I'll be the first to admit I know very little about acetaminophen, but what I know is that it can be good for breaking fevers and allegedly it's useful for pain relief (not my experiences)?
I try my hardest to avoid it due to the associated hepatotoxicity which, to my understanding, is less likely/not observed in other NSAIDs.
Huh, you are absolutely right. It's not an NSAID. Thank you for the correction.
Sure, I do agree that NSAID have their own pitfalls. I am sure most, if not all, medications have pitfalls at some intersection between dosage and time. My understand of acetaminophen is that the line between therapeutic help and harm is rather small for compared to many other OTC medications.
Just based off of a few brief searches it is recommended that an adult take no more than 2 tablets every 4 to 6 hours. One tablet is typically 325mg. According to this Harvard Health link [1]:
"For the average healthy adult, the absolute maximum daily dose is no more than 4,000 milligrams (mg) from all sources. But in some people, doses close to the 4,000 mg daily limit for adults could still be toxic to the liver. It's safest to take only what you need, and to not exceed 3,000 mg a day whenever possible, especially if you use acetaminophen often."
So, even with infrequent usage, and by following proper instructions, liver toxicity could still technically occur within just 24 hours of usage. How likely is it? Well, that I have not looked into.
Overall, my point is: why risk even go down that road? Now, I could be wrong (again), but most research I have seen on the topic pertains to pain relief where Tylenol doesn't seem as effective as alternatives. Perhaps for other aliments it's better, but again, that begs the question -- better compared to what else and what are those risks?
As I'm sure you know, the AI in NSAID is anti-flammatory; thus if you have some kind of non-inflammation pain, paracetamol (aka acetaminophen, Tylenol and other brands) is better. It's also better for lowering fever temperatures. Ibuprofen and other NSAIDs are also contraindicated by other medications, I'm sure there are some for paracetamol too, but I'm not aware of them vs. a few for ibuprofen.
I think you're overstating the risk to your liver, it's not even a prescription drug in any country I'm aware of, there are guidelines and dosages stated for a very good reason, sure, but if you're not taking it routinely (rather just to address an occasional issue) it's fine. And if you are you should see a GP, but the outcome might still be that they agree and prescribe a daily dose.
Ibuprofen should be taken with food to mitigate risk of stomach ulcers, but how many people follow that guidance? It's processed by and a toxin to kidneys instead of liver, can result in AKIs/renal failure, at least you have two of those I guess?
Personally I take ibuprofen for a migraine etc., but paracetamol for a fever. Neither is happening frequently, so I don't worry about occasional use within the guidelines/on doctor advice of either of them.
Might I add, if anyone is concerned about liver damage, just supplement NAC (n-acetyl-cysteine which is given for acetaminophen / paracetamol overdose), and milk thistle.
Because NSAIDs can lead to erosion and bleeding in your gut.
I've been told to avoid NSAIDs "forever", or at least until a gastroscopy has shown my stomach is fully recovered after using ibuprofen strictly within the dose limits. It's a known risk, and lowering the dose just reduces the odds - it doesn't remove the risk.
Acetaminophen/paracetamol overdoses do happen, but they're rare and usually involve significant overdoses rather than minor accidental excess use.
Their ability to bring down fevers etc. also tend to differ depending on source.
Acetaminophen/paracetamol is usually the first recourse in hospitals etc. because as long as you dose it right, the odds it both works and doesn't incur harm are better.
>even with infrequent usage, and by following proper instructions, liver toxicity could still technically occur within just 24 hours of usage.
Sorry, I find it hard to understand how you came to this conclusion. Even if taken every 4 hrs for the whole 24h (which is extreme case, rarely one needs more than 2-3 tablets for a pretty nasty fever) it gives us 6 doses per 325 mg = 1950 mg which is well below even the most cautious limit
It is often taken for long term chronic pain as opposed to a occasional fever as well. Could easily take 6 500mg pills a day for a long time. Add some drinking on top.
I was recently told by my cardiologist to avoid chronically taking ibuprofen and other NSAIDs for pain and to favor Tylenol. Not as a specific recommendation based on my own health either, just her general recommendation that they are not safe for chronic use.
Acetaminophen and ibuprofen are said to both have pro-inflammatory properties. My understanding is aspirin is basically safe, and naproxen (Aleve) is not terrible.
In India [1] the standard dose for acetaminophen has recently become 650mg, because the 500mg variant is price-controlled and allegedly one manufacturer spent roughly $ 120 million to market the 650mg variant to Indian doctors.
Prescription NSAIDs are one of the top 2-3 causes of adverse drug event hospitalizations in the US. Patients on opioids and NSAIDs lead to the highest rate of 10 day admissions. There is insufficient data capture of OTC drugs to factor them into this stat, I believe.
