Aspirin, ibuprofen, paracetamol: how to choose the right painkiller?

To relieve fever, headaches, toothaches, inflammatory pain, migraines, painful periods, body aches, burns, you have the choice of paracetamol, ibuprofen or aspirin. Which is the most effective? What kind of pain do you take them for? Can we combine them? How do you choose the painkiller that best suits your needs?

Favor paracetamol as a pain reliever

Analgesics are one of the most widely used drugs in France because they can quickly stem pain or lower fever, without the risk of side effects.

Paracetamol is a level I pain reliever, like ibuprofen and aspirin. It is the most widely used and has the lowest risk benefit. If it is painful or feverish, it is the first to take because it lowers fever, relieves headaches, period pain or toothache.

Marketed under various names, doliprane, dafalgan, or even efferalgan, paracetamol is the drug of first resort, in case of pain or fever. And for good reason, it is rarely responsible for side effects – except in cases of overdose or chronic use – and it is intended for everyone, pregnant women and young children included. This pain reliever can be taken even while breastfeeding.

Its safety should not, however, make us forget the cases where it is contraindicated: allergy to paracetamol and hepatic insufficiency. You need to be sure that taking this pain reliever will not affect your body.

Indeed, paracetamol is not a harmless product. In case of overdose, it can cause serious damage to the liver, sometimes irreversible. There is a risk of overdose if you do not follow the rules of good practice.

Paracetamol should be consumed in the smallest dose and for the shortest time possible.

How to properly use paracetamol?

• In adults weighing less than 50 kg, it is imperative to consult the instructions for the maximum recommended dose according to their weight:
  • When taking paracetamol in adults, start with the lowest possible dose (500 mg);
    to respect :
    • the maximum dose per dose: 1 g per maximum dose,
    • the interval between catches: at least 4 to 6 hours,
  •  Paracetamol: no more than 4g per 24 hours, unless the doctor advises otherwise.
  • not to consume alcohol during treatment.

• In children, the dosage (dosage and method of administration) of paracetamol is 60 mg per kilogram per day, to be divided into four or six doses, i.e. approximately 15 mg / kg every six hours or 10 mg / kg every four hours.
  For children, paracetamol usually comes in an oral solution. It is necessary to avoid taking capsules or tablets under 6 years.

Precautions for use with paracetamol

Paracetamol is rarely responsible for side effects. However, vigilance is required. Indeed, it can have a toxic effect on the liver in case of overdose (more than 4 grams per day) or if it is associated with alcohol intake. This is because alcohol and paracetamol are detoxified by the liver through a common mechanism. In the event of a fever that continues over several days, it is recommended to alternate at each dose between a medicine containing paracetamol and one that does not. Last recommendation: paracetamol and alcohol do not mix.

Also check for the presence of paracetamol in other medicines that you would take at the same time (used for pain, fever, allergies, cold symptoms or flu-like symptoms):

• read the instructions carefully. Special cases exist which oblige to modify the maximum doses, in the elderly for example;
• remain cautious and always ask your pharmacist for advice. Especially if you already have a treatment in progress and you plan to take paracetamol to treat transient pain.

Some medicines sometimes contain paracetamol and an overdose should be avoided.

In all cases, the pain reliever should stop as soon as the pain subsides. Finally, do not hesitate to discuss it with your doctor if you suffer from mild to moderate hepatic insufficiency, severe renal insufficiency, chronic alcoholism …

Choose aspirin for mild to moderate pain

Aspirin is also available without a prescription. Its use is reserved for light or moderate pain.

Aspirin is more likely to be used than paracetamol. It should not be taken for more than 5 days for the treatment of pain, and not to exceed the dose of 3 grams per day in adults, and 60 mg per kg per day in children.

Aspirin also presents an allergic risk, and should not be used in people with asthma or with a disease with risk of bleeding (especially stomach ulcers).

Aspirin is prohibited in pregnant women, in people with stomach problems, being allergic to aspirin and ibuprofen, or on anticoagulants. It is also not recommended for children.

How to properly use aspirin?

• For adults and children weighing more than 50 kg, the maximum recommended daily dose is 3 g of aspirin, or 6 effervescent tablets per day. The usual dosage is 1 effervescent tablet of 500 mg, to be renewed if necessary after at least 4 hours. In case of more intense pain or fever, 2 effervescent tablets of 500 mg, to be renewed if necessary after 4 hours minimum, without exceeding 6 effervescent tablets per day. When used to treat cardiovascular disease, the doses are lower. If this is the case, ask your doctor for advice.
• For a child weighing less than 50 kg, the dosage depends on the weight. It is necessary to weigh it in order to give it the most suitable dose. The recommended daily dose of aspirin is approximately 60 mg / kg / day, divided into 4 or 6 divided doses, or approximately 15 mg / kg every 6 hours or 10 mg / kg every 4 hours.

Precautions for use with aspirin

Taking aspirin is not harmless. Several side effects are to be feared, such as abdominal pain, nosebleeds or gums. In very rare cases, this can lead to bleeding in the digestive tract, which can lead to anemia.

