Aspirin vs. Tylenol (acetaminophen): What’s the difference?
- Aspirin and Tylenol (acetaminophen) are used to treat fever, and pain in the body.
- Aspirin is also used to prevent blood clots (antithrombotic).
- Aspirin and Tylenol belong to different drug classes. Aspirin is a nonsteroidal anti-inflammatory drug (NSAID) and Tylenol is an analgesic (pain reliever) and antipyretic (fever reducer).
- Brand names for aspirin include Bayer Aspirin, Ecotrin, and E.C. Prin.
- Aspirin and Tylenol are available over-the-counter (OTC) and as generics.
- Side effects of aspirin and Tylenol that are similar include rash, nausea, and liver toxicity.
- Side effects of aspirin that are different from Tylenol include abdominal pain, abdominal burning, cramping, gastritis, stomach ulcers, ringing in the ears, dizziness, serious gastrointestinal bleeding, kidney impairment, and spinning sensation (vertigo).
- Side effects of Tylenol that are different from aspirin include headache.
What is Aspirin? What is Tylenol (acetaminophen)?
Aspirin is a nonsteroidal anti-inflammatory drug (NSAID) used to treat fever, pain, and inflammation in the body. Aspirin is also used prevent blood clots (as an antithrombotic). Other NSAIDs include ibuprofen (Motrin), indomethacin (Indocin), and nabumetone (Relafen). NSAIDs work to reduce levels of prostaglandins, chemicals that are released when inflammation is present that cause pain and fever. NSAIDs block a certain enzyme that makes prostaglandins (cyclooxygenase), resulting lower concentrations of prostaglandins and reducing inflammation, pain, and fever. Inhibition of prostaglandins also decreases the function of platelets and the blood’s clotting ability. Because aspirin inhibits the function of platelets for prolonged periods of time, it is also used to lower the risk of another stroke or heart attack in people who have had a prior stroke or heart attack.
Tylenol (acetaminophen) is an analgesic (pain reliever) and antipyretic (fever reducer). The exact mechanism of action of acetaminophen is unknown. It may reduce the production of prostaglandins, which are chemicals that cause inflammation and swelling. Acetaminophen relieves pain by elevating the pain threshold, that is, by requiring a greater amount of pain to develop before a person feels it. It reduces fever through its action on the heat-regulating center of the brain. Specifically, it tells the center to lower the body's temperature when the temperature is elevated.
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What are the side effects of aspirin and Tylenol?
Aspirin
Most patients benefit from aspirin and other NSAIDs with few side effects. However, serious side effects can occur and generally tend to be dose-related. Therefore, it is advisable to use the lowest effective dose to minimize side effects.
The most common side effects of aspirin involve the gastrointestinal system and ringing in the ears.
Gastrointestinal side effects are
- ulcerations,
- abdominal burning,
- pain,
- cramping,
- nausea,
- gastritis, and
- even serious gastrointestinal bleeding and
- liver toxicity.
Sometimes, ulceration and bleeding can occur without any abdominal pain. Black tarry stools, weakness, and dizziness upon standing may be the only signs of internal bleeding.
Ringing in the ears
- Should ringing in the ears occur, the daily dose should be reduced.
Other side effects include:
Other side effects and adverse reactions
- Aspirin should be avoided by patients with peptic ulcer disease or poor kidney function, since this medication can aggravate both conditions.
- Aspirin may exacerbate asthma.
- Aspirin can raise the blood uric acid level and is avoided in patients with hyperuricemia and gout.
- Children and teenagers should avoid aspirin for symptoms of the flu or chickenpox because of the associated risk of Reye's Syndrome, a serious disease of the liver and nervous system that can lead to coma and death.
- Aspirin can increase the effect of medicines used to treat diabetes mellitus, resulting in abnormally low blood sugars if blood sugar levels are not monitored.
- NSAIDs should be discontinued prior to elective surgery because of a mild tendency to interfere with blood clotting. Aspirin, because of its prolonged effect on platelets, is best discontinued at least ten to fourteen days in advance of the procedure.
Tylenol
When used appropriately, side effects with acetaminophen are not common.
The most common side effects are rash, nausea, and headache.
