Acetaminophen (tylenol, tempra) and ibuprofen (motrin, advil)
are among the most commonly used drugs in children, if not the most
commonly used. Despite this commonality and years of experience with
their use, questiond concrning their use still exist. Which agent
is most effective? What dose and dosing schedule should be used? Does it
matter which agent and dose are used? Is alternating one agent with the
other more effective than using one agent alone?
Parents are well aware that the main indication for use of
acetaminophen or ibuprofen, fever, is in-and-of-itself, is not
inherently concerning. The underlying cause of the fever, the overall
health of the child and the adverse effects of the fever on the
youngster are more important.
Despite the fact that medical evidence indicates that fever plays a
beneficial role in the immune response to infection, parents often view
fever as a serious concern and an indication for immediate drug therapy.
“Fever phobia” has been documented and described in the literature.
Acetaminophen has been available as fever reducing medication
for use in children for over 25 years. Ibuprofen has become available
over-the-counter (OTC) only relatively recently. Acetaminophen is
usually mentioned as the medication of choice, while ibuprofen is also
commonly recommended to be given for “high fevers,” implying it is
more “potent." Acetaminophen may often be recommended initially
perhaps because of the years of clinical experience we have with it, and
because of its proven safety profile (when given in therapeutic doses).
The use of alternating doses of acetaminophen and ibuprofen is a
common practice that has no published medical literature to support this
practice as compared with the use of acetaminophen or ibuprofen alone
The treatment of fever remains controversial. Both acetaminophen and
ibuprofen are effective fever reducing agents. They should be considered equal
in their effectiveness . The use of alternating acetaminophen with ibuprofen has
not been proven to be beneficial over the use of maximal doses of either agent
by themselves. More important, parents should understand the natural course of
fever, its meaning, and its function in fighting disease. and its
Although both acetaminophen and ibuprofen are safe when used appropriately, the
potential for serious liver damage with acetaminophen means that parents should
know the proper dose and take necessary measures for poison prevention.