Tylenol vs. Ibuprofen: Which is Better for Fever?

Ahh, the age-old dilemma. When it comes to fever reduction, which works better - acetaminophen (Tylenol) or ibuprofen? I treat a lot of patients in the emergency department for fever-causing illnesses and recommend OTC medications on a daily (or more like hourly!) basis. But, when it comes to the exact stats for these medications, it can be difficult to remember to answer patients' F.A.Q. Which is better for fever reduction - acetaminophen or ibuprofen? And, how long does each medication take to kick in?

Studies show that fever severity and the age of the child probably matter more than which medication is administered when it comes to antipyretic efficacy in pediatric patients. Children with higher fevers and who are older than 6 years old have decreased response to medications like Tylenol and ibuprofen compared with younger children and those with lower fevers. Overall, acetaminophen and ibuprofen have pretty comparable results, both lowering temperature by about 1.8 to 3.6 degrees Fahrenheit and take effect in under an hour. Ibuprofen, however, lasts a couple hours longer than acetaminophen.

In anticipation of cold and flu season, here's a rundown of the fast facts for antipyretic medications. 

 

Acetaminophen (Tylenol) 

Average decline in temperature: 1.8 to 3.6 degrees Fahrenheit

Onset to effect: Less than one hour

Time to peak effect: 3-4 hours

Duration of effect: 4-6 hours

Approved ages: 3 months and older

 

Ibuprofen 

Average decline in temperature: 1.8 to 3.6 degrees Fahrenheit

Onset to effect: Less than one hour

Time to peak effect: 3-4 hours

Duration of effect: 6-8 hours

Approved ages: 6 months and older 

 

Alternating Medications Works! 

We've all heard about alternating acetaminophen and ibuprofen for fever, but does it work? Studies show that alternating these meds versus use of a single agent is effective. Initial changes in temperature are similar whether a single agent or alternating therapies is used. About 4 hours after the initiation of treatment, however, lower temperatures are observed in individuals combining acetaminophen and ibuprofen. 

While alternating acetaminophen and ibuprofen for fever can result in improved fever reduction, there is a risk that patients will misunderstand instructions or fail to dose these medications properly. So, make sure your patients have the information they need to alternate therapies safely and effectively. 

What clinical tips would help you in your practice? Let us know and we'll get answers!

 

Resource: American Academy of Pediatrics; Safety Profile of Cough and Cold Medication Use in Pediatrics