Which to choose?
Paracetamol: first choice for fever, pain without inflammation, pregnancy and gastric problems. Ibuprofen: pain with an inflammatory component (sprains, period pain, low back pain, dental pain). They can be alternated every 3 h for added effect.
Point-by-point comparison
Brands: Panadol · Calpol · Tylenol
Brands: Nurofen · Brufen · Advil
| Paracetamol | Ibuprofen | |
|---|---|---|
| Mechanism | Inhibits central prostaglandin synthesis (analgesic and antipyretic). NOT an anti-inflammatory. | Inhibits COX-1 and COX-2, blocking prostaglandin synthesis. Analgesic, antipyretic and anti-inflammatory. |
| Indications | Mild to moderate pain, fever. | Mild to moderate pain with an inflammatory component, fever. |
| Adult dose | 500-1000 mg every 6-8 h. Max 3 g/day (4 g/day in some countries). | 400-600 mg every 6-8 h. Max 2400 mg/day (1200 mg over the counter). |
| Onset of effect | 30-60 min | 15-30 min |
| Duration of effect | 4-6 h | 6-8 h |
| Pregnancy | Compatible — first choice. | CONTRAINDICATED from week 20-24 onwards. Avoid in the third trimester. |
| Breastfeeding | Compatible. | Compatible. |
| Paediatric use | From birth. 15 mg/kg/dose every 4-6 h. | From 3 months. 5-10 mg/kg/dose every 6-8 h. |
| Advantages | Well tolerated, safe in pregnancy and paediatrics, no gastric injury, no renal risk. | Acts on inflammation. Stronger analgesia in inflammatory pain. |
| Disadvantages | Hepatotoxic in overdose. Does not act on inflammation. | Gastric injury, renal risk, fluid retention, not for late pregnancy. |
Source: BNF, Spanish SmPC (AEMPS), SEFAC
Frequently asked questions
Which is better, paracetamol or ibuprofen?
Paracetamol: first choice for fever, pain without inflammation, pregnancy and gastric problems. Ibuprofen: pain with an inflammatory component (sprains, period pain, low back pain, dental pain). They can be alternated every 3 h for added effect.
Can paracetamol or ibuprofen be taken in pregnancy?
Paracetamol: Compatible — first choice. Ibuprofen: CONTRAINDICATED from week 20-24 onwards. Avoid in the third trimester. Always ask a doctor or pharmacist before taking a medicine in pregnancy.
And while breastfeeding?
Paracetamol: Compatible. Ibuprofen: Compatible.