What is the difference between paracetamol and acetaminophen

Screening and eligibility assessments were performed using Covidence. We included all published studies trials, cohort, case-control from any health care setting or country that compared short-term use of acetaminophen with ibuprofen for fever or pain in children younger than 2 years and reported 1 or more primary or secondary outcomes. Studies whose population included participants older than 2 years were included if they published data for the age group younger than 2 years or if study authors provided unpublished data via personal communication.

We included studies with both short-term and long-term follow-up. We excluded case series and studies in which there was medication cointervention. The primary outcomes were fever continuous variable or pain within 4 hours of treatment onset. Secondary outcomes included fever categorical variable within 4 hours and fever or pain at 4 to 24 hours, 1 to 3 days, and more than 3 days. If studies reported more than 1 data point within a period, we extracted the data that occurred at the earliest point within that period, except for secondary safety outcomes at more than 28 days, in which case we extracted the longest-term data that were reported.

Data from randomized and nonrandomized studies were analyzed separately on an intention-to-treat basis. Meta-analysis was performed separately for continuous and categorical outcomes for fever and pain and for secondary safety outcomes, using Review Manager version 5.

Heterogeneity between studies was calculated using the I 2 statistic in RevMan. If meta-analysis was not possible, a narrative synthesis is provided.

We planned a sensitivity analysis, excluding studies at high risk of bias. Of records identified, were excluded following title and abstract screening, were excluded following full-text screening, and 4 were ongoing studies.

Thus, 19 studies 20 publications 12 , 29 - 47 were included Figure 1. Of these, 9 reported fever outcomes, 29 , 30 , 32 - 36 , 39 , 40 4 reported pain outcomes, 33 , 35 , 39 , 40 and 9 10 publications 30 - 33 , 35 - 40 reported safety outcomes.

Of these, 2 reported fever outcomes, 42 , 43 0 reported pain outcomes, and 8 reported safety outcomes. They took place in various clinical settings, including pediatric and mixed emergency departments, pediatric wards, hospital-based clinics, and community clinics eTable 1 in the Supplement.

Participants ranged in age from birth to 18 years. Two randomized studies were at high risk of bias. All nonrandomized studies were at moderate or serious risk of bias eTable 2 in the Supplement. Moderate-quality evidence from randomized studies showed that compared with acetaminophen, ibuprofen was associated with reduced temperature within 4 hours 4 studies 29 , 32 - 34 with participants; SMD, 0.

None of the included studies reported pain outcomes within 4 hours from treatment onset. Subgroup analyses for fever reduction within 4 hours comparing lower and higher dosages of ibuprofen and acetaminophen did not alter the results eFigure 2 in the Supplement. Data were not available for the remainder of the planned subgroup analyses. In sensitivity analysis, exclusion of 2 studies at high risk of bias 29 , 43 did not alter the results.

For continuous fever outcomes Figure 2 , moderate-quality evidence showed that, compared with acetaminophen, ibuprofen was associated with reduced temperature at 4 to 24 hours from treatment onset 5 studies 30 , 32 , 33 , 39 , 40 with participants; SMD, 0.

Moderate to low-quality evidence showed that ibuprofen and acetaminophen had similar antipyretic profiles at 1 to 3 days 2 studies 35 , 40 with participants; SMD, 0.

For categorical fever outcomes Figure 3 , moderate-quality evidence showed that children treated with ibuprofen were more likely to be afebrile within 4 hours 5 studies 32 - 36 with participants; ibuprofen, of [ Data were not available after more than 3 days. For continuous fever outcomes eFigure 1 in the Supplement , very low-quality evidence from 1 study 42 with 40 participants showed that ibuprofen and acetaminophen had similar antipyretic profiles at 4 to 24 hours SMD, 0.

None of the nonrandomized studies reported categorical fever outcomes. For continuous pain outcomes Figure 4 A , moderate-quality evidence showed that compared with acetaminophen, ibuprofen was associated with less pain at 4 to 24 hours from treatment onset 2 studies 33 , 40 with participants; SMD, 0. Low-quality evidence from 1 study with participants showed that ibuprofen and acetaminophen had similar analgesic profiles at 1 to 3 days SMD, 0.

