(Montreal) Although acetaminophen (Tylenol) and ibuprofen (Advil/Motrin) are two over-the-counter medications on pharmacy shelves, their use must be taken seriously, as failure to follow the dosage instructions can lead to health problems, sometimes quite severe.
Acetaminophen and ibuprofen are two medications that are trivialized by many people, admits David Gauthier, pharmacist and owner of two Brunet group pharmacies in Sorel-Tracy.
From 2019 to 2023, Health Canada received 1,197 reports of adverse reactions related to acetaminophen overdoses leading to hospitalization or prolonged hospitalization and 446 with the active ingredient ibuprofen. These are not fatal overdoses, but they are a possibility in extreme cases.
One of the most common mistakes is taking too many pills at once. If the medication doesn’t work after an hour or two, the sick person can combine acetaminophen and ibuprofen, advises Mr. Gauthier. If the person has taken two Tylenol pills, for example, and the fever persists after two hours, they can take one or two Advil or Motrin pills. “If you follow the dosage for each, the two can be combined without any problem,” assures the pharmacist.
He notes that conversely, some people will avoid taking these medications despite pain. “Sometimes someone who is in pain will not take Tylenol because ‘it’s just Tylenol.’ In other people […] “When they have pain, instead of taking two pills, they will take three, even four. As a pharmacist, we hear all sorts of things,” says Mr. Gauthier.
Taking too much without knowing it
One thing that may not be known about ibuprofen and acetaminophen is that they are found in many other over-the-counter medications at the pharmacy.
Acetaminophen is found in flu medications, cough syrups and muscle relaxants (Robaxacet), among other things. “Someone can easily end up taking a lot of Tylenol without realizing it,” Gauthier warns.
“One of the big risks with Tylenol is that there is so much of it in different products that it is difficult to know exactly where it is. For the average person, for the elderly, it is even more difficult to identify acetaminophen and understand that this is what it is,” adds the pharmacist. As a professional, he himself double-checks the list of ingredients on certain packages.
For ibuprofen, it is found in muscle relaxants (Robax Platinum). It is also found in cold medicines, most often those aimed at congestion.
Health hazards
For healthy people, it is recommended to take up to 4 g of acetaminophen per day: the equivalent of the famous dosage of 1 to 2 extra-strength tablets every four to six hours, four times per day maximum. “For the elderly who will take it chronically, we reduce this dose to around 3 g per day. The main reason is really at the level of the liver, the hepatic enzymes that we want to pay attention to,” explains Mr. Gauthier.
Acetaminophen is indeed hard on the liver. It poses a risk of complications especially for the elderly, people who consume large quantities of alcohol and people who have kidney problems, says the pharmacist. “Acute and even chronic liver failure can occur with an overdose of Tylenol,” he warns.
But ibuprofen is associated with more contraindications. “Sometimes, pharmacists, it worries us a little more because we won’t catch the patient who is going to go over the counter to self-medicate,” he says.
Ibuprofen, which is a nonsteroidal anti-inflammatory drug, can have an impact on high blood pressure and the kidneys. It is also naturally harder on the stomach than acetaminophen. It will damage the natural mucous membrane that protects the stomach. A patient can end up developing a stomach ulcer, a particularly intense pain, according to Mr. Gauthier. For this reason, it is not possible to “keep a patient” on ibuprofen.
“There is no need to be alarmed,” Mr. Gauthier says. “We need the right medicine for the right person at the right time.” […] It’s basic, but it’s true. For example, you can use a nonsteroidal anti-inflammatory like ibuprofen on someone who has a blood pressure problem. It’s just that you have to use it for a short period of time with good monitoring.”
He has noticed that in recent years, people have been turning more to pharmacists and are not hesitant to ask for advice, which Mr. Gauthier is pleased about. He notices this a little less with young adults or people who never come to the prescription counter (so much the better, they are not sick, Mr. Gauthier points out). It is simply that this clientele is less likely to go and see a pharmacist. When self-medicating, they must be more careful and follow the instructions on the packaging carefully.
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