Unlike other weak painkillers such as acetylsalicylic acid (Aspirin) and Ibuprofen, Paracetamol has practically no anti-inflammatory effect. Just like these painkillers, paracetamol works by inhibiting an enzyme (cyclooxygenase) that produces substances (prostaglandins) that also have an anti-inflammatory effect. However, aspirin, for example, requires a very high dose of about 5 grams per day in order to have an anti-inflammatory effect, while the analgesic effect already starts at a daily dose of one gram.
Paracetamol, on the other hand, has little effect in blood cells and inflammatory cells, but rather in nerve cells in the brain and spinal cord. Although this has an analgesic and antipyretic effect, it does not inhibit inflammation. Incidentally, this is also the reason why paracetamol does not have a blood-thinning effect, although it inhibits the same enzyme as aspirin: Blood thinning is also mediated by cyclooxygenase in blood cells, which is not significantly affected by paracetamol. The dreaded side effects of aspirin and ibuprofen, such as stomach ulcers and bleeding, hardly occur with paracetamol, as the stomach cells are also hardly affected by this drug.
What other drugs are anti-inflammatory?
Anti-inflammatory drugs include acetylsalicylic acid (Aspirin) and ibuprofen. These drugs also have an anti-inflammatory effect through the same mechanism that causes pain relief. However, this requires a significantly increased dose, so potential side effects such as gastric bleeding and kidney damage argue against their use as anti-inflammatory drugs.
It should be noted that these drugs have the effect that they accumulate particularly well in inflamed tissue. Another group of anti-inflammatory drugs are the coxanes (e.g. celecoxib). In contrast to aspirin, coxanes predominantly inhibit cyclooxygenase 2, which is mainly found in inflammatory cells, while cyclooxygenase 1, which is found in blood platelets and stomach cells, is hardly inhibited at all.
As a result, Coxane has a relatively good anti-inflammatory effect, while side effects such as gastric bleeding occur less frequently. However, some of the coxanes greatly increase the risk of heart attack and stroke, so the drugs should not be used in patients with cardiovascular disease. Very effective anti-inflammatory drugs are glucocorticoids (e.g. cortisone).
These act by directly inhibiting inflammatory cells and reducing the production of pro-inflammatory hormones. However, due to their side effects, these drugs should not be given permanently, but only in the acute phase of an inflammation. Effective anti-inflammatory drugs that can be prescribed for chronic diseases are, for example, antibodies against inflammatory hormones (e.g.
Infliximab) or immunosuppressants that suppress the immune system (e.g. Methotrexate). However, the use of these drugs must be carefully considered due to high costs and/or severe side effects. Paracetamol has an antipyretic effect.
The dosage for adults is one gram, the maximum daily dose is four grams. In contrast to aspirin, paracetamol may also be administered to children and pregnant women in the last trimester; it is the most commonly used antipyretic. When and how much temperature should be lowered is controversial, so a doctor should always be consulted, especially in cases of high fever.
Special caution is required in patients with a weakened immune system and patients with impaired liver function. In these cases, paracetamol should only be used to reduce fever in consultation with a physician. If paracetamol must not be taken, ibuprofen is an alternative.
Paracetamol can be used for mild to moderate pain. It can be administered to adults up to four times a day in a dosage of 500-1000mg. The daily dose of 4 grams per day must not be exceeded under any circumstances, since paracetamol can cause liver damage from this dose onwards.
Paracetamol can cause liver failure and death from as little as 7 grams. Paracetamol can be given as a tablet, suppository or infusion. The use in children requires a dose reduction, children over 50kg may take up to 6 times 500mg, while infants between 3 and 6kg get a maximum of 4 times 40mg. The exact dosage should be discussed with a pediatrician.
