One thing every single member of the general public needs to get drilled into them: Medical science is NOT intuitive. You cannot just read the mechanism of action of a drug and infer a dozen things from it. A drug's mechanism of action, its indication (when it ought to be used) and its adverse effects CANNOT simply be inferred logically from each other. Biology is orders of magnitude more complex than SE/CS or any other field for that matter.
I presume majority of readers here have SE/CS background. Dudes! the artifacts and systems in SE/CS have the following two properties:
1. They are human artifacts. We know exactly how they are build. The theory is all publicly accessible in principle.
2. They are layered logically on top of each other. Machine code, assembly, C, Java ... so on. Firmware, OS, drivers, apps .. etc. Clean layering.
The above two core properties make it possible to more or less reliably reason about bit SE/CS systems from first principles. The complete absence of above two in medicine means you cannot do the same there. Be very very careful when you import thinking habits for daily life , or other fields of expertise, into medicine.
"This video is just for informational purposes. Consult your health care provider for your particular situation" ...is not just a legal precaution. It is a sound life advice. Nothing in life is more crucial to leave it to the experts as health/medical inference and decision making.
I was married to a doctor, helped them study for board exams, etc and was surrounded by other doctors within our social circle. What most people don’t realize, and most doctors themselves refuse to acknowledge, is how limited by specialization their knowledge can be and how the education of most doctors stops after med school and residency. Nutrition, for example, is barely covered at all.
Yes, there are continuing education requirements and countless journals but most doctors do the bare minimum and don’t keep up. I’d even argue that most physician knowledge tends to be updated more often through drug and instrumentation reps promoting their products by taking them out to dinner and entering them into referral programs, etc.
I would expect specialists to be subscribed to journals and reading the latest articles in their field. When I saw a specialist at UCSF this was definitely the case; while my GP still has gaps where their current knowledge on a specific subject is from their time at med school.
An equivalence would be a front-end engineer being naive to the happenings on the Linux kernel mailing list. They could likely understand what's going on if they took the time to read it, but that is not their focus.
Yeah I can't with the "biology is orders of magnitude more complex than SE/CS or any other field for that matter" and then thinking he can explain to the techies how technology works. Just put the pills in the bag bro. Oh wait, we need to go to a pharmacist for that.
The med students I've known have been some of the most insufferable people I've met.
I'm a doctor as well and I think your statement here is too broad. Plenty of specialists such as cardiologists, orthopedic surgeons, radiologists, etc are able to reason things from first principles. The issue is that many non-doctors may not know several key details about these systems that would let you reason through them. And even many doctors well versed in one specialty would be unable to reason about another specialty since they may not know in detail several key pieces of information from that other speciality.
I recall being an engineering classes, armed with just calculus and linear algebra and newton laws, I could attack just about every problem from first principles from my entire undergrad. Every. I didn't have to take into consideration real life presentation of the problem. First principles were enough to get me nearly there
Medicine is fundamentally not that way. Yes we learn the biology, but if you reason solely from biology, you will quickly end up in the wrong places. to become a doctor, I had to learn that hard way that yeah a disease doesn't just present this way just because the underlying physics and biology suggests it should. You separately have to learn how the disease presents, then try to tie it back to our extensive but still very very limited understanding of the possible biology.
I have problems with doctors that don't acknowledge how tenous that link is and despite how much we know, we still know so so little. We are far more useful than what we know.
I understand to biology majors, the few things that seem to follow physiologically from moelculqr biology dupes us into thinking medicine currebtly derives from first pricinples. But it doesnt.
0: https://plato.stanford.edu/archives/win2021/entries/galen/#M...
We’d all wish it’d be so, doctor. Sometimes it’s as clean as biological systems - touch something somewhere, a different seemingly completely unrelated thing elsewhere breaks.
Even in the dawn of the era, where accumulated complexity was a while lot lower, we have tales of 500-mile emails and “magic/more magic” switch ;-)
Inferring things in a legacy codebase old enough to drink can be quite a challenge. And the way I get it, you folks are dealing with a multimillenia-old mess of layering violations - so no surprise first principles are tricky.
I'm not sure saying to not try to reason at all about mechanisms of actions is a good idea. If someone knows Tylenol is metabolized into chemicals that are toxic to liver, that is simple enough to understand and reason about
The solace of made-up physics is there for every mediocre dude, from Uber founder Travis Kalanick down to any random guy who made $10M as the CTO of a third-rate video conferencing app and immediately broke up with his girlfriend.
Guess it depends on country. Here in Norway official sources[1][2] do say acetaminophen (paracetamol here) should be the default for treating fever and pain in kids, adults, pregnant women and elderly, and have for some time. Ibuprofen they say should be used with caution.
[1]: https://www.dmp.no/nyheter/behov-for-smertestillende-slik-ve...
[2]: https://nhi.no/for-helsepersonell/nytt-om-legemidler/arkiv-2...
Pain a warning signal from the body. It's something one should listen to, not just try to ignore and overrule. If I sprain my ankle it only hurts when I lean on it. Because it's healing. So I don't. Why would headaches or other "inconvenient" pains be different?
In my case headaches are usually caused by sleep deprivation causing high sensitivity to external stimuli, muscle tension, dehydration, or some combination of that. So I'll first try to take a nap and/or stick to low-stimuli environments, have a good stretch and/or heated up massage pillow for the neck, and make a quick home-made oral rehydration solution with some salt and sugar. That usually alleviates most if not all of the pain.
And I'm not saying painkillers should always be avoided. If I have insomnia-induced headaches in the morning and a long day ahead with many social interactions, then I know that headaches will make me a grumpy asshole, so I'll obviously will take a painkiller for everyone's sake. And sometimes I can only fall asleep if I take a painkiller to get rid of the headache first, so I need it to break the vicious cycle. I'm not saying people should "walk it off" here, just to focus on trying to figure out the actual cause first before medicating the symptom way. That's also healthier in the long run, no?
It was a desk job and my team was great. I didn't even think twice.
Work a manual labor job or one where you're on your feet all day and sprained your ankle? Would you rather miss a week of pay (or worse lose your job) or take some pain killers and work through it?
I work in an office, but Swedish law protects blue- and white-collared jobs the same in this regard.
This is going to vary more between blue/white collar workers than same fields in different countries.
That's a pretty apt explanation for why pain probably evolved via natural selection, but you can't therefore conclude that all or even most pain is a genuinely actionable warning sign.
Presumably the vast majority of OTC painkiller usage is for short-lived and low-severity pain. I don't think it's a hubristic affront to biology to feel a bit of soreness, note it, then take the painkillers.
which is far from harmless given how many people use them as a replacement for treating underlying symptoms and changing their life. Case study my dad. Kept taking ibuprofen to get rid of 'harmless' headaches and back pain because he was 'too busy', few years later he couldn't ignore it any more, turns out he had completely messed up disc in his cervical spine from years of physical stress, bad posture, no treatment or exercise etc.
just look at the sheer amount of back pain diagnoses. About a third of Americans report back pain at any given time, IIRC 10-15% of the population go to the doctor any given year for back pain. There's likely millions, if not tens of millions preventable cases if you replaced the liberal use of OTC drugs with actually solving the lifestyle problems.
I didn't read their comment that way at all. It seems they're critiquing the default action that many people take, which is "pain = pop an aleve/tylenol/advil/etc. and get back to it."
I always got headaches when I was younger and it didn't really stop until I went to college at a higher altitude. When I go back to my hometown, after a couple of days they come back. Some headaches will go away on their own with water or rest, but others that seem to go from one side of my forehead all the way down the same side of my neck seem to only go away with medicine.
I used to have to take Advil what seemed like every other day to get them to go away. Tylenol never seemed to help at all. Aleve actually works better than anything for me.
Imagine getting them every other day and no OTC has any affect. This is me until I went to a neurologist.
Botox + Triptans can usually stop mine ~98% of the time.
Since none of them are actual migraines, most advice was the standard: drink more water, get enough sleep, are you stressed at work, etc.
I won't move back to my hometown because of it and it hasn't been as much of a problem. My grandmother said that I had a distant cousin who would get sick whenever he came to our hometown from Chicago as well. Said that his doctor thought it might have to do with the swampy air around the area. Pee Dee region of South Carolina, where Francis "Swamp Fox" Marion operated during the Revolutionary War.
Long-winding tangential anecdote (which is why I'm replying to myself in a separate comment), but I have pretty extreme example of this: I managed to avoid nearly all suffering after getting a tonsillectomy in my mid-thirties, while using almost no painkillers.
My ENT surgeons warned that me "I'd hate him for about a month, then I'd love him for never having to deal with [serious medical condition that justified the removal of tonsils] again". He prescribed all kinds of stuff to alleviate the expected suffering, and advised me to try to take the weakest options I was comfortable with, because the heavier ones might have some unpleasant side effects. It's the only time in my life I've been prescribed painkillers at all, actually (this was in Sweden, btw).
I got codeine/paracetamol as a coughing suppressor and mild painkiller, a couple of heavier painkillers for if it got worse (I forgot the name but some kind of heavy-duty variation of diclophenac that you can only get with a prescription), and some kind of nasty solution to gargle with that supposedly would numb my throat if it got really bad. I've been told this is nothing compared to what you can expect in the US.