For categorical pain outcomes Figure 4 B , low-quality evidence from 1 study 35 with participants showed that children treated with ibuprofen were more likely to be pain free at 4 to 24 hours from treatment onset ibuprofen, 36 of 52 [ None of the nonrandomized studies reported pain outcomes. There were very low rates of adverse events reported across all studies, with most studies reporting 0 adverse events during their follow-up period. Of these, 4 studies 30 , 32 , 33 , 39 with participants had no SAEs in either treatment group.

Only 1 study 36 with participants reported outcomes for severe soft tissue infection and empyema, recording no events in either treatment arm. Data were not available from nonrandomized studies for short-term or long-term outcomes of hepatotoxicity and empyema. Sordillo et al 45 investigated the associations between intake of either acetaminophen or ibuprofen during the first year of life and asthma-related outcomes using data from mother-child pairs in Project Viva, 48 a longitudinal prebirth cohort study with a moderate risk of bias.

Adjusting for all covariates, they found no increase in likelihood of current asthma in midchildhood for higher infant acetaminophen or ibuprofen intake eTable 1 in the Supplement. Our review of acetaminophen or ibuprofen for fever or pain in children younger than 2 years found moderate-quality evidence that compared with acetaminophen, ibuprofen was associated with reduced temperature at less than 4 hours and at 4 to 24 hours and less pain at 4 to 24 hours.

The superiority of ibuprofen as an antipyretic did not continue beyond 24 hours after treatment onset. No data were available on analgesic outcomes at less than 4 hours. Overall, adverse events were uncommon or rare, with most studies reporting no events. These findings are supported by similar results from previous systematic reviews involving older children, 22 - 25 while adding to the body of evidence on the antipyretic, analgesic, and safety profiles of acetaminophen and ibuprofen in children younger than 2 years of age.

We demonstrated a statistical benefit at less than 4 hours and at 4 to 24 hours of ibuprofen compared with acetaminophen when used for fever. Although the SMDs were small, this benefit extended to categorical outcomes with children receiving ibuprofen being approximately twice as likely to be afebrile at these points.

Of note, these benefits were identified in the randomized studies, giving greater certainty to the results. However, the clinical importance of these findings is uncertain. Future studies should focus on these data. Evidence from randomized studies showed a benefit of ibuprofen in continuous and categorical pain outcomes at 4 to 24 hours, suggesting a clinical benefit at this time but not beyond.

Collectively, these findings provide weak evidence to support ibuprofen use over acetaminophen. Several authors have cautioned against the use of ibuprofen in healthy infants aged younger than 3 to 6 months due to safety concerns. Only 2 randomized studies 38 , 39 in our review included infants younger than 6 months; unfortunately, there were no extractable data for this prespecified subgroup analysis. The only large-scale randomized clinical trial RCT that included infants younger than 6 months is the Boston Fever Study, 50 a practitioner-based, double-masked RCT designed to assess the safety of ibuprofen suspension when used to treat fever in children.

In a post hoc analysis, 38 none of the infants aged 1 to 6 months were hospitalized for acute GI bleeding, acute kidney failure, asthma, or bronchiolitis, and risk of hospitalization did not vary significantly by antipyretic assignment. Our review did not identify any studies comparing acetaminophen vs ibuprofen for fever and pain in neonates.

Thus, we must be cautious of extrapolation of evidence to this age group. However, both ibuprofen and acetaminophen have been used for closure of patent ductus arteriosus in preterm infants, with little difference in safety profiles from a short course. A commonly cited reason for avoidance of ibuprofen in younger children is their perceived higher risk of kidney toxic effects, particularly in the context of dehydration.

Concern has been raised that ibuprofen use may increase the risk of serious bacterial infection in children, specifically, invasive group A streptococcal GAS skin infection in the context of primary varicella infection 6 , 53 and empyema.

Only 2 randomized studies 31 , 36 with participants contributed data for the analysis of these outcomes; both had small sample sizes and recorded no events.

Unadjusted and imprecise effect estimates of the likelihood of severe soft tissue infection were available from 3 nonrandomized studies 12 , 41 , 47 at serious risk of bias. These results may be confounded by indication bias because ibuprofen is generally reserved for more severe illness.

The only systematic review to specifically examine the risk of GAS infections with acetaminophen or ibuprofen treatment was inconclusive. A strength of this review is the inclusion of several important clinical outcomes that have direct relevance to pediatric patient care.

