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Comment by sillysaurusx | Hacker News Reader

Does anyone know if ibuprofen is risky with sustained, long-term usage of the recommended dose? I have a relative who uses it habitually, and I can’t help but worry.

It seems safer than Tylenol, but I don’t understand why it would be safer.

They recently had a toothache, and they took 4 right away and more several hours later. When I expressed concern, they said the doctor told them to go ahead and take 4 immediately when in severe pain. But it feels like more and more studies and anecdata are casting suspicions on Tylenol, so I wanted to ask if anyone knew the central reason why ibuprofen might be safe in comparison.

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Naproxen, ibuprofen, acetaminophen, aspirin are all ototoxic (damaging to hearing), so that is one concern.

I almost never use pain killers, but if I have to reach for one, it will be naproxen. Naproxen is longer-lasting. It has a metabolic half life of as much as 17 hours in the body, compared to just around two hours for those others. This has advantages, one of which is simple economics. One naproxen pill works like 4 consecutive ibuprofens or acetaminophens.

I was prescribed naproxen in the early 1990's, at the University of British Columbia sports medicine clinic for some wrist tendinitis. Stuff worked, so I remembered the name well. I didn't know that just a few years after that, it had become over-the-counter. One day I googled it by name and so it goes.

One down side of naproxen, sort of, is that it's not recommended for children. You will not find a children's naproxen.

Naproxen isn't a direct replacement for ibuprofen, acetaminophen or aspirin.

It much stronger and has different interactions. For example you shouldn't use when taking cipro.

I've used it and found it works really well but uses a different method for reducing pain compared to the others.

> uses a different method for reducing pain compared to the others

This is not true; all the over-the-counter painkillers are COX enzyme inhibitors. Of course, they are different molecules with different additional properties and metabolic products. For instance, aspirin is a blood thinner whereas naproxen isn't. The remarks about the different interactions are absolutely true.

With regard to mechanism of action, one oddball is paracetamol (acetaminophen, Tylenol).

Wikipedia: "Despite its common use, the mechanism of action of paracetamol is not completely understood. Unlike NSAIDs such as aspirin, paracetamol does not appear to inhibit the function of any cyclooxygenase (COX) enzyme outside the central nervous system, and this appears to be the reason why it is not useful as an anti-inflammatory.[24] It does appear to selectively inhibit COX activities in the brain, which may contribute to its ability to treat fever and pain."

What makes naproxen "stronger" is how it endures in the body.

> I almost never use pain killers, but if I have to reach for one, it will be naproxen.

Same. I also find naproxen to be the most effective on the rare occasions I need a pain killer.

Yes. Google “ibuprofen kidneys”.

All of the nsaid drugs have risks if chronically overused. End of the day, if you’re taking otc pain relievers for more than a week, you should look at treating root cause.

Thanks!

NSAIDs can reduce blood flow to the kidneys so they don't recommend it long term because it can cause kidney problems. Tylenol is metabolized into harmful byproducts (I think just like alcohol) but if you stay below some maximum amount per time period, your liver can neutralize it.

I believe Dr. Rhonda Patrick says that it can increase risk of stroke and heart issues after prolonged use. I would look her up and see because I might be wrong.

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