Then in the evening after the surgery, when I was trying to eat a soup with my mom, I realized soup didn't hurt as much as drinking plain tap water. And then I thought: isn't it odd that drinking plain water feels like a thousand paper-cuts in the open wound in my throat, but whenever the coughing made the wounds open and bleed, the blood doesn't hurt at all? Blood is mostly water, so what is the difference? Could it be the salt? Is this similar to why drinking demineralized water is bad for you? What's the opposite of demineralized water? Oral rehydration solution. Ok, trivial to make, let's try that. I'll drink it luke-warm to be close to body temperature too.
Turns out that that works. Oral rehydration solution is almost painless to drink after a tonsillectomy. I know this is anecdata, but sample size three: I've since shared this information with two friends who got a tonsillectomy, and they've been extremely grateful for this tip.
It even seemed to speed up my recovery, probably due to a lack of irritation triggering inflammation. I was eating solid food within days. DAYS. My mom, a retired family physician herself, couldn't believe her eyes.
I ended up only needing the codeine/paracemtal in the evening to suppress coughing in my sleep, and brought back all the other pain-killers without opening them.
The plain water hurts because it's causing cells to swell or even burst as water rushes into them to equalize the osmotic pressure. Adding a little bit of salt to that helps remove that pressure because the environment inside and outside of the cells are both equally salt.
My dad (also a doctor) called it a typical case of "the nurse's wisdom": the kind of quality of life interventions that typiqally get discovered by nurses and passed down orally, but never make it to official medical journals.
I'm convinced it's designed this way on purpose. Can't have people relaxing, ever. Must extract every ounce of productivity and blood while they're alive.
https://www.dol.gov/general/topic/benefits-leave/fmla
https://www.dol.gov/general/topic/health-plans/cobra
It’s not perfect, but the US isn’t a perfect union either. Healthcare is usually more of working class concern, or for the working age but unemployed, which is not a small risk …
But let’s at least admit where some protections exist.
So by all accounts it should be cheaper for for-profit insurance companies too, unless they have ways to externalize the costs onto the rest of society. Which I guess is more circumstantial evidence for how messed up the system must be.
UNH stock has been tanked all year, until the govt announced that they would raise Medicare advantage reimbursement rates. The insurance companies have an incentive to pursue volume instead of cutting costs for programs that the government is subsidizing. For everyone else, they just raise the prices which is a much more complicated issue.
(It is worthwhile to note, because Americans don't realize this, but not all medicines that a doctor prescribes for you is free, although the overwhelming majority will be.)
It depends on the insurance. I have pretty crap insurance and didn't expect them to cover a prescription for Omeprazole (aka Prilosec) since it's available OTC, but to my surprise they did.
Hard agree, same with fevers. Heat helps kill many diseases, dont blunt your body's defenses.
There are exceptions to both rules, but many people forget which part is the exception and which part is the rule.
Heat hot enough to kill diseases will have killed you long before. Fevers are really a pretty small temperature rise.
It does appear that fevers are an adaptive defense, but FWIW there's been basically no evidence that not taking medicine to bring down a fever will improve outcomes in practice. OTOH, evidence also shows that typical fevers won't themselves hurt you either, so they don't necessarily have to be treated.
Current medical guidance in kids and (non-pregnant) adults is to treat discomfort, usually the associated muscle aches, body chills, etc, but in general we shouldn't encourage people to suffer for no benefit. The fever isn't cleaning you out.
> In my case headaches are usually caused by sleep deprivation causing high sensitivity to external stimuli, muscle tension, dehydration, or some combination of that. So I'll first try to take a nap and/or stick to low-stimuli environments, have a good stretch and/or heated up massage pillow for the neck, and make a quick home-made oral rehydration solution with some salt and sugar. That usually alleviates most if not all of the pain.
Most Americans aren’t allowed to take naps at work or leave for some low-stimuli environment while on the clock. If they take time off to do those things, they aren’t getting paid. So why do Americans take more painkillers? Because they can’t afford to not do so.
So what’s the cultural aspect? That for some reason Americans find this preferable to socialized healthcare.
Painkillers are an interesting question since we have direct to consumer ads (uncommon globally as it turns out) and for clearly some reasons, we get sicker than other nations independent of how capable medicine is.
https://www.health.harvard.edu/blog/harvard-health-ad-watch-...
https://www.commonwealthfund.org/publications/issue-briefs/2...
Sicker is doing some work, and I think the US has such a diversity of health cultures and outcomes, you almost need to do it by zip code, but that’s another topic.
>So what’s the cultural aspect? That for some reason Americans find this preferable to socialized healthcare
Alternative universe where WW2-era employer provided healthcare didn’t emerge, would you wager we would be there now?
Yeah, and it’s The people who are on their feet for a 12 hour shift who probably need it most.
Sometimes I get headaches. I don't know why. Maybe there's a cause. I do try things to fix the underlying problem. But it's not instant. While I wait for it, why should I continue to be in pain when the pain medicine is pretty much risk free if I'm not reckless with it?
It's strange that you'll take a painkiller for the sake of others, so you don't bother them by being grumpy, but you wouldn't do the same for yourself. Surely you also don't enjoy being a grumpy asshole even when you're alone.
Pain is also suffering, and there is no virtue in suffering needlessly.
Even more importantly, there's also chronic pain, which can severely affect quality of file permanently and is essentially an illness all of its own. Research supports the concept of "pain memory", where chronic pain develops as the result of leaving the pain from a temporary condition untreated.
The discussion started in the context of taking painkillers regularly for things like "inconvenient head-aches" without pausing to investigate what causes those headaches. It should be clear from the context that I am not talking about something like people struggling with migraines. I know they try to figure out not to have them in the first place, and if they do have them deserve all the pain relief they can get. I've had migraines myself growing up.
Nobody is saying that people who suffer from chronic pain shouldn't have a relief from their suffering. But as another comment pointed out: the US seems to have a big issue with untreated conditions in general than other countries.Not in the sense of not treating the pain, but in the sense of not treating the conditions leading to pain. You don't even have paid sick leave apparently. Tackle issues like that and there will be fewer chronic pain sufferers to begin with.
In many countries if a doctor believes you're too sick to work you have a right to take leave until you recover, without risking your job and without expending limited "sick days". In those circumstances the doctor will of course prescribe something for your pain, but as a patient you have no incentive to insist the painkiller is strong enough to allow you to continue working.
As I've mentioned elsewhere, the Vioxx scandal is every bit as big as the Purdue one. Check this Wiki (lawsuits): https://en.wikipedia.org/wiki/Rofecoxib
If you've time watch this YouTube video on Merck and the Vioxx scam (if you weren't aware of the facts you'd think you were in Palermo/Mafia territory): https://m.youtube.com/watch?v=K0GrFnOpJoU
My assumption was this was always required to get regulatory approval to make abuse have harsher side effects. Liver toxicity of acetaminophen is pretty bad compared opioid abuse from what I understand
This is vastly overstating the rationality of the human body. It's no more rational than the human mind, which is often quite irrational. Your body isn't the product of medical school, nor intelligent design, but rather random natural selection, which is decent but demonstrably far from perfect.
Also, you were arguing we should not listen to pain when it's acting irrational, as in unreasonable. Then you switch to "all minds being irrational", as in actually not rational. That's not the same thing.
If you have a point to make, then make it literally, not metaphorically.
I made my point and you're ignoring it: you imply that all pain is unreasonable because the body is "irrational". By that logic, you are saying that my earlier example of a sprained ankle hurting when I lean on it means my body is "unreasonable" for signalling that I should not lean on a healing sprained ankle. Quite frankly I think anyone ignoring that and harming themselves more in the process is an idiot.
The example of a cat hissing at the veterinarian because it cannot distinguish the situation from a real threat does not mean that cat's never hiss at real threats. If you cannot even be bothered to tell the difference and blame your cat on every occasion, you're being more irrational than the cat.
Occasionally I have a headache. Not frequently, and I don't necessarily know why. These things just happen. I take a painkiller, and problem solved. I've been seen by doctors over the years for physicals or other reasons, and there's no indication of any underlying medical condition. An occasional headache is not an indicator of something more serious, and the painkiller is not "masking" a larger problem.
The same goes for random muscle aches. They're infrequent, but they can happen, for whatever reason, and there's no reason to panic or to suffer when you can just make them go away.
I don't think I'm unusual here. As far as I've heard, random, infrequent headaches or other aches are extremely common.
Moreover, there are pains that we know the cause: for example, I experience a bump or a cut. My body continues to annoy me with pain unnecessarily. Yes, I'm healing, I'm well aware of that. I just need my body to STFU with the pain and stop reminding me of it.
The same goes for muscle aches. There is also specific medicine for them. And you are probably better with an anti-inflammatory for a bump. (It's not normal for cuts to hurt for a long time.)
Thanks for the diagnosis, Dr. Internet Rando.
> you'll be much better taking an anti-allergic, or a sinus cleaner, or whatever else actually solves the underlying issue or make the specific symptom go away.
You can't even say what I should take. X or Y or... whatever else? That's not helpful at all.
Maybe HN commenters.
Neither is a car, but I still take it to get checked out when a warning light is on.
I can't believe I need to say this, but cars did not evolve by natural selection. Cars are intelligently designed (by humans, not by God) to show a warning light when there is a problem you should get checked out. So cars are actually rational in that respect.
Hacker News comments never fail to depress me.
You didn't need to say that because that's not relevant. The issue was about signal to noise. The logical stance is to assume signal is signal, until you know otherwise.
> Hacker News comments never fail to depress me.
That's also a signal.
I know otherwise. I have a lifetime of experience—lifetimes of experience, counting the experiences of other people—to know that pain is often just noise.
Pain is ancient. It predates rationality by millions of years, perhaps billions. The dumbest animal experiences pain. It's not a finely tuned system with documented diagnositic codes.
