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Paracetamol vs. Ibuprofen – How they work

The two most commonly sold over-the-counter pain relief substances are paracetamol and ibuprofen.  Although they are used in the same way and usually to treat the same problems, they are quite different from each other in significant ways. For most users, the differences won’t be very apparent, especially if they stay within the recommended dosage.

Paracetamol mimics codeine, Ibuprofen mimics aspirin

Codeine and aspirin are both derived from natural substances. Codeine is produced from opium poppies and aspirin is produced from willow trees. Paracetamol and ibuprofen are synthetics that try to mimic the effects of these drugs. Although all of them are used for treatment of pain, they work in different ways to achieve this aim.

Opiates such as morphine and codeine produce an analgesic effect by inhibiting pain receptors. These substances are alkaloids. The “War on Drugs” has created shortages in the supply of morphine and codeine, and has driven the price of opium up high enough that there is little incentive for farmers and manufacturers to waste their crop on legitimate uses. Paracetamol fills the void that has been left, although it requires much higher doses to achieve the same aim, which also increases the potential for side effects, although it is much less addictive than codeine and normally less expensive as well.

Aspirin, on the other hand, does not work by inhibiting pain receptors. It does its job by thinning the blood, reducing inflammation. While aspirin is a natural product, Ibuprofen is an artificial one that works in a similar way. Ibuprofen is less efficient than aspirin, but it can be administered in lower doses than aspirin. Unlike opiates, which are alkaline, aspirin and ibuprofen are acidic.

Ibuprofen is faster

Both aspirin and ibuprofen are faster acting because they don’t need time to work on pain receptors the way that paracetamol does, so the pain relief is usually more rapid (but not by a lot). If speed is the most important concern, aspirin trumps both paracetamol and ibuprofen by a clear margin, but both ibuprofen (especially) and paracetamol can treat a wider range of pain types than aspirin can.

Paracetamol is potentially less irritating

Much is made of paracetamol supposedly being “gentle on the stomach” and that ibuprofen (and aspirin) may cause gastric discomfort and potential gastric bleeding and intestinal bleeding. Aspirin can also cause bleeding in the stomach and intestines. Paracetamol can cause damage to the liver and kidneys if taken in excessive amounts or too frequently.

If in doubt, should you take both?

Well, only a medical practitioner can tell you what you should take, but you definitely can take both, and it’s unlikely to be fatal unless you consume too much. Whether you decide to do this or not depends on a lot of factors. First, you need to consider the potential gastric effects of ibuprofen and the potential effects on the liver and kidneys of taking paracetamol. Then there is the matter of cost, because taking both is obviously more expensive than taking only one.

Because they work differently, you need to take the same amount that you would normally take in a single dose, for example if you normally consume 1g of paracetamol, you would still need to consume 1g of paracetamol for it to be effective, and the same holds true for ibuprofen. If you only take 500mg of each, the analgesic effect will be noticeably lower and slower. While you can take paracetamol and codeine together, you should not take ibuprofen and aspirin together except on specific medical instruction.