The pill that appears innocent: Almost everyone knows this moment – a headache in the middle of a workday, a fever that rises in the evening, muscle soreness after a workout, or a toothache that starts specifically on Saturday. The hand reaches for the medicine cabinet, and usually Acamol, Dexamol, Nurofen, Advil, or a similar medication are found there. These are important, effective, and very common medications, but precisely because they are so readily available, many use them as if they are devoid of risk. This is the mistake.
Acamol, whose active ingredient is paracetamol, is designed to reduce fever and alleviate pain. It is not considered a significant anti-inflammatory, and therefore fits many situations where one wishes to relieve pain or fever without noticeably affecting the stomach, kidneys, or blood clotting. This is the reason it is considered in most cases as a first line for reducing fever or mild to moderate pain, both in children and in adults, when there is no medical contraindication.
Ibuprofen, known by names such as Nurofen, Advil, and Ibufen, belongs to the family of non–steroidal anti–inflammatory drugs. It reduces pain, lowers fever, and also reduces inflammatory processes. Therefore, it can be particularly effective for menstrual cramps, muscle aches, joint pain, certain backaches, toothaches, and localized inflammations. But that same anti–inflammatory action is also the source of some of the risks: Damage to the stomach lining, an effect on the kidneys, an increase in blood pressure, and sometimes an exacerbation of cardiac risk in certain patients.
The most common mistake is not the pill itself, but the dosage. People take a pill, do not feel an immediate improvement, add another one, and then another one, or combine several preparations without realizing that they contain the same active ingredient. Paracetamol, for example, is found not only in Acamol and Dexamol, but also in many remedies for flu, colds, sore throats, and sinuses. A person can take Acamol for a headache, afterwards a sachet of powder for a cold, and then another pill at night – without realizing that in practice, they have accumulated too high a dosage of the same substance.
With paracetamol, the central danger in an overdose is liver damage. This is a point that must be understood: Paracetamol is very safe in the correct dosage, but exceeding the recommended dosage can be dangerous, and sometimes liver damage is not felt immediately. The risk is higher for those who drink alcohol in a significant amount, suffer from liver disease, suffer from malnutrition, take certain medications, or take several preparations containing paracetamol without noticing. Therefore, it is important to read the active ingredients, and not just the brand name.
With ibuprofen, the common mistake is to treat it like a completely ordinary pain reliever. In a young, healthy person, a short course at the accepted dosage is usually not problematic. But for someone who suffers from a stomach ulcer, gastrointestinal bleeding, kidney disease, heart failure, unbalanced blood pressure, active heart disease, or someone who takes blood thinners or certain medications for blood pressure – ibuprofen may be less suitable and sometimes even dangerous. Combining ibuprofen with other anti–inflammatory drugs, such as diclofenac or naproxen, also increases the risk of side effects without necessarily providing additional benefit.
One of the common questions is whether it is possible to combine Acamol and ibuprofen. In principle, these are two different medications, and occasionally doctors recommend combining or alternating between them according to need, mainly when there is pain or fever that does not respond well to a single medication. But this does not mean that it is advisable to do so automatically or for days without consultation. Combinations increase the risk of confusion in dosages, especially in children, the elderly, and people taking additional medications. When in doubt, it is preferable to choose one suitable medication, use it according to the instructions, and consult a doctor if there is no improvement.
In children, caution is even more important. The dosage of Acamol and ibuprofen in children is determined by the child's weight and not just by age. A mistake of a few milliliters in the syrup, using a household teaspoon instead of a measuring syringe, or repeated administration before the recommended time frame has passed can cause an overdose. Meanwhile, ibuprofen is not suitable for every situation: In a child who is dehydrated, vomiting, has diarrhea, with suspected kidney impairment or in certain medical conditions, one must be particularly cautious. In young infants, and with any significant fever at an early age, one must act according to the doctor's instructions and not rely solely on medication to lower fever.
Another mistake is treating pain without asking why it appeared. A pain reliever can lower fever or ease pain, but it does not diagnose the problem. An unusual and sudden headache, chest pain, sharp abdominal pain, prolonged fever, back pain with weakness in the legs, a toothache with facial swelling, pain after a significant injury, or a fever in a child who looks very ill – are not situations that are solved with another pill. The medication can obscure the clinical picture and lead to the postponement of an important examination.
The duration of use is also important. Taking a pain reliever for a day or two due to a passing pain is very different from daily use for weeks. Recurring pain that requires pain relievers time and again demands an investigation. Chronic headaches can even worsen due to the overuse of pain relievers, a condition known as medication–overuse headache. In such a situation, the person takes a pill to ease the pain, but the repeated use itself begins to sustain the cycle of pain.
In adults and the elderly, there is an additional layer of complexity. Many take regular medications for blood pressure, diabetes, blood thinning, heart failure, kidneys, chronic pain, or depression. Ibuprofen and similar medications may clash with some of the treatments or exacerbate underlying conditions. Acamol as well, despite being considered usually safer, requires caution in liver disease or with alcohol use. Therefore, in an older person, and especially in someone who takes several regular medications, it is advisable to consult a doctor or a pharmacist before repeated use.
And what about pain after a workout or backaches? Here, many take ibuprofen to "reduce inflammation", but not every muscle pain is an inflammation that needs to be suppressed. Delayed onset muscle soreness after a workout is usually a natural response to exertion, and does not always require medication. Rest, hydration, gentle heating, gradual movement, and sleep can suffice. If there is sharp pain, swelling, weakness, inability to step on the leg, fever, or pain that does not improve – it must be checked and one should not suffice with self–treatment.
Before taking a pill, it is worthwhile to stop for ten seconds and ask four questions: What is the active ingredient, how much have I already taken today, do I have an underlying medical condition or regular medications that might clash, and is this pain ordinary or different. Sometimes these answers are the difference between the correct and safe use of a medication and a mistake that everyone makes just because the pill is in the cabinet and looks familiar.
The author is a specialist in pediatrics, a sports and aviation physician, and the medical commentator for Maariv