Americans' relationship with painkillers is absolutely unhinged.
Additionally, in EU you can just take a sick day to rest and recover pretty much any time you need it. In the US you have limited “sick days”. E.g I now only have 6 “sick days” per year.. (and I’m fortunate to work in tech, I just WFH when I’m under the weather. But people who are less well off need to suck it up and go to work).
Sprained ankle? Injured back? Headache? Broken bone? All things that people work through everyday with some NSAIDs because calling out sick means losing income
The office workers will just pop the same damn pills and show up too. Office workers are more likely to show up when in pain specifically because their job doesn't aggravate it. Most people don't have a lavish BigCo sick time policy and even if they do why burn sick time just to be in the same pain and pop the same pills at home. Most people will just have to work harder to make up for being out anyway. It makes sense to just be in pain at the office.
water?
EDIT: I see it's a thing. Salt, water and sugar.
The body does not absorb water passively but actively, and it's been known for a very long time that water with a bit of salt and sugar is absorbed faster. This has been crucial in reducing (especially child) mortality due to acute fluid loss from diarrhea due to, say, cholera[0]. (I personally find amazing that Robert K. Crane figured out the mechanism behind it in the sixties already[1])
Now, "proper" ORS, according to the WHO, is the following:
Sodium chloride 2.6 gr/l
Glucose, anhydrous 13.5 gr/l
Potassium chloride 1.5 gr/l
Trisodium citrate, dihydrate 2.9 gr/l
glucose facilitates the absorption of sodium (and hence water) on a 1:1 molar basis in the small intestine; sodium and potassium are needed to replace the body losses of these essential ions during diarrhoea (and vomiting); citrate corrects the acidosis that occurs as a result of diarrhoea and dehydration.
So you can usually get away with not having the potassium and trisodium if the reason for dehydration is neither diarrhoea or vomiting.
This translates to a simple home recipe of:
1 liter (or 4.25 cups) of water
1/2 a teaspoon of salt (3 gr)
2 table spoons of sugar (30 gr) OR 1 table spoon of glucose (15 gr)
[0] https://en.wikipedia.org/wiki/Oral_rehydration_therapy
[1] https://en.wikipedia.org/wiki/Sodium-glucose_transport_prote...
[2] https://www.who.int/publications/i/item/WHO-FCH-CAH-06.1 page 12 of the linked on that page (labeled as page 3)
[1]: https://www.cam.ac.uk/research/discussion/antidepressants-an...
Occasionally I'll find that the more I try to identify specific features of the sensation, the harder it gets to do so and the pain sensation fades away.
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.
It was withdrawn for sometimes being metabolized into another, toxic and carcenogenic, molecule.
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...
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.
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.
> but it does absolutely nothing with actual pain. It is placebo at best.
This is simply false.
When I took ibuprofen it did actually made an actual real change.
Be kind. Don't be snarky. Converse curiously; don't cross-examine. Edit out swipes.
(one of the major problems with paracetamol is that the effective dose is only a few multiples away from the dose which starts to cause liver damage! It is by a long way the most dangerous OTC drug)
Paracetamol got it's start as replacing the more effective but much more dangerous and withdrawn drug Phenacetin.
Why don't people notice that it's such a small benefit over nothing? Well because placebo effect is quite good for pain and pain is usually transitory anywhere..if you have a tension headache you're probably going to aim to relax. Turn away from the screen or even have some caffeine and those are more effective than paracetamol!
Here is an example from the Cochrane library
> For the IHS preferred outcome of being pain free at two hours the NNT for paracetamol 1000 mg compared with placebo was 22 (95% confidence interval (CI) 15 to 40) in eight studies (5890 participants; high quality evidence), with no significant difference from placebo at one hour.
A NNT of 22 means that in absolute terms 1/22 people met the positive endpoint criteria more than placebo. This figure is usually quoted as 20% for placebo and 25% for paracetamol giving NNT of 20.
The NNT of 22 gives 1/22= 4.5%.
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD...
Episodic tension type headache tested with ibuprofen Vs placebo NNT is 14. (Btw that's not great itself) But it's better than paracetamols often quoted figure 20.
Here's why I say it's not great. Why don't you guess some reasonable NNTs for say moderate depression treated with SSRIs, or no relapse in schizophrenia treated with an antipsychotic. Now guess the NNT for a statin to prevent a first heart attack.
SSRI for moderate depression about 10, antipsychotics to prevent schizophrenia relapse over 2 years NNT= 3 (excellent )Statin to prevent a first heart attack 200! (This one always shocks me). Statins have a clear role of course.
[0] https://thennt.com/nnt/ibuprofen-treatment-episodic-tension-...
It is only packet size restricted in supermarkets, you can still buy bulk packs from chemists.
For ibuprofen you need to go to a pharmacy.
You can't buy antihistamines either, only in pharmacies and they are quite expensive. I remember you could get them in Tesco or Asda for like £2.
Unfortunately, for me ibuprofen doesn't seme to help at all with any of these. Like I understand that my pain are often inflammatory based, and i try ibuprofen, but the pain doesn't dull at all even if I take 800mg etc...
I take 1000mg acetaminophen and boom my pain is vastly reduced...
In my experience it works far better at managing headaches/migraines.
It works against fewer or maybe mild inflammation and what not ... but it does absolutely nothing with actual pain. It is placebo at best.
Neither paracetamol nor ibuprofen work by blocking pain. Depending on the type of pain and your physiology it can range from really effective to not at all.
I only take paracetamol, it works better than both ibuprofen and opioids for me. I know other people who have the exact opposite experience. There’s no absolute here.
I wish they dipyrone was sold here, but alas I can only get it when I travel abroad.
For mild stuff I use ibuprofen, if it gets worse, diclofenac works every time.
Soluble paracetamol literally turned the pain off like a switch - of course I was limited as to how much I could take, which I was careful to stick to but I was almost in tears waiting for the time to come where I could take more paracetamol.
So in some situations paracetamol can be an extremely effective painkiller.
Acetaminophen is like a wonder drug for me while ibuprofen doesn't seem to ever do anything for me.
Double blind placebo controlled trials have shown that acetaminophen/paracetamol is superior to a placebo at controlling pain.
I did not said it cures the root issue, frankly I dont care that much. I am taking it so that the pain stops and I can function normally.
Paracetamol does not stop pain/hurt. It is like taking nothing and just waiting. It may help with fewer or some such, but I am not taking Ibuprofen for fewer.
I always thought a simple over-the-counter supplement (NAC) being the cure for an overdose was so cool. It's a pretty cool substance in a lot of ways, and this is a great spur to myself to research it more thoroughly.
Apparently for some people it also helps with lessening tolerance for their ADHD meds, but I'm not so sure about that.
I'd believe it. I first heard of NAC on the nootropic subreddit in a past lifetime. The benefits vary, but generally it's a safe thing with a low chance of making anything worse, but a possibility to improve things. Many neurodivergent folk have written about how they benefit.
I'd give more info on the exact benefits they found (iirc OCD and rumination loops could be broken more easily), but unfortunately my memory is failing me.
Usually here in Canada it's available in capsule form which I find less effective.
Meanwhile, it's funny that it seems like acetaminophen should safer in more scenarios, but the other has a lot of overdoses with typical use, I guess that's why there's a gap between the two, because ODs are apparently a lot more common or at least more legible than problems caused by the other drug.
> The glutathione hepatic values in mice obtained by intraperitoneal injection of the ester are superimposable on controls and the oral LD50 was found to be greater than 2000 mg kg^-1 and the intraperitoneal LD50 was 1900 mg kg^-1 ...
That's for pyroglutamic and glutamic acid esters of paracetamol: https://pubmed.ncbi.nlm.nih.gov/8799871/
and more general analogs apparently can also be designed to not produce NAPQI:
> Thus, in 2020, N-sulpharyl-APAP prodrugs 39–40 (Fig. 11) were developed. [...] They are not hepatotoxic because they do not generate toxic metabolite NAPQI, even in concentrations equal to a toxic dose of APAP (600 mg kg^−1 in mice).
https://pubs.rsc.org/zh-tw/content/articlepdf/2024/ra/d4ra00... p. 9702.
These would probably require trials, though.
Its also a pretty popular choice for people trying to kill themselves, though, so I suspect a non-trival chunk of ODs in the statistics given in the article were intentional.
There is a limit to the amount of opioids they will prescribe you, even if you are in mind shattering pain. For instance while attempting to get your dental insurance to actually cover a treatment you may find yourself between risking organ damage or risking $5000+ in ER visit bills only to have them refuse to give you anything but Tramadol.
I guess it is much better than the situation before that, where you paid $5000+ and they also gave you an opioid addiction.
Having a condition that actually warrants strong opioids and not being able to get them at any price is definitely not an improvement.
The problem is fundamentally that we want to pretend doctors can always distinguish two people describing the same symptoms when one person actually has them and the other is trying to get drugs. The often can't, so you can either make it hard for people to get pain medications even if they need them, or you can make it easy for people to get them even if they don't. And between these the second one is unambiguously better, because the first one is the government screwing innocent people and the second one is guilty people screwing themselves.
Could not agree more. Depriving people with legitimate pain of opioids is IMHO legitimate torture. It's a bit of a variance on the trolley problem in that the doctor/government isn't causing the pain, but their inaction is prolonging it.
Brother (or sister), you were simply not trying hard enough. I live in a very clean, safe, expensively-policed county, and even I know where to buy fentanyl for much lower cost than a hospital. I would happily turn to that than take 20(!!!) advils in s single day.
