Acetaminophen or Ibuprofen?
As pediatricians we get asked this question all the time. And I’m going to go over the data below, with two important caveats.
Both are good. Both work. Both are safe. And in this moment when some may be struggling to find one or the other, use the one you have! But if you’re wondering what the actual answer is…read on.
First things first
The first thing to remember is that fever its the body’s way of handling immune challenges. We treat it primarily to maintain comfort - and as such, the goal of treatment is less about bringing the temperature to normal, and more about addressing any pain, chills, fatigue, etc. Bringing the temperature down CAN help these things - but fixating on the number is a recipe for spiraling. Here are prior posts on why fevers happen and how to approach fever.
One other thing to keep in mind: in the US, we do not recommend any fever reducing medication under 2 months unless you have explicitly been instructed to give them by your physician. And we do not recommend ibuprofen below 6 months.
So which is better?
There are a few studies that compare acetaminophen (often called Tylenol or Paracetamol), and ibuprofen (often called Motrin or Advil). The conclusions seem to be that Ibuprofen works marginally better for pain and fever than Tylenol does. (PMID: 35273783, 33125495)
But your kid hasn’t read the research. Anecdotally, some kids to seem to do better with Acetaminophen over Ibuprofen - since both are considered safe and effective, either is fine to try. Don’t fix what isn’t broken!
Other factors to consider…
Frequency of administration
If your child hates taking medicine - or it takes a wrestling match (in a toddler) or a lengthy argument to get them to agree, there is a good argument to be made for choosing a medication that needs to be given less frequently; typically, acetaminophen can be dosed every 4 hours, while ibuprofen is dosed every 6-8 hours.
Flavors
My kids have strong opinions about what flavors they like. And while many of the flavors these medications come in are fairly generic, kids have opinions. Pick your battles!
Routes
The good news is both are available in multiple forms, including liquid, chewable tablets, suppositories and regular pills.
For dosing information based on the form the medication is in, check out my guides page for a free download.
What about alternating?
These medications can be given in combination — they have different mechanisms. And we do have some evidence that alternating is a good way to achieve symptom control - but most pediatricians, myself included, advise caution.
My hesitation is based on personal experience. I’ve made errors twice before when we were alternating, so we no longer do it. When you’re sleep deprived because you’ve been caring for a sick child (or when you’re sick yourself), or when there is more than one caregiver, its so easy to make a mistake.
With that said: even if you’re giving just one medication, I always recommend writing down the details of the medication dosing to prevent an error. See the brand new medication tracker on my guides page for a free printout you can use the next time your child is sick.
What about side effects?
Both of these medications, especially if overdosed, can be fatal. They can cause kidney and liver issues, as well as stomachaches and gastritis.
This is why it is especially important to make sure you have the correct dosing for your child. Ideally, we recommend dosing based on weight, but in a pinch - age will do.
What about the Tylenol/Glutathione connection?
Fear mongering generates share-worthy content, and so it is not uncommon for influencers (who are not trained in physiology) to share scary “facts” about Glutathione depletion and the connection with Acetaminophen. Like many other things, there is a grain of truth in the fear-mongering, but the interpretation and perspective are missing.
This is the deal: Acetaminophen does decrease the level of an anti-oxidant called Glutathione. This is because when it is broken down in the liver, it forms a byproduct that then is removed by Glutathione. So if you have too much Tylenol then you overwhelm the supply of Glutathione and that byproduct builds up. This can absolutely lead to liver damage.
But the dose makes the poison.
This mechanism is relevant when someone has too much Acetaminophen in their system (ie. an overdose or long term chronic use). For purposes of this discussion, or during an acute illness in a child, it is irrelevant - and simply fear-mongering. A few doses will not cause a problem. Just make sure you’re dosing correctly — I have a free download with dosing information in the guide section of this website.
FAQ:
Q: How many days is too many for giving fever-reducers?
A: Any of these medications should not be used for longer than 5 consecutive days without oversight by a doctor.
Q: What about the bad press around Acetaminophen and Autism, ADHD, Asthma?
This is a topic for its own post. But the brief bottom line is this: anything we give has potential risks. But in these cases, many of the claims are based on observational data and associations - they’re not well-controlled trials. And it is hard to determine causality based on the information we have right now.
The claims about ADHD and autism primarily relate to observational data about prolonged exposure during pregnancy. Taking the medications occasionally does not seem to show any increased risk, and to be honest these studies cannot control for the other environmental and genetic factors that play a role in the development of these conditions. Correlation does not equal causation!
If you’re looking for a more thorough analysis, I highly recommend checking out Professor Emily Oster’s information on this topic.
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