General painkillers have specific uses and risks
Tylenol, ibuprofen, Aspirin may all work on a headache, but affect body differently
Should you take Tylenol for a fever? Ibuprofen for menstrual cramps? Low-dose Aspirin for heart health?
It can be confusing to understand the difference between over-thecounter medications — especially because the right choice depends on other factors, such as what other medications you’re taking and your overall health.
Take ibuprofen (the active ingredient in Advil). This drug will fight your fever as effectively as Tylenol according to the newest research. But unlike Tylenol, it also reduces inflammation — the major cause of back pain, arthritis symptoms and a host of other pains such as menstrual cramps and some forms of headaches.
Ibuprofen and naproxen, part of the class of medicine called non-steroidal anti-inflammatory drugs (NSAIDs), are powerful because they work on both COX-1 and COX-2 — enzymes that activate key molecules in your body that cause pain, inflam- mation and fever. Some NSAIDs only work on COX-1; others on COX-2. Ibuprofen is very broad in its effect.
But COX-1 enzymes play a beneficial role as well: they help to produce mucus that lines the stomach, and to build buffers for acid in the gastrointestinal (GI) tract. Any drug that reduces COX-1also tampers with these two important aspects of GI health. As a result, people who take NSAIDs such as ibuprofen (or higher-dose aspirin) regularly have an increased risk of GI bleeding and ulcers.
You should also tread carefully with this class of drug if you have kidney problems. That’s because NSAIDs reduce a substance called prostaglandins, which causes fever but also allows the blood vessels that feed the kidneys to dilate. This means they play a role in regulating sodium and water. Worse, if you’re on a diuretic for management of heart failure or hypertension, NSAIDs will blunt their effect, since diuretics need to be delivered to the kidney to act. And finally, NSAIDs can also exacerbate asthma.
Good old aspirin is also an NSAID and, at higher doses, it works similarly to ibuprofen to treat fever and reduce pain and inflammation. It also comes with the same risks at full dose.
Where aspirin really breaks out of the pack is when you take it at daily at a low dose for blood thinning. Aspirin (or ASA) is unique in its ability to cause permanent interference with COX-1 in platelets, which means it reduces your blood’s ability to clot when taken regularly.
Finally, there’s Tylenol. This staple drug works more in the central nervous system than in other areas, so it targets the centre of the pain. That may be why some people swear by Tylenol for migraines, which come from the central nervous system. Tylenol isn’t as hard on the GI tract or the kidneys, and it’s better for people with GI and heart issues than NSAIDs. But because Tylenol is more specific to the central nervous system, it really only works on pain and fever — not inflammation. So it may not be a good choice for back pain or menstrual cramps.
Tylenol can also be hard on the liver, so if you’re a heavy drinker, you might be better off taking an NSAID. Even if you’re not a problem drinker, try to avoid Tylenol for hangovers. Your liver is already working hard to clean up the alcohol in your system.
People often ask me about natural alternatives for pain and inflammation. Most health food stores seem to sell Arnica, a herb from the sunflower family that does seem to have an effect, according to the limited re- search we have. But as with all herbals, you need to get a brand in which the active chemicals are properly extracted from the right part of the plant.
In the less-regulated industry of herbal supplements, it can be difficult to know this. If you do experiment with Arnica, a topical product (applied to the skin) is the safest bet, and there’s some evidence it can help with muscle soreness and tissue injury.
A final point: NSAIDs and Tylenol should not be taken at the same time unless supervised by a health-care provider.
Talk to your doctor about how to juggle them, but the rule of thumb is that if you have to overlap these drugs, try to stagger the dosing so that you’re coming to the end of the first one’s effectiveness as you hit peak with the other drug.
If you have multiple health issues, make sure to talk to your doctor, nurse or pharmacist about the best painkiller for you. Michelle Arnot is an associate professor in the Faculty of Medicine’s department of pharmacology and toxicology. Doctors’ Notes is a weekly column by members of the U of T Faculty of Medicine. Email doctorsnotes@thestar.ca.