1) We make it hard to lawfully acquire pain medications. You pay $$$ to see a doctor and you pay it even if they refuse you. If they do, you then have to pay $$ to get them from Stringer Bell, or start there to begin with if you didn't have $$$, and hope they're not cut with drain cleaner or unevenly mixed so that some days you get 100% corn starch and other days you get a fentanyl overdose.
2) We make it easy. Anyone can get them from Walmart. The people who need them pay the same $ they do for a bottle of Advil/Tylenol instead of paying $$ to murderers or $$$ to waste scarce medical resources that could have saved someone else's life. The bottle from Walmart always has a consistent amount of the drug in it and neither the dental patients nor the addicts get a surprise fentanyl overdose.
The first option is still the bad one, right?
Seriously, how can you guys consider this acceptable. I am not of faith but doesn't bible teach to be kind to your fellow men above all? One would expect more adherence to such basic moral rules in such conservative christian society.
Who says that? I don't think anyone sane can believe that US healthcare is "solved".
If you did a socialist system then everything is "free" but possibly slow and expensive on the back end when the government isn't efficient.
If you did a libertarian system then everything is cheap but it's caveat emptor because nobody is stopping you from buying morphine for $10 from Amazon.
The US system isn't either one. It pretends to be a market sometimes but then has a bunch of rules to thwart competition. Doctors are required by law to do residency but the government limits the number of residency slots in response to lobbying from the AMA so there aren't enough doctors. "Certificate of need" laws explicitly prohibit new competitors for various services. Insurance is tied to employment to make it hard for individuals to shop around. Laws encourage, require or have the government provide "prescription drug coverage" to make patients price insensitive so drug companies can charge a huge premium for patenting a minor improvement or simple combination of existing drugs and have the patient will something which is marginally if at all better even if it's dramatically more expensive because they don't see the cost when the insurance/government is required to pay for it.
It's a big pile of corruption, because all that money is going to places. But then if you try to fix it, half the population insists on doing the first one and the other half is only willing to do the second one, and the industry capitalizes on this to prevent either one.
Maybe instead we should do both rather than neither. Have the government provide a threshold level of services, like emergency rooms and free clinics and anything more than that the local government wants to fund, and then have a minimally regulated private system that anyone can use if the government system doesn't satisfy them.
The market also won't assist us, as we can't exactly compete future treatment costs against unknown illnesses.
Merely providing emergency rooms and "free clinics" will ensure that people only use these services.
A public option eliminating profit margin seems to at least be sane, and ideally would starve private funding from existence. Any remaining options would highlight deficiencies in the existing system.
A schumpeterian system, if you must slap an ideology on it.
Emergency rooms operate by triage. If you're having a heart attack, you're going in right now. If your shoulder has been bothering you for six months, you might have to come back multiple days in a row and spend the whole day waiting before there is a slow enough day that you can be seen. There is then an obvious incentive to go pay a private physician to be seen immediately instead. Free clinics are similar: There are no appointments, it's first come first served, and then most people prefer to pay $100 to schedule an appointment rather than wasting an entire day waiting in a queue, but you still have that option for people with no money.
Emergency rooms are also a natural monopoly because in an actual emergency the primary consideration is which one is closest, which doesn't make for a competitive market. So it makes sense to have the government do that. Whereas non-emergency care (which is the large majority of medical expenses) would allow people to compare prices or make cost trade offs against distance or convenience etc., if we would actually expose people to pricing. For example by requiring price transparency and then having insurance pay the second-lowest price for that service within 100 miles of your location, but then letting you choose where you actually want to go and make up any difference yourself, or choose the lowest cost option instead of the second lowest and then put the difference in your HSA.
> A public option eliminating profit margin seems to at least be sane, and ideally would starve private funding from existence.
It's not clear how a government option that doesn't have taxpayer subsidies would do this any better than a private non-profit. There are many existing non-profit healthcare providers and they don't have meaningfully lower costs than for-profit ones.
The general problem is that "non-profits" and government-operated services still have money flowing through them and "profit" can be extracted in all manner of ways other than paying dividends to shareholders. The officers can just pay themselves high salaries, or whoever is in charge of the budget can take bribes/kickbacks to shovel money in the direction of the contractors or unions paying them off.
Meanwhile the nature of "profit" in a competitive market is largely misunderstood because of accounting differences. If a non-profit wants to buy an MRI machine, they have to take out a loan, and then pay back the loan with interest which they account for as an expense. A for-profit company might get the money to buy it by selling shares to investors, and then paying dividends to the shareholders instead of paying interest on a loan, which goes on the books as "profit" instead of interest expense. But you couldn't just replace them with a non-profit and then lower prices by the amount of "profit" they were making because then they also wouldn't have had private investment and you're back to needing the loan and paying the same money as interest to the bank.
The thing that requires providers to be efficient is competition, because then the ones wasting money or taking bribes have to cover the amount wasted/embezzled by charging more to customers and then the customers don't choose them because they have higher prices. But that's the thing the existing regulatory system goes out of its way to thwart.
I'm fairly sure that caused some liver damage. I wasn't aware of anything apart from feeling a bit weird.
At the time, I had no idea it was potentially deadly.
20 not-especially-large tablets
edit: https://www.24pharma.nl/paracetamol-eg-1000mg-120-tabletten
However the last time I went to my GP she scoffed at me taking the maximum and suggested I take literally double the maximum recommended dose 4-5 times a day which totaled I think 2.5x the daily maximum on the package. I am very much a "believer" in science and reasonable medical authority but this experience sowed the seeds of doubt, because from what I have always heard, that can actually kill you or cause permanent liver issues. I was also taking diclofenac simultaenously, and when I told her how many mg, she asked "where can you even buy such small doses, that's what I would give a small child" =/
Suppose your arthritis is acting up, so you start taking Tylenol 8hr Arthritis Pain[1]. That's 2 tablets every 8 hours. They're extended-release with 650mg per tablet. A total of 3900 mg in 24 hours.
A few days later you get the flu, so you decide to add what seems like a completely different medication: Theraflu Flu Relief Max Strength[2]. It has a cough suppressant and an antihistamine. But each caplet also contains 500 mg of acetaminophen. It says to take 2 caplets every 6 hours, so you take 8 of them in 24 hours[3]. That's another 4000 mg.
Between the two, you're at 7900 mg.
Then you wake up in the morning and take both medications, but 30 minutes later you've forgotten you took them. You're not thinking straight because you're sick. So you accidentally take a second dose. That additional 2300 mg brings your total to 10200 mg.
---
[1] https://www.tylenol.com/products/arthritis/tylenol-8hr-arthr...
[2] https://www.theraflu.com/products/day-night-flu-relief-max-s...
[3] You weren't supposed to take 8 of them, though. If you'd read the label very carefully, you'd have seen it also says not to exceed 6 in a 24-hour period.
I did toss on the other option, stand alone, at one point so I could get some sleep.
It left the medication I was more comfortable taking as an add-on option if things got bad enough. (This particular medication has much lower risk of overdose, so if I got stupid and took it again there would be no significant additional risk.)
It's ironic, but taking the combined medication with a known higher risk of its own was better than taking the lower risk medication.
One was controlled, higher risk, taken at specific times, while the other was taken in addition, on demand, as required.
Also, loved your TV show back in the day. :-)
I didn't until I had a bulging lower back disc pressing on my sciatic nerve. My leg felt like it was constantly on fire no matter what position I put myself in. In the past I've torn my ACL and had surgery to reconstruct and that pain was like stubbing my toe compared to the back pain. I understood how people become addicted to pain meds after my back situation.
Speaking as someone who is not-infrequently in significant pain, I sincerely hope that you never have to.
... Suddenly I'm maintaining a continuous note of when I'm taking which medicine to avoid crossing safe limits (which I anyway was crossing most days).
I was only told to take 2 paracetamols a day (bullshit dose, I'd be waking up from the pain even with more pain meds).
"Diclofenac for rare use" - well, if nothing else is touching the pain, is it an emergency?
Eventually after forever I was able to transition to Ibuprofen + paracetamol. And I already have a health condition which is heavy on my kidneys... pain management can be absolutely crazy.
Fun fact, you can totally get them to pause the procedure without saying a word. All you have to do is end up in a lot of pain, have your heart rate skyrocket like anything, and get everyone in the OT very concerned ;)
I presume your protein intake was adequate and diverse prior to this misadventure....
Ibuprofen is a Nonsteroidal Anti-inflammatory Drug (NSAID) that reduces pain and inflammation, while acetaminophen does not. (Acetaminophen is believed to act mainly in the brain rather than at the site of injury).
Ibuprofen- Fundamentally, if the pain is caused by inflammation, reducing the immune systems response to it can reduce pain, but if the pain is more acute it won't make a dent.
With acetaminophen, taking more isn't a solution in most cases, you need another method to reduce the pain further if it doesn't achieve its goal.
(That's why it's combined with things like codeine, which affects the brain in a different way for an additive effect)
I don’t know about “most cases” but often you don’t want to reduce the pain _further_, you want to reduce the pain _again_. (Having an alternative definitely helps in the meantime.)
Sure, that's extreme. But if you're unaware of the risks, you feel sick, and you believe it's helping you.
I mean, people aren't killing themselves in masses with it, but it happens every now and then. Easily imaginable that one in a few million people will have enough tendency to take more pills and is unaware of the overdose danger.
I arrived in Aus in 2021 and was amazed to be able to buy a pack of 40+, coming from the UK where the limit had been in place for some years.
