 medications every 4 hours – and certainly not to treat the infamous “high fever that won’t come down.”
The single toxic dose of acetaminophen in pediatrics is 150 mg/kg; 200 mg/kg in healthy children aged between 1 and 6 years.
The therapeutic dose most commonly used in pediatrics is 15 mg/kg (ranges from 10-15 mg/kg): a dose at least 10 times higher is therefore necessary to deplete the famous glutathione, causing serious liver damage!
A child weighing 10 kg (22 lbs), instead of taking 150 mg, would need to take 1,500 mg (which is 3 tablets of 500 mg each!).
What happens if I give Ibuprofen incorrectly?
What could happen using ibuprofen during viral infections if not indicated or anyway as a first choice?
Although it is safe regarding the risk of gastric damage, it has been shown that:
- It increases the risk of complicated pneumonia in children during respiratory infections;
- It can lead to serious necrotizing infections of soft tissues during chickenpox (yes, unfortunately we are seeing this again).
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Remember, we are with you.
SOURCES
1. https://www.salute.gov.it/imgs/C_17_pubblicazioni_1256_allegato.pdf
2. https://emedicine.medscape.com/article/820200-overview
3. Lesko SM, Mitchell AA. The safety of acetaminophen and ibuprofen among children younger than two years old. Pediatrics. 1999 Oct;104(4):e39. doi: 10.1542/peds.104.4.e39. PMID: 10506264.
4. Quaglietta L, Martinelli M, Staiano A. Serious infectious events and ibuprofen administration in pediatrics: a narrative review in the era of COVID-19 pandemic. Ital J Pediatr. 2021 Jan 29;47(1):20. doi: 10.1186/s13052-021-00974-0. PMID: 33514404; PMCID: PMC7844800.