Paracetamol, ibuprofen, aspirin or naproxen? All are sold without a prescription in pharmacies, and all relieve pain — but they work through different mechanisms, with specific risks and benefits. Here is the full comparison, with doses, contraindications and use cases.
In short — what to choose for what
- Mild-to-moderate pain, fever, children: paracetamol.
- Muscle pain, sprains, inflammation: ibuprofen / naproxen.
- Chronic joint pain: naproxen (longer-lasting).
- Migraines: ibuprofen + paracetamol combined, or high-dose aspirin.
- Cardiovascular prevention: aspirin 75-100 mg/day only on medical advice.
Paracetamol (acetaminophen)
The most widely used painkiller in the world. It acts centrally, with no anti-inflammatory effect. Excellent safety at correct doses — it is the first choice for children, pregnant women and people with gastritis or an ulcer.
Adult dosage
500-1000 mg every 4-6 hours. Maximum 4 g/day. For moderate pain, 1000 mg is more effective than 500 mg.
Children's dosage
10-15 mg/kg every 4-6 hours. Maximum 60 mg/kg/day. Forms: syrup, suppositories, tablets. Panadol is paracetamol; Nurofen does not contain paracetamol — beware of the confusion.
Risks
Liver toxicity in overdose (over 10 g in an adult). Watch out for combinations — many cold and flu syrups already contain paracetamol. Do NOT combine with alcohol.
Ibuprofen
A non-steroidal anti-inflammatory drug (NSAID). It works by inhibiting cyclooxygenase (COX-1 and COX-2). The combination of painkiller + anti-inflammatory makes it ideal for muscle pain, sprains and acute joint pain.
Adult dosage
200-400 mg every 4-6 hours. Maximum 1200 mg/day (OTC) or 2400 mg/day on medical prescription. With food — for stomach protection.
Children's dosage
5-10 mg/kg every 6-8 hours. From 3 months upwards. Nurofen syrup, Brufen, Ibalgin.
Risks
Stomach irritation (gastritis, ulcer), kidney risk with prolonged use, interference with anticoagulants, contraindicated in the 3rd trimester of pregnancy. NOT for dehydrated children (kidney risk).
Aspirin (acetylsalicylic acid)
The first NSAID in history. Painkiller + anti-inflammatory + antiplatelet agent. The latter is the reason it is prescribed for cardiovascular prevention (75-100 mg/day) in people at risk of a heart attack or stroke.
Adult dosage for pain
500-1000 mg every 4-6 hours. Maximum 4 g/day. With food.
Caution with children
Do NOT give it to children under 16 with viral infections (flu, chickenpox) — risk of Reye's syndrome, rare but potentially fatal.
Risks
Marked stomach irritation, bleeding, allergies (aspirin-induced asthma), interactions with anticoagulants.
Naproxen
An NSAID with a longer duration of action than ibuprofen — one dose lasts 8-12 hours, ideal for chronic or joint pain.
Adult dosage
220-440 mg every 8-12 hours. OTC: Aleve, Naproxen Terapia. Maximum 660 mg/day without a prescription.
Risks
Similar to ibuprofen. A somewhat better cardiovascular profile than other NSAIDs, but harsher on the stomach.
Comparison table — indicative prices
- Generic paracetamol 500 mg x 20 tablets: 3-5 RON
- Panadol 500 mg x 20 tablets: 14-17 RON
- Generic ibuprofen 400 mg x 20 tablets: 5-7 RON
- Nurofen 400 mg x 24 tablets: 15-17 RON
- Aspirin 500 mg x 20 tablets: 8-12 RON (Bayer) / 4-6 RON (generic)
- Naproxen 275 mg x 20 tablets: 15-22 RON
Check the current prices in HartaFarmacii — the Painkillers category.
Combinations that work
Paracetamol + ibuprofen alternated — 3 hours apart, one after the other (e.g. paracetamol at 8, ibuprofen at 11, paracetamol at 14). Continuous cover for severe pain or a stubborn fever.
Paracetamol + caffeine (Excedrin, Panadol Extra) — caffeine boosts the painkilling effect by 20-30%.
Ibuprofen + paracetamol in the same dose (Nuromol, ExtraStrength) — clinical studies in dental pain and headache show greater effectiveness than either component alone.
When OTC is not enough — see a doctor
- Acute, severe, persistent abdominal pain.
- A headache with high fever and a stiff neck (suspected meningitis).
- Chest pain radiating to the arm (suspected heart problem).
- Pain that does not ease with OTC medicines after 3-5 days.
- Severe post-operative pain — you need opioids/tramadol.
Important interactions
- Paracetamol + alcohol — increased liver toxicity. Avoid alcohol for 48h before/after high doses.
- Ibuprofen + anticoagulants (warfarin, apixaban) — risk of bleeding. Prefer paracetamol.
- Aspirin + ibuprofen — ibuprofen blocks the antiplatelet effect of cardiac aspirin. If you take aspirin 75-100 mg for your heart, take the aspirin 30 min before or 8h after the ibuprofen.
- NSAIDs + ACE inhibitors/sartans — a reduced antihypertensive effect, an extra kidney risk. Caution for people with hypertension who take ibuprofen daily.
- NSAIDs + lithium — they raise blood lithium levels, with a risk of toxicity.
Special cases — children, pregnant women, older people
Pregnant women: paracetamol is the first choice throughout pregnancy. Ibuprofen is allowed in the 1st-2nd trimesters and forbidden in the 3rd trimester (risk of premature closure of the ductus arteriosus in the foetus). Low-dose aspirin (75-100 mg) is recommended when there is a risk of pre-eclampsia; high doses are contraindicated.
Older people: paracetamol remains the first choice. NSAIDs raise the digestive and kidney risk. If they are necessary, combine them with stomach protection (omeprazole, pantoprazole).
Conclusion
Paracetamol is the first choice for children and pregnant women. Ibuprofen for muscle pain and acute inflammation. Naproxen for chronic pain. Aspirin rarely for pain in adults (mostly for cardiovascular protection). Do NOT combine at random — doses add up and toxicity increases. Check the doses before taking them with the HartaFarmacii search.
Frequently asked questions
- Which is safer — paracetamol or ibuprofen?
- Paracetamol is safer for the stomach and kidneys, making it the first choice for pregnant women, children and people with an ulcer. Ibuprofen is more effective for inflammation, but with more risks. Both are safe at correct doses.
- Can I combine paracetamol with ibuprofen?
- Yes, they can be given alternately 3 hours apart, which gives continuous pain relief. E.g. paracetamol at 8 AM, ibuprofen at 11 AM, paracetamol at 2 PM. Or combined formulations (Nuromol) in the same tablet.
- Why is aspirin not given to children?
- The risk of Reye's syndrome — a rare but potentially fatal hepatic encephalopathy associated with giving aspirin to children under 16 with viral infections. In children, only paracetamol or ibuprofen is used.
- How often can I safely take an OTC painkiller?
- Paracetamol: maximum 4 g/day. Ibuprofen: maximum 1200 mg/day (OTC). Occasional use — safe. Daily use for more than 2 weeks — see a doctor. Chronic pain needs investigation.
- Which painkiller is the cheapest in Romania?
- Generic paracetamol (Terapia, Labormed) is the cheapest — 3-5 RON for 20 tablets. By comparison, Panadol (brand) costs 14-17 RON for the same quantity. Check the prices on HartaFarmacii.