I don't think you can even do that in the UK.
Yeah we usually have a few packs hanging around, and I get the 'it seems stupid' thing, but sometimes just adding a tiny bit of friction when someone's trying to kill themselves might save a life. I dunno, I hope that's shown in the evidence anyway. Otherwise it's just pointless like the whole pseudoephedrine song and dance, which has inconvenienced anyone looking for a decongestant while doing sweet FA to the availability of meth.
No, when you visited they were still on the shelf. They only put them behind the counter in 2025.
> sometimes just adding a tiny bit of friction when someone's trying to kill themselves might save a life
I'm philosophically not for making suicide harder. If someone wants to die, that's their right. And practically, while you might be able to show a stat-sig decrease in paracetamol poisoning, I'd expect the suicides to largely just move to other methods.
This just adds a tiny amount of friction to impulsive attempts, which may be a classic cry for help or just someone in the depths of some sort of mental health episode. Such folks may think better of it the next day and a very small amount of inconvenience will put them off. I think suicide is serious enough that you should probably mean it, and societally saying 'think twice about this' is a good thing.
On the idea that it just shift deaths, as your sibling poster points out (from the UK) -
"in the 11 years following the legislation there were an estimated 765 fewer suicide and open verdict deaths from paracetamol poisoning, which represented a reduction of 43% [...] This reduction was largely unaltered after controlling for a downward trend in deaths involving other methods of poisoning and also suicides by all methods."
https://www.psych.ox.ac.uk/research/research-groups/csr/rese...
So it looks like this tiny, tiny barrier does actually deter people. And that definitely points to them not really being sold on it in any rational way.
That quote doesn't say what you think it means. It's not talking at all about whether suicides shifted to other methods; it only says that there was a secular decline in poisonings (-32%) and suicides in general (-10%) during the study, so they have to also discount some of the raw 48% drop in paracetamol as being part of that broader trend and not due to the treatment. They come to the 43% number only with a generous assumption that had the law not gone into effect, there would have been an increasing trend in deaths from paracetamol poisoning, which seems wrong to me. The more obvious way to derive the prior would be to look at non-paracetamol poisonings and expect the same trend, in which case the effect might be something like -24%.
Anyhow, it's still perfectly possible that the people who were deterred from paracetamol poisoning committed suicide some other way; the data in that paper says nothing about it.
Then this minor frictional measure is the very least of your worries. For a start, any given pharmacy has an entire pharmacopoea of compounds that people are kept away from for their own good. Not to mention liquor licensing rules making landlords cut folks off at a bar if visibly drunk etc. And guard rails to stop people climbing to high places. And ... preventing people from doing stupid shit in the moment is everywhere in our societies.
There are a heck of a lot of things I'd put higher up my list of concerns than "may have to visit two shops if wanting to kill myself"
tl;dr: Yes
Paraphrasing from [0], after September 1998 when the restriction was introduced, "The annual number of deaths from paracetamol poisoning decreased by 21% [...] the number from salicylates decreased by 48% [...] Liver transplant rates after paracetamol poisoning decreased by 66% [...] The rate of non-fatal self poisoning with paracetamol in any form decreased by 11%"
See also [1]: "in the 11 years following the legislation there were an estimated 765 fewer suicide and open verdict deaths from paracetamol poisoning, which represented a reduction of 43% [...] This reduction was largely unaltered after controlling for a downward trend in deaths involving other methods of poisoning and also suicides by all methods."
[0] https://pmc.ncbi.nlm.nih.gov/articles/PMC31616/
[1] https://www.psych.ox.ac.uk/research/research-groups/csr/rese...
It's the usual public health balancing act of help vs harm.
You can overdose on water too, they haven't banned 5-gallon jugs (yet).
Harm reduction is about shifting probability distributions, not guaranteeing outcomes. Kids can still get into pill bottles with childproof medication caps, but accidental ingestion of aspirin by children reduced by 40-55% after they were mandated. [0]
Alcohol and Acetominophen/paracetamol should not be mixed.
When alcohol enters the picture, it increases the activity of CYP2E1, so the body produces more of the NAPQI toxin. Alcohol also decreases glutathione production, the body’s natural defense mechanism, meaning NAPQI is more likely to build up in the liver in dangerous concentrations.
Sorry, crappy link. If you don't like it, it is easy to search for a better one.
Your crappy source is vague in what consumption pattern constitutes a risk and actually cites a better source that supports the idea that acute alcohol consumption reduces paracetamol toxicity. https://www.biorxiv.org/content/10.1101/2020.07.07.191916v1....
That's a mathematical model, but this relationship between the two is what I was taught in medical school and it is still supported by the science. There's plenty of other sources, I just picked that one because your article cites it. Just search for "paracetamol ethanol" on Google Scholar.
Also applies to most similar phrases ending in -proof. Should be eye-opening.
The positive of it is it got me in the habit of logging whenever I take it, either in a note on my phone or just a sheet of paper I place on my dresser under the bottle. This helps make sure I stay under the 3-4g/d limit.
Last year I was diagnosed with a rare headache disease (NDPH). We thought it completely came out of nowhere, but I had logs in my phone recording headaches and acetaminophen use intermittently from a few weeks prior. This proved useful in the diagnosis.
Moral of the story: log when you take it to avoid overdosing. Combine that with some basic symptom logging (like 1 line, 10 words or less). You never know when that might be useful for your doctors later on.
The benefits stack, the side effects don't.
So if you are going to be loading up on higher doses of pain relief, take half acetaminophen and half ibuprofen.
Rationalizations like “they probably put the limit way lower than the real limit so idiots don’t OD themselves, so I can safely take a bit more” become very attractive when you’re in a lot of pain.
I know people with permanent pain due to medical conditions who have been given a doctor's approval to exceed the limits printed on the packaging (after having previously been monitored). You can exceed the limit on the packaging by one or two pills.
A bit more is often not deadly, but it's very easy to take more than a bit. When I had a messed up mouth for several days, I took the maximum doses and set timers to help me regulate the dosage throughout the day, but I sure wished I could've taken more at that time.
From personal experience if i have a headache I'll take 1000 mg all at once; it either works right away or it doesnt and I stop bothering until I've had a good nights rest...
I had only very brief experiences with longer intense pain but it made my mind into pudding and desperate knot of how-to-stop-this-at-all-costs. Normal life is not possible and sanity is not granted.
"My head is pounding. Shit...did I take this at 3PM or 5PM? I know I took it and then fell asleep, but I can't remember when. It is now 9PM, can I take more or not?"
Also, people with memory issues...
This article is explicitly considering usage as painkiller.
You can’t use Tylenol as an anti-inflammatory so it’s meaningless to compare them for that distinction usage.
I'm aware of acetaminophen's down sides, and yet recently I was taking it combined with 2 other medications at the time.
Why? Because all three medications are recommended for dealing with the issue I had. (Alone and in combination)
The moment it wasn't helping further? Done.
There is this broken idea, particularly apparent in North America, but in western society that more is better for many things. It's not.
More pain killers don't do anything if they max out the relief they can give you, overloading their mechanism doesn't reduce anything, but taxing your liver or your kidneys.
All medications are potentially toxic, your body wants to dispose of them. In appropriate dosages they will benefit you, but more isn't inherently better.
Even water can kill you in sufficient quantity.
We do the same with diet; where someone declares one ingredient in a meal healthier than another; it isn't. A single ingredient isn't better or worse for you in a meal. Your diet however can be good or bad; over time that matters.
> There is this broken idea, particularly apparent in North America, but in western society that more is better for many things. It's not.
But it is. The faster I go, the earlier I arrive at a destination. The more I eat, the later I'll be hungry again. The more I pay, the more I can buy. The more I smile, the more people smile back. It's all-pervasive in life, and "more is better for many things" is just obviously true. Not for all things and there are limits of course.
> More pain killers don't do anything if they max out the relief they can give you, overloading their mechanism doesn't reduce anything, but taxing your liver or your kidneys.
A higher dose gets broken down slower, as in, the threshold below which the effect is reduced is reached later. Not a reason to damage your kidneys and better take smaller doses more often, but it's not fully accurate to say there is a limit and anything above has zero effect.
Acetaminophen worked far, far better than all these. It worked so well, but i wanted to be careful to limit myself to 3000mg a day, so I took 1 500mg pill every 4 hours for a few days while awaiting surgery. It's the only thing that got me through it. Even a epidural lumbar steroid injection didn't help...
Took me 3 months, out of 2 i wasn't able to sit. Luckily I could walk and that give me great relief. So walked for hours.
Keeping the habit, will mostly being coding from my phone & walking from now on.
Acetaminophen worked wonders, even better than an opioid.
I've never once thought about taking more than the recommended dosage of acetaminophen, largely because I had no expectation that it would provide additional benefit..
In reality, I try to consume 1/2 doses of anything or nothing at all, unless it's a serious medical treatment being administered by a professional.
An interesting thing with ibuprofen is that at the regular dose of 400mg it inhibits pain but if you take 1600mg it doesn't inhibit much more pain than the 400mg dose, but the inflammatory effect does increase significantly. A lot of people don't know that and take too much thinking it scales linearly.
And when you want to be gentle, you alternate between them.
So don't be the "smarter" person. Do as your doctor says and if you have doubts, consult another doctor before just doing what you think is safe, but actually isn't.
In general, taking a lower dose than recommended can cause problems, but aside from antibiotics, the problems are probably going to be from insufficiently treating the underlying condition, rather than the medication itself. Most OTC drugs give a single recommended dosage for all adults, so some people will necessarily get a lower "effective" dose than others (eg. a 200 lb man compared to a 90 lb woman).