Also watch out for interactions with other drugs such as anti-inflammatory drugs or anticoagulants. In addition, any overdose or prolonged intake exposes the patient to complications. In order to avoid overdose, aspirin should never be taken at the same time as another nonsteroidal anti-inflammatory drug, for example ibuprofen.

Choose ibuprofen in case of inflammation

Ibuprofen is a pain reliever and an anti-inflammatory drug, prohibited for pregnant women, people with stomach problems, people who are allergic to aspirin (cross-allergic) and people who are on blood thinners.

How to properly use ibuprofen ?

Ibuprofen is used in the treatment of certain forms of rheumatism and osteoarthritis, tendonitis, low back pain, sciatica, and painful periods. It is not indicated for dental pain as its anti-inflammatory effect could mask a potential infection. For adults and children over 30 kg, the usual dosage is 1 tablet (400 mg) per dose, to be renewed if necessary after 6 hours. In all cases, do not exceed 3 tablets per day (i.e. 1200 mg per day).

Advil, Nurofen and Spédifen are analgesics to take if the pain does not go away with paracetamol. They are indeed more effective and generally have fewer side effects than aspirin. They are recommended for fever, toothache, joint pain, migraines.

The dosage is 200 to 400 mg per dose and an interval of at least 6 hours between each dose should be observed. The maximum dose per day is 1200 mg. They are prohibited from the 6th month of pregnancy, in the event of breastfeeding, kidney or heart failure. They can also cause stomach pain or diarrhea.

Precautions for use with ibuprofen

Like aspirin, but to a lesser extent, ibuprofen thins the blood. This medication should therefore be avoided in the event of asthma or a history of bleeding or ulcers. It is also contraindicated in cases of liver, heart or kidney failure.

• Ibuprofen is more at risk than paracetamol.
• Do not exceed 5 days of self-medication in case of pain and 3 days in case of fever.

Pregnant women should not consume it from the fifth month as there are risks for the fetus. Regarding the first phase of pregnancy, the effects are still poorly understood: the drug leaflet does not indicate anything on this subject, but researchers from the National Institute of Health and Medical Research (Inserm) claim that ibuprofen would be dangerous for the fetus from the first weeks of pregnancy. Regarding breastfeeding, ibuprofen passes in small amounts into breast milk. As a precaution, its use is therefore not recommended during this period.

In all cases, it is imperative not to exceed the doses and duration of treatment indicated by the doctor, at the risk of serious adverse effects: heartburn, irritation or bleeding from the digestive tract, allergic reactions, attacks of asthma, fatigue or even dehydration. In addition, since ibuprofen is part of NSAIDs, it has an inhibitory effect on ovulation, which may reduce fertility in women. However, this effect is reversible when stopping treatment..

Never choose analgesics for children and pregnant women without medical advice

In children, as in pregnant women, it is imperative to discuss this with the doctor beforehand. Indeed, to avoid any risk of wrong dosage or complications, self-medication is strongly discouraged.

For children, the pediatrician’s recommendation should be followed, who, depending on age, weight, any history or allergies, will refer to a particular analgesic, for which the indicated dosage should be observed. Persistent fever in children, or accompanied by associated symptoms, however, requires medical attention.

For pregnant women, no medication should be taken during pregnancy without medical advice. Paracetamol is most commonly indicated for mild pain. It is the best known and safest pain reliever and antipyretic for pregnant women, regardless of the term of pregnancy. Nonsteroidal anti-inflammatory drugs (NSAIDs) are formally contraindicated from the sixth month. They can cause the fetus to risk serious renal and cardiovascular damage, even death.

Our advice on self-medication and analgesics

• Beware of the risks of overdose: In 2017, a young woman, Naomi Musenga, died after being mocked on the phone by an operator of the Samu in Strasbourg, which caused a big wave of emotion in France. According to the investigation, this death was “the consequence of intoxication with paracetamol absorbed by self-medication over several days”.
• Always ask your pharmacist or doctor for advice before taking any medicine, even if taking it seems harmless.
• If you hesitate between several painkillers, tell your healthcare practitioner what other medications you are taking because they may already contain paracetamol, for example.
• And if you are on treatment for a long-term condition (ALD), never take painkillers for self-medication.

Sources :

1- https://sante.lefigaro.fr/article/aspirine-ibuprofene-paracetamol-comment-choisir-/

2- https://www.doctissimo.fr/sante/douleur/traitement-de-la-douleur/choix-anti-douleur

3- https://www.vidal.fr/actualites/24050-paracetamol-ibuprofene-et-aspirine-fin-du-libre-acces-en-pharmacie-a-partir-du-15-janvier-2020.html

4- https://www.ameli.fr/assure/sante/medicaments/utiliser-medicaments/utiliser-antalgiques

5- https://www.lalsace.fr/magazine-sante/2019/12/24/paracetamol-ibuprofene-aspirine-comment-eviter-le-surdosage