It's shocking to me how we still refer to paracetamol and ibuprofen in the same breath when their relative risks are so different.
I mean, most people don’t know anyone who has died or been injured from acetaminophen, so from most normal people’s everyday perspective it simply does the same thing as ibuprofen, regardless of whether that’s scientifically correct. Thus it’s easy to understand why people talk about them in the same breath.
On the subject of aspirin being a COX inhibitor, so are Omega 3's. Omega 3's interact with the COX enzyme's so their Nett Effect is tantamount to being a COX inhibitor! Omega-3's also reduce inflammation but they take several weeks to months to have a noticable effect, in which time, weather can improve which is cited as the cause of the improvements.
Short term once or twice use cases, Aspirin can be useful, but if anyone is needing to consume anti inflammatories like Aspirin, consider looking into dietary changes which can also reduce inflammation, like increasing Omega-3 intake.
On the point of the indoleamine dioxygenase, there are many enzymes which can target cancer, copper will increase some of the InterLeukins which modulate the immune response.
It is handy to know that aspirin slows the breakdown of the amino acid tryptophan into its metabolite kynurenine by inhibiting associated enzymes called indoleamine dioxygenases, or IDOs.
I'll have to try taking some aspirin with some tryptophan on an empty stomach or protein free meal so that the tryptophan is not crowded out by the handful of amino acids typically found in meat and other protein sources at the blood brain barrier, in order to see if it will improve my mood. Blue light exposure via the eyes is needed to increase the serotonin in the brain according to some studies.
Acetaminophen 'usage' dose is usually 500-1000mg (1-2 pills). The dosage where it becomes significantly toxic is ~7500-10000mg (7.5-10g), which is somewhere in the range of 10x the dose.
Ibuprofen on the other hand, 'usage' dose is 200-400mg (1-2 pills, again). Toxic dosage is closer to ~16000-25000mg (16-25g), which is more like 50x the usable dose.
Since people invariably take more than the recommended dose when they're really in pain, I'd prefer the NSAID that is less toxic at higher doses... since it's not like they post toxic doses on the side of bottles.
I think the fact that for most people there is almost no risk is why they are mentioned in the same Breathe
It's the risk of seriously damaging a small subset of people even if they stick strictly to the recommended dosage that I find strange. Maybe that's the case for a lot of medicines and I'm just less aware of those. But I see people popping ibuprofen like candy and I don't think many of them have even considered whether they might be in that small group of people that definitely shouldn't touch it.
[1] The therapeutic index (TI; also referred to as therapeutic ratio) is a quantitative measurement of the relative safety of a drug. It is a comparison of the amount of a therapeutic agent that causes the therapeutic effect to the amount that causes toxicity. https://en.wikipedia.org/wiki/Therapeutic_index
[2] Paracetamol toxicity is the foremost cause of acute liver failure in the Western world, and accounts for most drug overdoses in the United States, the United Kingdom, Australia, and New Zealand. Paracetamol overdose results in more calls to poison control centers in the US than overdose of any other pharmacological substance https://en.wikipedia.org/wiki/Paracetamol
yup people are shocked when they learn it is good ol' Tylenol that is killing people or making them deathly ill, not those evil steroids or opioids hyped by the media. That is not to say those are not dangerous, but paracetamol is way easier to accidentally overdose. Taking to much of an oral steroid at once will not cause liver failure. Neither will too much codeine.
I wonder if people in general are or were always as blasé about the risks of easily obtainable medicines as the people around me seem to be today. Could trust in government regulations to protect us from harm have the side effect of eroding personal responsibility? Or could the era of click-through EULAs and warnings on everything etc. be training people to not bother reading any instructions/warnings? ("This product contains water, which is known to the state of California to cause cancer and birth defects.")
I'm rambling. Maybe I don't have a coherent point. But something bugs me about it.
And it's shocking to me how we still refer to paracetamol (Acetominophen for us USAians) and ibuprofen in the same breath, when paracetamol might as well be a sugar pill, for all the good it does and ibuprofen is the liniment of the gods!
I added "acetaminophen" because most USAians wouldn't know what "paracetamol" was if it came up and smacked them upside the head.
For people like me it’s simply not even an option.
Good. More for me. ;)
More seriously, you're absolutely right. Which is why even folks who can take ibuprofen should only do so within appropriate limits (IIUC, 2400mg/day maximum).
I have spinal issues (disc degeneration, stenosis) which have, in the past, caused serious amounts of pain. If that pain is acute and not too serious, ibuprofen has been a life saver for me. Naproxen sodium, acetaminophen and other NSAIDs have absolutely no effect on me.
Without ibuprofen, my life would be a nightmarishly painful endeavor. And so, while I do understand your circumstance (which sucks because NSAIDs are wonderful as analgesics, it's a shame you can't use them), those who ibuprofen can help is a much larger pool than those it harms.
Hopefully, one day we'll discover/invent analgesics which don't cause GI issues.
If that pain (usually sciatica) becomes chronic, ibuprofen isn't enough. When that's happened, I've ended up having epidural steroid injections[0] which knocks out that inflammation post-haste.
[0] https://paindoctor.com/faq-epidural-steroid-injections/
Edit: Fixed typo, removed extraneous text.
Paracetamol is an analgesic and antipyretic, but it is not anti-inflammatory. And there are other divergences e.g. ibuprofen has been linked to protecting against Parkinson’s, where neither paracetamol nor aspirin (which is an anti-inflammatory) have shown such property.
The TLDR is that they’re different molecules, and while they have overlap in their antipyretic and analgesic properties, that does not make them substitutable in all cases.
I guess what I'm suggesting is it should be available over the counter, but not off the shelf.
https://en.wikipedia.org/wiki/Drug-induced_aseptic_meningiti...
I think you're probably right.
Acetaminophen does absolutely nothing for me. Nor does Naproxen Sodium. But ibuprofen does. And consistently over decades.
I wonder if there's been any research into what makes different analgesics more or less effective for various cohorts. Unsurprisingly, there has been[0][1].
[0] https://www.npr.org/sections/health-shots/2011/09/26/1407055...
[1] The meta-study referenced in the link is from 2011.