> Specifically, the two mentioned in the article. [...] but if my doctor tells me to take 1 ibuprofen every 6 hours or so, if I halve that am I actually doing more damage?
With the caveat that I'm not a doctor, you should be fine: the only effect of acetaminophen is pain suppression, so if the pain is tolerable, then you should be fine. Ibuprofen has some anti-inflammatory effects that could be important here, but realistically, if the anti-inflammatory effects are the primary reason for the prescription, then your doctor is more likely to prescribe naproxen or celecoxib.
But if this ever comes up for you again, probably the best solution would be to tell your doctor/pharmacist "I have a high pain tolerance, would it be okay if I take less?", since in my experience, medical practitioners are generally pretty happy to hear when you want to take less drugs.
Dr. Pasricha adds: "I don’t get too concerned if my patients take one or two doses every now and then. But through regular use, such as several times a month or more, NSAIDs are well-known to increase intestinal permeability. In other words, NSAIDs can damage the lining of our guts. That’s because NSAIDs reduce the blood flow in the tiny vessels feeding our guts and disrupt the intestinal cells forming a barrier between the outside world and your insides. This has been proven over and over again through decades of research."
Conclusion: Acetaminophen is generally safer than ibuprofen, naproxen and aspirin.
https://www.washingtonpost.com/wellness/2024/12/09/ibuprofen...
I'll second the claim that no doctor at any point in his life had told him the risks of doing that, and many encouraged the use of ibuprofen over any other alternative (including the alternative of not using OTC painkillers every single day).
I had a relative with a different story in the same theme. It sucks and I want to see this technology do something truly beneficial for a change....
Paracetemol has always been seen as first thing you'd take for pain relief, and you'd "step up" ibuprofen as an escalation, but that might more to do with marketing of Panadol (paracetemol) vs Nurofen (ibuprofen).
We'd look on at the US where you were taking Advil like candy in confusion.
One great thing you learn as a parent, you can alternate acetaminophen and ibuprofen. Both of them are recommended every four hours, but you can stagger one by two hours to maintain consistency of pain-relief taking ibuprofen then paracetemol two hours later
Can confirm this is true in India.
Paracetamol is widely used. Paracetamol + Ibuprofen is more common than Ibuprofen by itself.
The same is the case in the Netherlands.
Also: in Europe everybody normally takes paracetamol and not FANS as a first reach to minimize adverse effects. So this article looks like very US centric. AFAIK liver failure because of paracetamol in Europe is very rare. So here there could be cultural issues at play (medical culture of what is prescribed, and the fact that Europeans in general take lower dosages of everything).
EDIT: trick, if you very rarely take paracetamol and other pain medications, the next time try to take just 250mg. It works for most people, no need to take 750 or even 1 gram of paracetamol. 500 works for almost everybody, 250 for many folks.
This is not my experience. After moving to Germany from the UK, I feel like people take and expect Ibuprofen far more often than Paracetamol. It seems like the first port of call for colds and general headaches, with Paracetamol being treated with some suspicion, despite it being far more effective in my experience for certain things (I've taken a lot of Ibuprofen and other NSAIDs in my time so am quite familiar with how they affect me).
Acetoaminophen also has issues for people with weaker stomachs (I can attest), and will come with additional medication to cover these effects as needed. The whole "Is it safe yes/no" table has many asterixes and might be outright false depending on the how you look at it.
As usual, it's just complicated.
I avoid both and stick with naproxen sodium. Any issues with that one? Lasts the longest too.
I would definitely have a chat with a doctor about it.
Whenever its prescribed here, its paired with some sort of intestine protection medicine to stop it burning holes in your stomach/intenstines
Ibuprofen is much safer, so long as you eat with it.
Paracetamol is also safer, so long as you don't OD.
BUT! so long as you stay below 4 grams a day, you'll be safe. (yes yes, in some situations you can take double, but unless you are under supervision, thats asking for liver pain.)
wild.
I know that blister packs are a pain, but in the places that they are introduced they reduce pill based suicide by up to 40%[1]
Sorry I should have been more clear about the 4g, that was for paracetamol. I have no idea what it would be for naproxen
Max dose combination (IBU/APAP FDC) can be useful as a substitute in emergency therapeutic situations compared to opiates. Not recommended ordinarily because of liver, kidney, and stomach impairment.[0]
Taking ibuprofen with questionable stomach condition may want to consider taking a famotidine adjuvant or duexis [1] or acetaminophen instead.
Overdose treatment of acetaminophen poisoning is the stinky N-acetylcysteine (NAC), so that maybe worth stocking whenever Tylenol is kept in a house with kids. Overdose of ibuprofen is palliative, requiring IV fluids and dialysis.
0. https://www.researchgate.net/publication/382639515_Ibuprofen...
I Am Not A Doctor And This Is Not Medical Advice.
(I think?).
Ibuprofen damages the kidneys -- and that damage is often permanent. The little filtering devices inside the kidneys don't grow back once they're destroyed. A dog who survives the poisoning can end up with lifelong kidney disease, which means special diets, more frequent vet visits, and a shorter life than she should have had.
(I watched this happen to my own dog after a house sitter stepped on her paw and gave her ibuprofen to "help." My dog lived, but she needed a special diet for the rest of her life.)
Acetaminophen wrecks the liver, and it also can damage red blood cells so they can't carry oxygen properly. A poisoned dog may get lethargic, vomit, start to breathe heavily... This is especially dangerous for older dogs, or any dog whose red blood cells are already compromised, by conditions like IMHA.
Yours is just rudeness. (=
If you don’t realize your kidneys are already damaged you might die from kidney failure because of ibuprofen.
IBU: -stomach -kidneys -bp+ -clotting --NERD --NECD --NEUD --SNIUAA --SNIDR --DRESS
APAP: -liver --DRESS
-- extreme, rare side-effects
Having gout, I've also had some pretty severe bouts where the pain level has been in the 8/10 range. Unfortunately nether paracet or ibuprofen worked.
In any case, when I see regular people eating these painkillers as candy, I'm starting to wonder what pain levels they are experiencing. I'm generally very cautious of using this stuff.
So we should not be too quick to dismiss the pain of others.
As far as 10/10 pain goes, I've heard cluster headaches can get so bad it has driven people to suicide during an episode.
Even then, doctors are usually disapproving of ibuprofen (or some combination of it with paracetamol) unless paracetamol is contraindicated for some reason, and I had always wondered why.
What you describe in an interesting contrast to the situation in The Netherlands. Here, virtually no one is prescribing ibuprofen _without_ also prescribing a baseline of paracetamol.
[1]: https://99percentinvisible.org/episode/579-towers-of-silence...
Context: I’m t1 diabetic.
I was recovering from an injury, and I switched from ibuprofen to acetaminophen. But the whole time I was on it, my sensor glucose was reading 50-60 mg/dl higher than my blood glucose. This is really bad on a closed loop system as my pump kept trying to lower my blood sugar, but it was pushing me into hypoglycemia (50 mg/dl).
Turns out this is a common effect, but a relatively new discovery that no one told me about.
Needless to say we had covid at least 12 times at this point, all with positive tests so no mistake there. Plus few other questionable cases without tests. Some were brutal, like first and second one, that was before vaccines, and then a recent one when we seem to have lost most of immunity. Back then I lost taste for few weeks completely and smell didn't fully come back till 6 months after (sniffing bottle of vodka did smell like forest air, even later my perfume smelled rotten). Weird times, eating nice looking gunk and trying to imagine how it tasted before.
I don't think I had flu that many times over my whole life, hate that shit with fiery passion and having small kids in creche/school is just a 24/7 virus importing service. None of our peers had it as bad as we did, no idea why the 'luck'.
FDA FAERS is the official dataset for reporting Adverse events from taking a drug. FDA adverse event reports about 2 million cases and 4,067 unique drugs
I agree the results are not easy for non medical professionals to interpret correctly. For example DEATH is very strong with Parecetemol and so is DEPENDECE. The latter because from AI it is a confounding factor. Acetaminophen/parecetemol is frequently co-formulated with opioids (like Hydrocodone or Codeine). The "Dependence" signal is likely attributed to the opioid, not the Acetaminophen itself...
Adverse Event Acetaminophen PRR (95% CI) Acetaminophen n ibuprofen PRR (95% CI) ibuprofen n ACUTE KIDNEY INJURY 0.87 (0.80-0.96) 498 4.27 (3.91-4.67) * 483 ANAPHYLACTIC REACTION 0.61 (0.51-0.72) 122 9.85 (8.90-10.90) * 382 ANGIOEDEMA 1.31 (1.13-1.53) 170 15.26 (13.77-16.92) * 378 DEATH 1.44 (1.40-1.49) 3958 0.07 (0.06-0.10) 42 DEPENDENCE 237.12 (231.51-242.88) * 39679 0.02 (0.01-0.05) 4 DEPRESSION 2.18 (2.05-2.31) * 1157 0.39 (0.29-0.52) 43 DRUG EFFECTIVE FOR UNAPPROVED INDICATION 16.77 (16.11-17.46) * 3180 44.17 (42.18-46.25) * 1921 DRUG HYPERSENSITIVITY 0.57 (0.51-0.64) 327 3.30 (2.98-3.65) * 372
Have gotten into a habit of keeping a note of which med when on the fridge.
To mitigate this, I supplement with NAC (N-Acetyl-L-Cysteine) anytime I'm forced to take acetaminophen. I will also sometimes take Betaine Anhydrous.
