Tylenol vs. Motrin: When Should I Give Them to My Heart Warrior?
Many parents who have children with congenital heart defects wonder when they should be giving their children acetaminophen (Tylenol) and when they should be giving ibuprofen (Advil/Motrin). Children’s Healthcare of Atlanta Cardiology pediatric cardiologist Glen Iannucci, MD, provided answers to some frequently asked questions about when to use each one.
Q: Can you explain the differences between acetaminophen and ibuprofen in terms of how they work and their effects on children’s health?
A: Both acetaminophen and ibuprofen are commonly used medications for pain and fever relief. There are a few key differences. Ibuprofen is a non-steroidal anti-inflammatory (NSAID) medication that is metabolized by the kidneys. This medicine can occasionally be associated with mild platelet dysfunction. Platelets are a cell type found in blood that helps with forming clots. As an anti-inflammatory, this can be very useful for musculoskeletal injuries with swelling.
Acetaminophen is a medication that has been used for pain and fever reduction for more than 100 years and was marketed for pediatric use beginning in the 1950s as a replacement for aspirin. The main accepted mechanism is that it acts on the central nervous system to reduce the perception of the pain. This medication is metabolized by the liver.
Q: When should parents consider using acetaminophen versus ibuprofen for managing their child’s pain or fever? Are there specific situations where one medication may be more appropriate than the other?
A: In general, both medications can be used interchangeably for fever. Some families find that their children respond more favorably to one or the other. My wife swears Motrin works best for our kids! For severe fevers, you can use both at the same time because they work by different mechanisms.
For musculoskeletal injuries such as strains and sprains, there may be an advantage to using ibuprofen due to the anti-inflammatory effects that can reduce the swelling, which is partly causing the pain. Ibuprofen also reduces production of prostaglandin, a molecule involved in menstrual cramping, which makes it the preferred medication to reduce menstrual pain. Like fever, if the pain is substantial, you can use both medications at the same time.
Q: Are there any factors or medical conditions that parents should consider before giving their child either acetaminophen or ibuprofen? How does the child’s age, weight, or medical history come into play when making this decision?
A: In general, we avoid ibuprofen in children under the age of 6 months due to immature kidneys and the theoretical risk of kidney injury. Beyond six months of age, both medications are permissible. Dosing of almost all medications in pediatrics is based upon weight. Follow the manufacturer recommendations on the bottle. In general, dosing for ibuprofen is 10mg/kg every eight hours, and acetaminophen is 15mg/kg every six hours.
Medical factors to consider:
- If there is any concern for liver dysfunction, ibuprofen is a better choice.
- If there is any concern for kidney dysfunction or increased risk of bleeding (for example, a patient who is on blood thinners), acetaminophen is a better choice.
When in doubt, ask your physician!
Q: Are there potential risks or side effects associated with using acetaminophen or ibuprofen in children, especially for those with heart conditions or undergoing cardiac treatment?
A: Tylenol can be dangerous or even life-threatening in overdose. It should always be kept on a high shelf and out of reach of children, which is true of all medications. For patients on blood thinners due to their cardiac disease, Tylenol is a better choice.
Q: How do acetaminophen and ibuprofen interact with other medications that children with heart conditions may be taking? Are there any potential drug interactions that parents should be aware of?
A: As noted above, ibuprofen is metabolized by the kidneys, and some of the other medications that our patients may be taking (ie diuretics like Lasix or ace inhibitors like lisinopril) can also be hard on the kidneys. For patients on these therapies, it’s important to maintain good hydration to reduce this risk. Tylenol is preferred for those who are already on blood thinners, as ibuprofen can negatively affect platelet function.
Q: In what situations should parents contact their child’s physician before giving them Tylenol or Motrin? Are there any warning signs or symptoms that may indicate a need for medical attention?
A: If the patient has a history of kidney or liver disease it’s important to discuss these medications with their physician. Warning signs indicating a need for medical attention are alteration in consciousness, neck pain, persistent vomiting, trouble breathing, or other concerns for progressive dehydration (this is not an exhaustive list). If a child who is receiving ibuprofen has dark, tea-colored urine, they should be evaluated. Additionally, if you find that you are having to use either of these medications around the clock for pain or fever control for more than a couple of days, it’s worth checking in with your child’s physician.
Q: How does the use of acetaminophen or ibuprofen align with overall cardiac health and treatment plans for children with heart conditions? Are there any considerations specific to this patient population?
A: Tylenol and Motrin are commonly used treatments in children both with and without heart conditions. They are useful for the management of both fever and pain in those with heart disease.
Q: As a pediatric cardiologist, what advice would you give to parents regarding the safe and appropriate use of over-the-counter pain relievers like Tylenol and Motrin for their children?
A: Follow the dosing instructions on the label. You should not exceed the recommended dose of Tylenol, as this could cause permanent liver injury. If you ever have questions or are uncertain, feel free to contact your child’s healthcare team – it’s what we’re here for!
