When it comes to managing pain or fever, two of the most commonly used medications in the UK are paracetamol and ibuprofen. While both help relieve symptoms, they work differently and have distinct recommendations under NHS guidance.
What are they, and how do they work?
Paracetamol is a mild pain reliever and fever reducer. It’s widely used for headaches, muscle aches, toothache, colds, flu, sprains, minor arthritis, and period pain. Unlike ibuprofen, it has very minimal anti-inflammatory effects.
Ibuprofen is a non-steroidal anti-inflammatory drug (NSAID). It not only reduces pain and fever but also tackles inflammation. It’s often used for menstrual cramps, dental pain, arthritis, back pain, post-surgical discomfort, and more.
When should each be taken?
Paracetamol is usually the first choice, especially when anti-inflammatory benefits are not needed. NHS considers it generally safe and a go-to for reducing fever or mild pain.
Ibuprofen may be more appropriate when inflammation is a factor – such as in sprains, sore throats, or toothaches. It’s important to take ibuprofen with or soon after food to minimise stomach irritation. According to the NHS, ibuprofen for adults is best taken with or after food or a milky drink to reduce the risk of gastrointestinal upset, and should be avoided if you are pregnant.
Can they be taken together?
Yes, but timing matters – especially for children. For adults, taking paracetamol and ibuprofen together is considered safe if needed.
As for children, NHS advice recommends staggering the doses rather than giving both at the same moment. One example is to give paracetamol and then, if fever or pain persists after 1 hour, give ibuprofen. Each takes 30–60 minutes to work, so wait about an hour between providing the second painkiller. You can also alternate – e.g., paracetamol at 8am, ibuprofen at 11am, and paracetamol again at 2 pm – to avoid exceeding the maximum daily doses.
A 2010 research review found that combining paracetamol and ibuprofen provides better fever relief than paracetamol alone, and may outperform ibuprofen alone in maintaining a reduced temperature over 24 hours.
What should each not be used for?
Paracetamol:
- Generally has few side effects but can be harmful in overdose.
- Liver toxicity risk increases significantly in high or prolonged doses, particularly in those with liver disease, heavy alcohol intake, or low body weight.
- Long-term use may be associated with higher risks of gastrointestinal bleeding, cardiovascular events, and renal issues.
Ibuprofen:
- Can cause stomach pain, indigestion, bleeding, ulcers, kidney impairment, high blood pressure, and allergic reactions.
- It may exacerbate asthma or heart failure, especially with prolonged use.
- Not recommended in later stages of pregnancy due to potential foetal harm.
- Should also be avoided in children with chickenpox or dehydration.
Summary
| Medication | Use Cases | Key Precautions |
| Paracetamol | Fever, mild pain (headache, cold) | Avoid overdose; watch liver risk; long-term use risks |
| Ibuprofen | Inflammatory pain, fever, cramps | Take with food; avoid in asthma, ulcers, pregnancy, dehydration |
| Combined use | When one isn’t enough (esp. children) | Stagger doses; track doses carefully |
Be painkiller safe
Both paracetamol and ibuprofen are valuable tools for pain and fever management. NHS guidelines recommend using them appropriately:
- Start with paracetamol for general pain or fever unless another choice is advised.
- Consider ibuprofen when inflammation is present, but be mindful of proper administration.
- Combining both, or alternating them, can be effective – especially in children – but always follow dosage guidelines carefully and space the doses out as advised.
If symptoms persist or you’re unsure which to use, consult your pharmacist or GP for personalised advice.