I do the same for ibuprofen, but sans betaine and instead take aloe, probiotics (bacillus subtilis/coagulans, Mastic Gum and experiment with other things.
For acute pain, neither does anything. And though I'll get attacked for this here, I find a stout dose of quality, lab tested Kratom (red strain) to be far more effective than both acetaminophen and ibuprofen combined. However, for regular pain, this is not a good plan, as the withdrawals can exceed the nature of the problem itself.
I sure do wish we'd get over the anti opiate [1] craze someday, or at least discover and make available an effective alternative.
1. Aside from constipation and obvious risks of dependency (or abuse), opiates have none of the deleterious effects of ibuprofen or acetaminophen, and the constipation is easily mitigated, and a bit of agmatine sulfate for saying adios when the pain subsides.
I have personally never found a use for ibuprofen that ever made any noticeable impact for me. I have tried it for headaches, fever, muscle pain, nerve pain, etc. It never made a noticeable improvement for any of these while acetaminophen works amazingly for all these. Acetaminophen even works better for me for pain than an opioid like Tramadol...
I don't understand it, but it is what it is.
The article mentions this but it’s my answer to “how are laymen supposed to know?” In my case it’s painfully obvious to use ibuprofen with caution
I've had doctors prescribing short runs of opioids (2 weeks for surgery recovery) but they always said "try Tylenol first and if the pain is too much you can fill the prescription". I liked having the option but never really used it up to this point.
I wish people would stop saying "drinking" to mean alcohol consumption. I genuinely thought it meant after drinking any fluid until I read the description and realised it meant alcohol. I also don't like how alcohol is singled out as a "special" drug. What about other drugs? Is alcohol special in this regard?
I didn't know about this acetaminophen risk. So I'll be looking for alternatives. Ibuprofen is for inflammation and not headaches. Naproxen is a candidate.
Ibuprofen is very well supported as a treatment for migraines. Not necessarily headaches generally, but definitely migraines.
But there are multiple classes of abort drugs now that a doctor might be able to prescribe you, like triptans and CGRP inhibitors, that work much better than either NSAIDs or acetaminophen.
But yet in some countries pediatricians will libreally prescribe it to toddlers
[1] https://www.bmj.com/content/368/bmj.m1086
Also from [2] "In this systematic review of NSAID use during acute lower respiratory tract infections in adults, we found that the existing evidence for mortality, pleuro-pulmonary complications and rates of mechanical ventilation or organ failure is of extremely poor quality, very low certainty and should be interpreted with caution."
https://bpspubs.onlinelibrary.wiley.com/doi/10.1111/bcp.1451...
Acetaminophen is part of ECA stack weight loss formula, while article says not OK with fasting. Either way, more safe solutions are known these days.
56,000 emergency room visits is the key here, because "the mortality associated with acetaminophen overdose is low if recognized and treated within the first 8 hours after an acute ingestion."
So I guess it depends on if you think 56,000 is low or not.
Source: "Acetaminophen Toxicity", David H. Schaffer; Brian P. Murray; Babak Khazaeni. 2026/02/19. https://www.ncbi.nlm.nih.gov/books/NBK441917/
So when pondering the issue of numbers, it matters what path people took to overdose.
1. Acetaminophen: Dangers noted in article, and stats given in my parent comment
2. NSAIDs: "NSAIDs are ingested commonly in overdose, however severe toxicity is rare"
3. Salicylates "Severe salicylate poisoning follows ingestion of greater than 500 mg/kg". For an adult weighing 150lbs that is 68kg, which means severe poisoning requires 34g of aspirin, which at 325mg per pill is 104 pills total. Hardly easy to do this accidentally.
[1] "Acute poisoning: understanding 90% of cases in a nutshell", S L Greene, P I Dargan, A L Jones, Postgrad Med J 2005;81:204–216
Also, possible blood clotting or stomach issues sound scary, but Aspirin has similar (opposite) issues. Pharmacists regularly push its combinations with Acetominophen (which has, of course, synergetic bonuses, but is not the reason) under multitude of brands with a hefty premium when people ask for either one. So in many situations you need to consider the added risks from Aspirin too.
Ideally, I'd like to have an optimized strategies of using all three of the aforementioned substances for common situations. Like, is rotating ibuprofen/acetominophen during the day safer than consuming just one?
I'll admit I find ibuprofen to be a bit of a wonder drug. When I have a cold or flu, ibuprofen by itself is the most impactful medicine I take. The anti-inflammatory effects make my whole body better, including my sinuses (my sinuses are a disaster normally anyway, though). I do avoid taking it otherwise because my headache doctor says it causes rebound headaches, though.
But if I need to go out somewhere and am not feeling well? 2 advil and I'm good to go. The only medicine I've found more effective for that is (real) sudafed, but if I take that after like 10am I won't sleep that night.
That being said I weirdly find Naproxen the most effective of all of these. Everyone is different though
Why? Because Celebrex (celecoxib) is a dangerous drug which can cause irreparable harm (heart attacks and related) if taken for long periods. In fact, its sister drug Vioxx (rofecoxib) was banned and Merck had to pay billions in damages. There's more here: https://news.ycombinator.com/item?id=47835635#47862704
Whilst Celebrex is safer than Vioxx it still has the same side effects profile as the latter.
I'd also recommended you watch the YouTube video in the link on Vioxx, it demonstrates the dangers of COX-2 drugs shouldn't be underestimated.
[1] https://www.thisamericanlife.org/505/use-only-as-directed
[2] https://my.clevelandclinic.org/health/drugs/18080-capsaicin-...
Since I've had a fair share of it in my life so far (more than 1kg of it so far, in total), and I investigated the disparaging studies and they are definitely not convincing at all; more recent ones somewhat absolve it (check the Wikipedia page).
I've never had any side effects from it, and I don't know anyone who did, unlike for any other painkiller (diclofenac, ketoprofen, ibuprofen, acetaminophen / paracetamol).
It is a medicine where I'm almost 100% sure the studies against it are intentional sabotage by pharma companies, and the vigor and persistence this is done with is really telling (lots of doctors and pharmacists in my extended family, including in regulatory bodies). The campaign against it never ends.
But it is not a miracle drug. Metamizole-induced agranulocytosis absolutely exists, and the insidious thing is that you don't know in advance if you will get it or not. You're trading common but avoidable side effects (ibuprofen, APAP/paracetamol) for rare but unavoidable ones (metamizole).
I've seen patients with severe side effects of all three classes of non-opioid painkillers (severe GI bleeds from ibuprofen-induced ulcers; acute liver failure from APAP overdose; metamizole-induced neutropenic fever). None of them seemed very pleasant. But if I had to choose, I'd still use APAP first line because it's the only one where you can avoid the severe side effect with certainty, by simply staying under the recommended maximum intake.
The medications that change who we are - https://www.bbc.com/future/article/20200108-the-medications-...
Excerpt:
Mischkowski’s own research has uncovered a sinister side-effect of paracetamol. For a long time, scientists have known that the drug blunts physical pain by reducing activity in certain brain areas, such as the insular cortex, which plays an important role in our emotions. These areas are involved in our experience of social pain, too – and intriguingly, paracetamol can make us feel better after a rejection.
Mischkowski wondered whether painkillers might be making it harder to experience empathy
And recent research has revealed that this patch of cerebral real-estate is more crowded than anyone previously thought, because it turns out the brain’s pain centres also share their home with empathy.
For example, fMRI (functional magnetic resonance imaging) scans have shown that the same areas of our brain become active when we’re experiencing “positive empathy” –pleasure on other people’s behalf – as when we’re experiencing pain.
Given these facts, Mischkowski wondered whether painkillers might be making it harder to experience empathy. Earlier this year, together with colleagues from Ohio University and Ohio State University, he recruited some students and spilt them into two groups. One received a standard 1,000mg dose of paracetamol, while the other was given a placebo. Then he asked them to read scenarios about uplifting experiences that had happened to other people, such as the good fortune of “Alex”, who finally plucked up the courage to ask a girl on a date (she said yes).
The results revealed that paracetamol significantly reduces our ability to feel positive empathy – a result with implications for how the drug is shaping the social relationships of millions of people every day. Though the experiment didn’t look at negative empathy – where we experience and relate to other people’s pain – Mischkowski suspects that this would also be more difficult to summon after taking the drug.
Also see the previous thread; A social analgesic? Acetaminophen (paracetamol) reduces positive empathy - https://news.ycombinator.com/item?id=31263305
Why should I trust someone who doesn’t test properly but just suspects?
Dominik Mischkowski is a Pain Researcher at Ohio University who has been studying this for a while. The word "suspects" here is statistical research-speak meaning there is a correlation (w.r.t. positive empathy) but more studies are warranted (w.r.t. negative empathy). That is all.
Acetaminophen = Paracetamol
Not only you can't take more than 4 grams of paracetamol per day, you must not take it for more than 3 days straight, it says so on the leaflet.
Biochemistry and medicine are hard and complex, all the quacks out there that preach snake oil treatments went down the path of thinking their domain specific knowledge in random domains somehow transfers to medicine it does not.
That said, I've found great relief at times taking a moderately large dose of ibuprofen for several days to break what seems to be a cycle of persistent inflammation. YMMV I guess.
