Medical Myths

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This is a republished post from March 22, 2022

Rotating acetaminophen and ibuprofen

For my first post about Medical Myths, I wanted to present a myth that has plagued me and the medical world, here in the States at least.

QUESTION) Your child has a fever; what do you do?
Alternate acetaminophen (Tylenol) and ibuprofen (Motrin)

WRONG ANSWER!!!

So, why is this common belief wrong?

Well first off, it has never been studied. I did an exhaustive search about this practice several years ago and found absolutely no evidence to back it up.
It always bothered me from a pharmacologic standpoint (pharmacologic is the science behind the medicine.)

Every medication has what is known as a half-life. This is essentially the time it takes for a medication to break down in your system to be at half its original strength.

Medication dosages are based on the half-life of the medication. Both acetaminophen and ibuprofen have a half-life of 2-3 hours. That means that a 100 mg dose of the medications will be around 50 mg in 2-3 hours in your body.

If you are rotating the two medications, then you are giving one of the medications every 4 hours, which means that you are giving a dose of Tylenol every 8 hours and ibuprofen every 8 hours in alternating fashion.
Neither one of these medications is designed to be given in this timeframe.

How should it be done?

There is an entire other debate as to which medication works best for fever control. Studies show that they are pretty much equal at reducing fever.

My recommendation to my patients, or their parents, is to choose which medication you find works best for your child and then stick with that one medication for general fever control.

Can they be used together?

This is one of my favorite treatment options for parents. This works especially well when the child wakes up in the middle of the night with a high fever and the entire house is awake and buzzing.

**This presentation with a high fever is the ideal time to give a dose of BOTH medications. They work in different pathways and work great together.
**
This is also helpful when the child has a fever over 102.5 F or 39 C.

As a side note, never just treat a fever and ignore it. If your child continues to run a fever for more than 2 days, you need to see their medical provider. A child younger than 3 months with a fever needs to be seen sooner.

A fever in a child can be very worrisome for a parent. Remember to keep your child well hydrated and treat as discussed above.

Until next time,
John Novak PA-C

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46 comments
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Having raised a houseful of children, I agree you should do what works for each child. Some of my children reacted very differently to some medications. I was blessed with a good pediatrician who always started with, "Mom, tell me what is going on..." It was my job to know what was normal for my child and his job to use the info I gave him to inform his recommendations. !BBH

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Having a good Pediatrician is a definate plus.

Thanks, Kimberly. I appreciate the comment.

!BBH
!ALIVE
!PIZZA

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This is a very useful information and this would stem abuse. Thank you so much for sharing.

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It is my pleasure, @tranquil3

I am glad you found it useful.

!BBH
!ALIVE

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Oh that's great, I had always thought ibuprofen more of a pain reliever than a fever reliever.☺️

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Thanks, @edith-4angelseu

I am glad that you found it helpful.

!BBH
!ALIVE

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There are so many myths in the medical circles and these mostly lead to abuse of medicine. Thanks for shedding some light on this one. Happy new week.

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That is so true.

!BBH
!ALIVE

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My boss tells me that the first drug she gives to her child when he’s feeling fever or so is Ibuprofen
That’s wrong but she does not listen, lol

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It is okat to start with ibuprofen for fever, I just don't recommend rotating them.

Thanks @rafzat

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@rafzat! You Are Alive so I just staked 0.1 $ALIVE to your account on behalf of @ beststart. (10/10)

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Perfectly said and that is why I will also recommend that medication should be properly prescribed

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Keep up the great work and continue sharing your thoughts @beststart. Getting closer to the 10k comments 😅

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When my children were infants and toddlers, the alternate A&I was the standard advice dispensed by medical professionals in my community, so it makes me all smiles to see awesome members of the medical community clarify things.😊 Thanks @beststart

!PIZZA

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It is my pleasure, @generikat

I have providers that I work with that advise parents to rotate them still.

It really bugs me, lol

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You have told very good way how to control fever I will share this post with my friends too.

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Valuable information here in Venezuela these medicines are administered as water. They can even be consumed without a doctor's order, that is to say, we medicate ourselves without any remorse. I think I will go through your publications more often @beststart

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I think as much we find the symptoms of fever in a child, take it serious and visits the doctor. The Immunity sytems of children are not much strongs.They needs care.

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