Other important side effects include:
- Hypersensitivity reactions
- Serious skin reactions
- Kidney damage
- Anemia
- Reduced number of platelets in the blood (thrombocytopenia)
Chronic alcohol use may also increase the risk of stomach bleeding. The most serious side effect is liver damage due to large doses, chronic use or concomitant use with alcohol or other drugs that also damage the liver.
Other serious side effects that have been reported include bleeding in the intestines and stomach, angioedema, Stevens-Johnson syndrome, and kidney damage. A reduction in the number of white blood cells has also been reported.
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What is the dosage of aspirin vs. Tylenol?
Aspirin
Aspirin should be taken with food. Doses range from 50 mg to 6000 mg daily depending on the use.
- Usual doses for mild to moderate pain are 350 or 650 mg every 4 hours or 500 mg every 6 hours.
- Doses for rheumatoid arthritis include 500 mg every 4-6 hours; 650 mg every 4 hours; 1000 mg every 4-6 hours; 1950 mg twice daily.
- Heart attacks are prevented with 75, 81, 162 or 325 mg daily.
- 160 to 325 mg of non-enteric coated aspirin should be chewed immediately when experiencing symptoms of a heart attack.
- The dose for preventing another stroke is 75 to 100 mg daily.
Tylenol
- The dose for adults is 325 to 650 mg every 4 hours or 500 mg every 8 hours when using immediate release formulations.
- The dose for extended release caplet is 1300 mg every 8 hours.
- The maximum daily dose is 4 grams.
- The oral dose for a child is based on the child's age and weight. If less than 12 years of age, the dosing is 10-15 mg/kg every 6-8 hours not to exceed 2.6 g/day (5 doses).
- If older than 12 years of age the dose is 40-60 mg/kg/day every 6 hours not to exceed 3.75 g/day (5 doses).
What drugs interact with aspirin and Tylenol?
Aspirin
Aspirin is associated with several suspected or probable interactions that affect the action of other drugs. The following examples are the most common of the suspected interactions.
NSAIDs may increase the blood levels of lithium (Eskalith, Lithobid) by reducing the excretion of lithium by the kidneys. Increased levels of lithium may lead to lithium toxicity.
Aspirin may reduce the blood pressure lowering effects of blood pressure medications. This may occur because prostaglandins have a role in the regulation of blood pressure.
When aspirin is used in combination with methotrexate (Rheumatrex, Trexall) or aminoglycoside antibiotics (for example, gentamicin) the blood levels of the methotrexate or aminoglycoside may increase, presumably because their elimination from the body is reduced. This may lead to more methotrexate or aminoglycoside-related side effects.
Individuals taking oral blood thinners or anticoagulants, for example, warfarin, (Coumadin) should avoid aspirin because aspirin also thins the blood, and excessive blood thinning may lead to serious bleeding.
Tylenol
Acetaminophen is metabolized (eliminated by conversion to other chemicals) by the liver. Therefore drugs that increase the action of liver enzymes that metabolize acetaminophen, [for example, carbamazepine (Tegretol), isoniazid, rifampin (Rifamate, Rifadin, and Rimactane),] reduce the levels of acetaminophen and may decrease the effectiveness action of acetaminophen.
Doses of acetaminophen greater than the recommended doses are toxic to the liver and may result in severe liver damage. The potential for acetaminophen to harm the liver is increased when it is combined with alcohol or drugs that also harm the liver.
Cholestyramine (Questran) reduces the effect of acetaminophen by decreasing its absorption into the body from the intestine. Therefore, acetaminophen should be administered 3 to 4 hours after cholestyramine or one hour before cholestyramine .
Acetaminophen doses greater than 2275 mg per day may increase the blood thinning effect of warfarin (Coumadin, Jantoven) by an unknown mechanism. Therefore, prolonged administration or large doses of acetaminophen should be avoided during warfarin therapy.
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Are aspirin and Tylenol safe to use while pregnant and breastfeeding?
Aspirin
Aspirin is generally avoided during pregnancy because it may adversely effect the fetus. However, low aspirin doses have been safely used for the prevention of complications of pregnancy.
Aspirin is excreted into breast milk and may cause adverse effects in the infant.
Tylenol
Acetaminophen is excreted in breast milk in small quantities. However, acetaminophen use by the nursing mother appears to be safe