Ibuprofen is mostly for inflammation and Acetaminophen for fever and pain. Now there's overlap in that both work on headaches and some other kinds of pain but the main use case for each is different.
it seems to happen more when i'm overweight, making me think it's blood pressure (BP) related, but then doing the valsalva maneuvre, which spikes BP, doesn't cause any problems at all.
i've tried acetaminophen, even 1.2g of it, to no avail. it doesn't help.
i've also tried every other remedy, such as curcumin, fire/ice locally, hot and cold showers, neck massages, working out muscles that may be involved in it, everything. nothing helps.
except for ibuprofen. 400-600mg kills it every time.
at least for me, there seems to be a definite difference, as ibuprofen can anecdotally help in some situations that acetaminophen can't. i wonder what exactly it can / can't treat and why.
I take acetaminophen for fever, and those kind of full-body diffuse ill-feeling.
I take ibuprofen for localized intense pain.
I take aspirin for headaches and sore muscles.
Unrelated, but it feels like an oversight that this article said nothing about how both acetaminophen and ibuprofen reduce fevers. They aren't used solely for reducing pain.
I find it interesting that people take these as fever reduction mechanisms. Fevers are a defence mechanism, not just an inconvenience. Maybe it makes more sense in places without decent workers' rights (like having a limited amount of sick days you need to manage), but it feels weird for me to actively harm your body's defence mechanisms unless you're in "you should see a doctor" territory already.
1g of Paracetamol with 400mg of Ibuprofen gives similar pain relief as 2mg of IV morphine.[1]
This is semi recent research on how it might be blocking pain
[1] https://pubmed.ncbi.nlm.nih.gov/40819833/
[2] https://ddeacademy.dk/ddea/what-new-research-reveals-about-p...
Acetaminophen is the only medication of its kind approved for infants under six months because the liver develops faster than the kidneys.
> Acetaminophen has a scarily narrow therapeutic window. The instructions on the package say it's okay to take up to four grams per day. If you take eight grams, your liver could fail and you could die.
Gee I don't know, I think this is a wide enough window to not miss it. That difference is 8 500mg pills
> that for most people in most circumstances, acetaminophen is safer than ibuprofen, provided you use it as directed. I think most doctors agree with this.
Could be but I think a lot of doctors underestimate the dangers of paracetamol as well
All of the factors the author mentions about IBP are true. But it's all about the details. Safer? Safer in which condition?
"Dehydrated" ok take a glass of water. Active bleeding? Most NSAIDs interfere with that, and no you won't become a hemophiliac by taking one Ibuprofen
Also, some countries do add a notice for kidney problems for Paracetamol as well (e.g.) https://www.medicines.org.uk/emc/product/5164/pil
An as a conclusion, I find it "funny" that nobody considers how healty/safe it is to take paracetamol and have mild analgesia (translation - you're still in pain) and taking ibp and having better analgesia
On the other hand, if in the early 2000s you were to share those concerns with certain doctors, they would propose a more effective and non addictive alternative to morphine instead. Only the first part of what they would tell you was true.
Tylenol/acetaminophen is good for fever which NSAIDs won't help. Otherwise, take both and alternate their dosing times for better pain coverage.
A fever is not dangerous within normal parameters, except for being dangerous to the virus and bacteria that threaten the body. Your body runs a fever because it engages in a battle to the death with these microbes.
If you defeat the body's own defenses by lowering the fever, for example if you are a nervous mother who hates her baby's fussing, or if you're hospitalized and the nurses are laser-focused on "number go down" treatments, then you can expect to be ravaged by the contagion for much longer than expected.
Yes, ignorant consumers and physicians across the world.
You can't just 'vibe medicine' or 'vibe biology' - please don't comment if you don't know what you're talking about.
The vast majority of the time medicine can only ever help with (acute) symptoms and rarely the underlying cause unless it is something like vaccines or antibiotics.
Medicine has side effects because if there was a free lunch to be obtained from medicine, the human body would have synthesized the medicine directly. Hence medicine is always about making tradeoffs.
When it comes to general health, there is always a causal chain of cause -> primary symptom -> secondary symptom -> tertiary symptom -> ... and a lot of medicine tends to work on the secondary or tertiary symptom.
Pain evolved to be an accurate indicator of damage to encourage you to stop ruining your body and not a punishment.
Just imagine someone trying to lecture a network engineer about how really async bugs should really never be different than bugs you see single-threaded if you use a semaphore. I mean, that's why we have semaphores!
Anyway, the temperatures attained during fevers are at best bacteriostatic (read not helpful in actually treating an infection that would lead you to seek medical care). If you've got evidence-based arguments, happy to counter them. Just please don't evoke 'evolution' to explain your bias-du-jour.
Evolution didn't create the personal computer or build a skyscraper. We're firmly in uncharted territory wrt things our bodies were evolved to deal with. As a great example, human temperature has been going down over time—evolution tells us that must mean we're all more susceptible to getting sick!!! https://med.stanford.edu/news/all-news/2020/01/human-body-te...
I did a fevered research dive last time I had the flu and came to the conclusion that there wasn't really any good evidence that fever is helpful for flu, and I should have few compunctions about suppressing it. (And that most of the situations where fever is really valuable for are ones where in the modern world you should go to a hospital and in the case of a bacterial infection be given antibiotics)
You take too much and it can give you a fever, which might entice you to take more aspirin. Nasty.
Obligatory Reye's mention:
https://www.uspharmacist.com/article/reyes-syndrome-a-rare-b...
and my own editorializing -- this is not just a problem for little kids. As various articles explain, if you've had flu-like symptoms (from whatever cause) you should be wary of aspirin. Will one standard dosage kill you? Unlikely. But if you've got better options, particularly pre-loading NAC before Tylenol, why not consider them first?
Further reading:
https://www.nhs.uk/medicines/low-dose-aspirin/who-can-and-ca...
And for those of you with kids: https://www.nhs.uk/conditions/kawasaki-disease/
Of course it's not all bad. There's even some discussion of anti-cancer potential. How might this work? One hypothesis: https://www.nature.com/articles/srep45184
This topic is a bit personal for me and I'm glad it's getting some attention here. Bravo, hackers.
That's NAC (N-acetylcysteine, C5H9NO3S), mentioned in the article many times.
If you’re taking more meds than that without clinical supervision Id say something is wrong in the system or your medicine practices.
Where I’m from it’s common to walk to the nearest pharmacy and get meds when needed. Even over the counter stuff like paracetamols. And talking to the pharmacist. They’ll ask what you’re already taking and tell you what else to get.
Of course, we could press the fix this immediately button by requiring acetaminophen to be sold mixed with NAC but that would be too easy.
And from what I see in pharmacies, you would rarely see a "cough syrup" called just like that if it contains paracetamol. It would usually be marketed as a flu-relief all-around symptom relief.
It works similarly, but stays a lot longer (half life is cited as being anywhere from 12 to 17 hours).
Acetaminophen and ibuprofen are just for temporary problems, like a headache that would go away on its own in a couple of hours.
They are uneconomic and inconvenient if you have something more persistent to keep at bay. Four ibuprofens or one naproxen? No brainer.
The main disadvantage of naproxen is that it's not approved for kids. So there is no naproxen syrup for infants or anything of the sort. Thus, you still need acetaminophen for that.
Convenience vs ibuprofen is a thing given the longer half life, but it still generally comes with similar risks. If you are taking anything for more than just an occasional headache, definitely discuss with a doctor, COX2 selectives like celecoxib may be a better risk profile and even more convenient.
(COX1 and COX2 selectivity loosely separate which systems get the brunt of the side effects)
Where I am (Australia), most doctor's prescriptions that have to be taken long-term are issued as the first script plus five repeats. Not so with Celebrex, a script can only be dispensed three times (3 x pk of 30 200mg capsules — one per day, for 90 days max) and scripts can only be dispensed every 21 days. Reason: Celebrex is only recommended for short-term use because it's considered a dangerous drug with possible irreversible side effects if taken for too long.
This was not news to me even before taking Celebrex, way back in the 1990s I was prescribed its sister drug called Vioxx (rofecoxib) for back pain and it was much more effective than Celebrex (at least it was for me).
Anyway, sometime around 2000 I read an article in the journal Science about a significant statistical increase in deaths by heart attack, stroke etc. by those talking rofecoxib. At the time I said to myself it won't be long before Vioxx is banned. It took another three to four years for that to happen as Merck Pharmaceuticals fought the decision every inch of the way. It's worth reading the Wiki about this (when it's between a drug company and millions of dollars profit patients come off second best):
https://en.wikipedia.org/wiki/Rofecoxib
What's relevant here is that the related drug Celebrex survived because its side effects—whilst manifestly similar—aren't quite as bad as Vioxx. In short, Celebrex's COX-2 selectivity versus other less selective NSAIDs like aspirin (which target both COX-1 and COX-2) was deemed sufficiently beneficial despite its potential serious side effects.
Note: I'm not offering medical advice here and you should always take that from your medical practitioner. I mention this because only several days ago I had a discussion with two younger doctors who'd never heard of Vioxx let alone the Vioxx/Celebrex controversy.
You may be interested in this YouTube video on Vioxx. Unfortunately it's over hyped and designed to alarm but it's essentially factually correct: https://m.youtube.com/watch?v=K0GrFnOpJoU
There are also slow release forms of naproxen. (Which make sense given its long action: lets people fade in the next one while the previous dose slowly fades out). That could also help make it easier on the GI tract.
Unless I am missing something, the data really doesn't back that up. naproxen is much more longer lasting and has a higher chance of causing ulcers. Hence why its not over the counter in the UK and is prescribed with omeprazole to reduce the risk of issues.
Naproxen will be around longer due to its long half-life, so it creates more opportunity for this problem.