Ibuprofen and paracetamol: what's the difference?

Should I take a paracetamol or an ibuprofen? It's a common question for people with headaches or other discomforts. Two of the most widely used drugs in the world, the pain killers get mixed up by millions of people.

We've gathered information from several experts to indicate the differences between paracetamol and ibuprofen: nps.org.au, londondoctorsclinic.co.uk, and theglobeandmail.com. However, if you are still unsure about which medicine to take, have side effects, or continue to have pain after taking the medication, you should see a doctor.

Ibuprofen belongs to the group of non-steroidal anti-inflammatory drugs (NSAID). Non-steroidical means that it is not derived from cortisone. The active ingredient of ibuprofen is used mainly as an anti-inflammatory (against infection) and analgesic (to relief pain). It also has an anti-thermal effect, which means it could help bring your temperature down.

As ibuprofen both counters inflammation and relieves pain, the doctor may prescribe ibuprofen when localized pain is accompanied by swelling, heat, and possible infection. This occurs in cases such as muscle injuries, menstrual pain, toothache, or arthritis, for example.

Ibuprofen is indicated for mild to moderate pain. Ibuprofen is also used to control fever, when acetaminophen (an element of paracetamol) does not suffice to do so.

One of the contraindications of ibuprofen is that it can potentially damage the barrier that protects the stomach. If you tend to have acid indigestion or heartburn, doctors recommend that you take ibuprofen in limited doses and for short periods only. The package leaflet of the medicine will also explain whether and how to use it safely in case of stomach problems. Apart from that, ibuprofen may have harmful effects on the cardiovascular system.

To avoid problems with ibuprofen, it is advisable to take the appropriate doses and, above all, to avoid self-medication. Usually, doses range from 400 to 600 mg, but it's best if the doctor indicates the dose. It should not exceed 1,200 mg per day to avoid damaging the membrane layer of the stomach (or gastric mucosa).

Ibuprofen metabolizes through the kidney. Therefore, the drug is contraindicated in patients with nephropathy.

Paracetamol is the alternative for ibuprofen in case of bodily aches. Paracetamol, too, works to relieve pain and fever. It is both an analgesic and an antipyretic. However, paracetamol is not anti-inflammatory.

Paracetamol is usually used to treat injuries or illnesses that are not accompanied by inflammation. This includes simple headaches or the usual joint pains caused by the flu or fever.

Paracetamol has fewer contraindications than ibuprofen. It is much less aggressive on the gastric mucosa.

Doses of paracetamol range from 500 mg to 1 gram every eight hours, depending on the doctor's prescription.

The daily limit for paracetamol is set at 3 grams per day. If we exceed these limits, we could risk severe liver damage.

Paracetamol is metabolized by the liver. Therefore, it is contraindicated for patients with hepatology.

That being said, what should we take for our headache? Ibuprofen may be more effective because it has an anti-inflammatory effect. At the same time, paracetamol is less harmful for the stomach. It's best to limit ibuprofen and stick to paracetamol if you don't have inflammation.

But how can you tell if you have inflammation in addition to pain? Inflammation is characterized by heat, swelling, pain, loss of function and redness of skin (erythema). In that case, it may be more effective to take ibuprofen. If you only have pain, paracetamol may suffice.

That being said, it is always better to ask an expert than to take medicine if you're not sure of its effects. Also, if symptoms continue or become worse, we recommend that you see a doctor.

How about COVID-19? Should we refrain from taking ibuprofen and / or paracetamol if we get infected? Researchers have not found an answer to this question yet. In June 2020, the BBC reported on the basis of NHS advice that you make your decision the same way as you would with a regular headache. This means: first try paracetamol. If that doesn't work, try ibuprofen. If symptoms continue or worsen, see a doctor.