Comment by rustyhancock
9 hours ago
Ibuprofen is better are reducing fever and managing headaches.
Paracetamol is the safer version Phenacetin. You used to be able to buy aspirin, phenacetin and caffeine..but phenacetin with withdrawn. APC when it was marketed was very popular but soon you were told to never give children aspirin for a fever so we used Paracetamol. Then Phenacetin was withdrawn and paracetamol became part of APC (like Alka selzta XS , or just the popular caffeine paracetamol combos)
Paracetamol came in as safer but similar, yet no where near effective. It captured bith the market feeling of its pros and cons. So we interpreted it as safer than alternatives (especially aspirin for children due to Reye syndrome). But also dangerous which might be why OPs view was that ibuprofen is safer.
The NNT (number of people you'd need to take it) to be headache free after 2 hours is about 12-20 for paracetamol. But only 7-10 for ibuprofen.
It's quite surprising that paracetamol became the defacto analgesic given it performs so poorly but it was historical inertia. And plenty of people argue that if we were to start over we would not make paracetamol OTC.
Wiki for phenacetin says it's mechanism of action is being metabolized into paracetamol. IDK about your "nowhere as effective".
It was withdrawn for sometimes being metabolized into another, toxic and carcenogenic, molecule.
Here is a summary of COCHRANE evidence on Paracetamol "widely used and ineffective"[0].
It's a paradox no?
Paracetamol is only the presumed only active metabolite, and that is why paracetamol rapidly replaced phenacetin.
There is a quirk though, phenacetin actually delivers paracetamol to your brain and spine (where it primarily reduces pain) faster than an oral dose of paracetamol.
Similarly IV paracetamol is far more effective that oral paracetamol.
Phenacetin was also considered mildly addictive, and induced a gentle euphoria and then sedation.(We still see sedation after paracetamol in children and the elderly). But general use we don't see these effects in paracetamol, why did phenacetin do this more effectively? Probably the higher peak levels around nerve endings.
These effects are both wanting of an explanation of phenacetin is just paracetamol and directly analegisic.
[0] https://web.archive.org/web/20240721144157/http://www.eviden...
Interesting.
I guess it tracks with personal experience. I find Paracetamol is OK for fevers/generic cold symptoms but absolutely useless for a headache, Ibuprofen is the only thing that shifts them.
Well it's the only thing that shifts them now I'm in a country where I can't buy soluble aspirin and codeine OTC.
I end up using paracetamol often for pain because it's what's to hand.
What annoys me is that so many people have your experience and are effectively gaslit about the fact it seems to often perform so poorly.
Reminder: don't take medical advice from someone who can't write correctly.
Have you seen my doctor's handwriting?
Very interesting though that the original article makes no comment on efficacy. It's all about metabolic safety which is not contentious.