Paracetamol Vs Aspirin: Things You Should Know


Paracetamol and Aspirin belong to the analgesics and antipyretic class. However, they differ from one another in various ways; questions arise in our minds what, how, why, and when?

Paracetamol (Panadol®) and aspirin (Dispirin®) are two over-the-counter (OTC) drugs that can be used as pain relievers and fever reducers. OTC drugs are easily available in pharmacies and medical stores without a doctor’s prescription. Paracetamol is an analgesic used for mild to moderate pain while aspirin is a nonsteroidal anti-inflammatory drug. According to the U.S. National Library of Medicine, over 25 billion paracetamol doses are sold yearly in the United States.

What are they and how do they work?

Paracetamol, also called acetaminophen, belongs to the class of medicines known as analgesics. It is used to treat mild to moderate pain with little or no anti-inflammatory action. The usual dose is 500-1000mg for optimal activity. It inhibits prostaglandin synthesis in the Central Nervous System which is responsible for pain and fever.

Aspirin is acetylsalicylic acid, a nonsteroidal anti-inflammatory medicine. It is used to treat mild to moderate pain with inflammatory activity.  It blocks the release of cyclooxygenase enzymes (COX-1 and COX-2) and as a result, pain is muted without prostaglandins. For pain reliever and fever reducer, its usual dose is 300mg every 4-5 hrs.

What are their differences?

Aspirin is available in two doses, i.e., 75mg or less and greater than 300mg. At low doses, it acts as anti-platelet aggregation, preventing clot formation in angina, stroke, and heart attacks. At higher doses, it uses to reduce fever and relieve headaches, sprains, and strains and minimizes the symptoms of rheumatic fever and arthritis.

Paracetamol is available in different doses depending on which age group is consuming it. For adults, its dose is 500mg as a painkiller and 1000mg as a fever reducer. It is used for headaches, toothache, migraines, sprains, and fever.

 Paracetamol vs AspirinParacetamolAspirin
Analgesics (pain reliever)YesYes
Antipyretic- fever reducerYesYes
Anti-platelet ActivityNoYes
Side effectsNo upset stomach or internal bleedingStomach wall irritant, blood anti-coagulant, internal bleeding, and ulceration
Overdosage effectsSerious kidney, liver, and brain damageGastrointestinal bleeding following the use of alcohol
AllergiesRare0.5% get skin rashes, respiratory difficulty, shock
Child-useYesNo; causes Reye’s Syndrome- fatal liver and brain disorder
Table by Sumaira Faiz

When is paracetamol preferred over aspirin?

Aspirin belongs to NSAIDs and can cause high blood pressure and kidney damage by decreasing the flow of blood to the kidneys. As a result, it could lead to the accumulation of body fluids and increased blood pressure. Prostaglandins protect the lining of the stomach and gastrointestinal tract (GIT). Aspirin inhibits the release of it which results in GIT irritation and damage by gastric acid leading to bleeding in the stomach and gastritis. While paracetamol does not interfere with the release of COX enzymes, therefore there is no damage to the lining of the stomach. Paracetamol is on the World Health Organization’s List of Essential Medicines, the safest and the most effective medicine in the health care system. It is also prescribed and considered the safest drug in pregnancy.

What are the conditions for preferring aspirin over paracetamol?

Paracetamol is not recommended in patients with liver or kidney problems as the primary site for the metabolism of paracetamol is the liver.  Patients with a history of long-term alcohol misuse, underweight, and who has had an allergic reaction to paracetamol in the past. Aspirin is preferred for those patients who are suffering from angina, heart attack and strokes (low dose), rheumatic fever and arthritis, osteoarthritis, body pain, headaches, and backaches (high dose).

Is there any interaction between paracetamol and aspirin?

According to United Kingdom NHS, it is safe to take aspirin as a painkiller with paracetamol or codeine. But do not take aspirin with ibuprofen or naproxen without consulting doctors.

According to the literature, aspirin is reported to interact with 328 other medicines and paracetamol interacts with 106 drugs.

Picture by Sumaira Faiz

Why is aspirin no longer recommended?

Due to aspirin’s anti-platelet aggregation activity, it can reduce the chance of 2nd heart attack or stroke, but it can increase the risk of bleeding in the brain, stomach, and intestines. It is no longer recommended in patients with peptic or gastric ulcers.

It can be concluded that if you are suffering from mild to moderate pain without inflammation it is safe to use paracetamol. However, if there is inflammation and you have an upset stomach or an ulcer then it is better to use other NSAIDs like ibuprofen and diclofenac sodium. Aspirin is a highly recommended medicine in low doses due to its anti-platelet aggregation activity in patients having the chance of a second stroke after a first heart stroke.

Who is Miss Sumaira Faiz?

Sumaira Faiz is a known pharmacist by profession and has done M.Phil. in Pharmaceutics. She has an experience in industry and retail setup. She loves writing articles and blogs about public health and issues produced by the misuse and polypharmacy in Pakistan. Through her blogs, she has involved herself in generating public awareness about medicines; their right uses, right time, and right doses; their equivalents (counterparts), their alternatives, and their generics under the guidance of her respected teacher, Sir Syed Kazim Ali.

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