We identified both randomized and observational studies to address our review questions. Consequently, a degree of heterogeneity was found across studies with respect to study setting, sample size, drug dosages, and treatment duration. However, this diversity reflects the use of acetaminophen and ibuprofen in routine clinical practice and may strengthen the applicability of our review findings to patients with differing illnesses in various clinical settings.

A key limitation already alluded to is the small number of participants ie, who could be included in the analgesic analysis, with only 4 studies 33 , 35 , 39 , 40 reporting pain outcomes, none of which reported our primary outcome of pain within 4 hours of treatment onset. Furthermore, the small sample size in many of the studies included made the comparison of adverse events difficult because of the low rates reported across most studies.

Additionally, only 9 studies 12 , 31 , 37 , 38 , 41 , 44 - 47 investigated safety as a primary outcome, and it is possible that there is measurement bias during adverse event data collection in the remainder of the studies. Randomized studies in our review were typically short, providing limited data on adverse events at more than 28 days. Many of the long-term adverse events captured in the review were from observational studies, with their inherent biases. Thus, results of this review pertaining to safety outcomes should be interpreted accordingly.

In this study, ibuprofen use was associated with reduced temperature and less pain within the first 24 hours than acetaminophen use. Side effects that occur as a result of taking paracetamol are rare, but the most common side effects of paracetamol are:. Overdose of paracetamol is potentially very harmful, and anyone who thinks they may have taken too much paracetamol should seek urgent medical attention. Since paracetamol is mainly broken down by the liver, overdose can lead to acute liver damage hepatotoxicity.

When taking cold remedies, it's important to be aware that these commonly contain paracetamol too. Taking both cold treatments and extra paracetamol tablets for example should be avoided, to prevent the risk of accidental paracetamol overdose. Ibuprofen is used in a very similar way to paracetamol; it treats pain but can also be used to treat fever. The main difference is that ibuprofen reduces inflammation.

This means that ibuprofen will reduce inflammation. In the body, inflammation occurs for a variety of reasons: it may be a sign of infection or it is the body's response to damage. Although the pain-reducing effect will occur shortly after taking the drug, the anti-inflammatory component can take weeks to work optimally. Ibuprofen is available in a number of different forms: capsules, tablets, sprays, gels and creams. Ibuprofen gel is a popular remedy to back pain and muscle pains , as they provide effective, local pain relief.

Ibuprofen gels and creams are effected for local relief of back and muscle pains. Unlike paracetamol not everyone is able to take ibuprofen. The following people should avoid taking ibuprofen:. Book a cervical screening. Pregnant women should always take advice from a doctor before taking any medications. During pregnancy , paracetamol is generally a more appropriate painkiller. Ibuprofen should be completely avoided in the third trimester of pregnancy , as it can affect the foetal heart.

Pregnant women should avoid ibuprofen during the third trimester, as there is a risk of damage to the baby's heart.

Ibuprofen can interact unpredictably with drugs therefore it is very important that before taking ibuprofen you check that the other medications that you may be taking do not have any interaction. Ibuprofen has a larger number of side effects than paracetamol :.

Overall, both paracetamol and ibuprofen are wonderful drugs that can relieve pain quickly and can be easily accessed over-the-counter of a pharmacy. It is important to be aware of which is the more appropriate drug to be taking depending on the nature of your pain. Combinations of acetaminophen with other drugs can be effective in reducing pain and have been found to be more effective than acetaminophen alone. Acetaminophen is used in hundreds of over-the-counter and prescription medication combinations.

Too much acetaminophen can damage or destroy the liver. In , FDA officials presented evidence to a panel that people a year died of acetaminophen toxicity and more than people were hospitalized. In , an FDA panel considered a ban on acetaminophen but then voted narrowly to ban only two drug combinations: Percocet and Vicodin.

These two drugs are a combination of acetaminophen and a narcotic. Patients may be taking them for some time to deal with pain and the panel noted that over time, patients often needed to increase their dosage of these drugs to continue to achieve the same effects and that this could result in acetaminophen overdose.

The panel recommended that the FDA reduce the amount of acetaminophen in combination medications similar to Vicodin and Percocet. The FDA issued a warning on drugs containing combinations of acetaminophen and opioids and asked drug makers to lower the amount of acetaminophen in their drugs to no more than mg per dosage by