Aspirin


APAP vs NSAIDs

FAQ

What’s the difference between acetaminophen (Tylenol) and ibuprofen (Advil/Motrin)?

APAP

Acetaminophen (A-SEET-a-men-o-fin, APAP) is in a class all by itself and science isn’t 100% sure how it works. There is a suspicion that there is an enzyme in the inflammation cascade that is only found in the central nervous system, and that enzyme is inhibited by APAP. But because it’s central, this is why APAP works on pain and fever but not swelling. APAP is metabolized by the liver, and that metabolism pathway produces a very toxic by-product if it gets into a traffic jam. This is why APAP dosing limits have been adjusted, and APAP overdoses are so dangerous, even if one does not have liver disease or consume alcohol.
Podcast Episode: Too Much Acetaminophen

NSAIDs

Ibuprofen is in a class many call NSAIDs (non-steroidal anti-inflammatory drugs – because the other medications used to treat inflammation are steroids). NSAIDs, including ibuprofen work on a specific enzyme step in the inflammation process that result in pain, swelling, and fever. That is why joint and muscle injuries respond well to NSAIDs. It is also why the inflammatory response due to viral or bacterial infections are subdued easily by NSAIDs. NSAIDs are metabolized and processed through the kidneys. An overdose can lead to kidney damage, as well as kidney disease can be worsened if these medications are used.  Aspirin is also a NSAID, as well as naproxen.

Bottom Line

In my personal experience, APAP works well on fever and overall body aches (think the flu). Ibuprofen and naproxen work well on injured joints and muscles, as well as sore throat symptoms due to viral infections.  Aspirin doesn’t get recommended for the same things as NSAIDs, mostly because it has such a big reputation as a blood thinner.

Too Much Acetaminophen?

An image of multiple red and while capsules that resemble acetaminophen pills.

Why is this important

Studies have been done regarding deaths caused by Acetaminophen (APAP) overdose, and they are finding that kids and adults are dying from having too much medicine with just a little bit extra over the recommended dose. [This American Life did a whole episode on Tylenol overdose stories]

Acetaminophen Basics

APAP is processed by enzymes in your liver. They are like little boats that carry drugs from one place to the other and cause them to make changes so it can do it’s job when it gets to the other side. So, APAP rides in it’s own little boat, and the body then uses it to reduce pain or fever.

The problem is, if there’s more APAP than boats, other things start happening to it, and it becomes very toxic. It not only damages liver, it can damage the DNA of your body. The only way to get it back in order and bind it back up, is for you to receive other pharmaceuticals in a hospital.

Most likely, if someone has had too much APAP, it takes about 4 days for them to experience any symptoms, and therefore, it’s probably too late for them to receive help.

Excedrin Migraine = Acetaminophen (APAP), Aspirin (ASA), Caffeine

Take Aways

Please don’t take more APAP than recommended.

They changed the maximum dose allowed from 4000mg per day to 3000 mg per day.

Extra strength APAP: 500 mg/ tab (1-2 tabs q 6 h) —> 500 x 2 = 1000 mg —> 3 doses in a day (6 tablets)

Non-steroidal anti-inflammatory drugs (NSAIDs) include Aspirin, Ibuprofen (Advil or Motrin), Naproxen (Aleve)

The Side effects of NSAIDs are much more instantaneous, so if you take too much, you will know right away and can back off.

Many prescription pain medications contain APAP too.

Maximum Doses
APAP: 3000mg in 24 h
Aspirin: 6500 mg in 24h
Ibuprofen: 3200mg in 24h
Naproxen: 1250 mg in 24 h

Connect with me

Support us on Patreon

*NEW* Join the Pharmacist Answers Podcast Community on Facebook

Subscribe: iTunes, Stitcher, GooglePlay, TuneIn Radio

Like the Facebook page