Is Paracetamol Anti-Inflammatory?
In contrast to other weak pain relievers like acetylsalicylic acid (aspirin) and Ibuprofen Paracetamol has practically no anti-inflammatory effect. Just like these pain relievers, paracetamol works by inhibiting an enzyme (Cyclooxygenase), the substances (Prostaglandins), which also have an inflammatory effect.
However, aspirin, for example, requires a very high dose of around 5 grams per day to have an anti-inflammatory effect, while the analgesic effect starts at a daily dose of one gram.
Paracetamol, on the other hand, hardly works in blood cells and inflammatory cells, but rather in nerve cells in the brain and spinal cord. This has an analgesic and antipyretic effect, but no anti-inflammatory effects. Incidentally, this is also the reason why paracetamol does not have a blood thinning effect, although it inhibits the same enzyme as aspirin: The blood thinning is also mediated via the cyclooxygenase in blood cells, which is not significantly influenced by paracetamol.
The dreaded side effects of aspirin and ibuprofen, stomach ulcers and gastric bleeding hardly occur with paracetamol, as the stomach cells are hardly influenced by this drug.
What other drugs are anti-inflammatory?
Examples of anti-inflammatory drugs are acetylsalicylic acid (aspirin) and Ibuprofen. These drugs also impart anti-inflammatory effects through the same mechanism that provides pain relief. However, a significantly higher dose is necessary for this, so that the potential side effects such as gastric bleeding and kidney damage speak against its use as an anti-inflammatory. 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 coxans (e.g. Celecoxib). In contrast to aspirin, coxans predominantly inhibit cyclooxygenase 2, which occurs primarily in inflammatory cells, while cyclooxygenase 1, which occurs in blood platelets and stomach cells, is barely inhibited. As a result, Coxanes achieve a relatively good anti-inflammatory effect, while side effects such as gastric bleeding occur less often.
However, some of the coxans greatly increase the risk of heart attacks and strokes, so the drugs must not be used in patients with cardiovascular diseases.
Very effective anti-inflammatory drugs are glucocorticoids (e.g. Cortisone). These work by directly inhibiting inflammatory cells and reducing the production of inflammatory hormones. However, due to their side effects, these drugs should not be given permanently, but only in the acute flare-up of inflammation.
Effective anti-inflammatory drugs that can be prescribed for chronic diseases include antibodies against inflammatory hormones (e.g. Infliximab) or Immunosuppressantsthat suppress the immune system (e.g. Methotrexate). However, the use of these drugs must be carefully considered due to the high costs and / or serious side effects.
What other effects does paracetamol have?
Antipyretic effect
Paracetamol has an antipyretic effect. The dose for adults is one gram and the maximum daily dose is four grams.
In contrast to aspirin, paracetamol can also be administered to children and pregnant women in the last trimester; it is the most commonly used antipyretic. When and how much the temperature should be lowered is controversial, so a doctor should always be consulted, especially if you have a high fever.
Particular caution is required in immune-compromised patients and patients with impaired liver function. In these cases, paracetamol should only be used to lower fever in consultation with a doctor. If paracetamol cannot be taken, ibuprofen is an alternative.
Also read our article: Paracetamol in pregnancy.
Pain relieving effect
Paracetamol can be used for mild to moderate pain. For this purpose, 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, as paracetamol can cause liver damage above this dose. Paracetamol can cause liver failure and death from as little as 7 grams.
Paracetamol can be given as a tablet, as a suppository or as an infusion. Use in children requires a dose reduction, children over 50kg may take up to 6 times 500mg, while infants between 3 and 6kg receive a maximum of 4 times 40mg. The exact dosage should be discussed with a pediatrician.
