Alternating Medicines to Treat Fever in Children 6 Months and Up

Health officials across the United States are responding to an outbreak of respiratory disease caused by a new coronavirus. For the latest on the situation and steps you can take to prevent illness, visit the following resources:

• CDC: Coronavirus Disease 2019
• National Alliance for Hispanic Health: COVID-19 – What You Need to Know (in English & Spanish)
• American Academy of Pediatrics: How to Protect Your Family from the Coronavirus
• AARP: What Older Adults Need to Know About the Coronavirus

Tricia Jean (TJ) Gold, M. D.

• If your child needs a fever reducer, it is best to choose one type of medicine: either acetaminophen (Children’s Tylenol) or ibuprofen (Children’s Motrin, Children’s Advil).
• Always consult your doctor first if you are considering alternating between acetaminophen and ibuprofen to treat a stubborn fever.
• If your doctor does recommend alternating, write down on a piece of paper the dosage of each medicine used and the exact time it was given in order to avoid an accidental overdose.

Click here for additional important safety tips.

A child with a fever can be worrisome for any parent. But contrary to what many believe, a fever doesn’t always need to be treated. One of the most common questions I get asked by parents is when to treat a fever and how. This can be difficult and depends on several factors, including the severity of the fever, the level of discomfort your child is experiencing and your child’s response to certain medicines.

When a fever does need to be treated, some parents will ask me about alternating between acetaminophen (Tylenol) and ibuprofen (Motrin, Advil) as a way to treat their child’s fever. In certain situations—not all—a child may benefit from alternating medicines to reduce their discomfort. In all cases, if you are considering using this method to treat your child’s fever, always consult your doctor first.

While some pediatricians may recommend this, no clinical evidence exists to suggest that this method is more effective than using just one type of medicine to treat a fever. In general, if your child does need a fever reducer, it is best to choose one type, either acetaminophen or ibuprofen. If the fever reducer you choose doesn’t seem to work, consult your doctor.

If your doctor does recommend alternating, it’s important to note that this approach allows you to give medication to your child more frequently (up to every three hours as opposed to every six hours with a single type of medicine). This creates an easy opportunity for overdose that parents need to take steps to prevent. Though it’s rare, when I do suggest this approach for alternating, I always stress that parents write down on a piece of paper the dosage of each medicine used and the exact time it was given in order to avoid an accidental overdose. This is very important because when you have a sick child who is up at 3 a.m. and you’re exhausted, it can be very easy to lose track of time and proper dosing intervals.

So when might this method be beneficial, and when would it not? Consider the following scenario:

A parent gave his child ibuprofen (Motrin) at 10 p.m., before putting him to bed, to treat a fever. At midnight, the father went to check on his child. The fever was still there—101° F—but the child was sleeping comfortably. The father called me asking what he should do. Because the child was sleeping soundly, my advice was to not give him additional medication. Let him rest. His next dose of ibuprofen (Motrin) could be given at 4 a. m., if he needs it.

Seems straightforward enough. So when might it be beneficial to alternate medicines? Consider this example:

Recently, a mother brought her child into my office with a fever of 105° F, who was having a febrile seizure. It can be challenging to examine children under these circumstances to determine the cause of the fever and if more urgent medical attention might be required. First I gave the child Motrin, but after more than an hour, his temperature hadn’t changed. Rather than wait another five hours to give him a second dose of ibuprofen (Motrin), I gave him acetaminophen (Tylenol) in hopes of controlling his symptoms. Within two hours, the child’s fever was down to 100.7° F. He was finally lucid and I was able to examine him in the office. After another hour, he was able to go home. In this instance, alternating this child’s dosing might have been a key element to controlling his specific symptoms enough so that he did not require a visit to the ER.

This method of treatment, however, is not a typical practice and is often not recommended by pediatricians because of the risk of an accidental overdose. But as you can see in the second example, there are very specific circumstances in which it might be useful.

After speaking with your pediatrician, if you decide that alternating medicines is the best method to treat your child’s fever, it’s absolutely vital that you maintain six hours in between the use of the same medicine, while alternating between medicines every three to four hours. For example, if you give your child acetaminophen (Tylenol) at noon, you can give him ibuprofen (Motrin) at 3 p.m. and then acetaminophen (Tylenol) again at 6 p.m. and ibuprofen (Motrin) again at 9 p.m. Neither medicine should be used for more than 24 hours without consulting a physician.

No matter how you and your doctor decide to approach treating your child’s fever, keep in mind these other important safety tips:

• Most physicians recommend only treating a fever with medicines if the fever is above 102° F.
• Talk to your doctor before giving a pain reliever or fever reducer containing ibuprofen if your baby is younger than 6 months.
• Talk to your doctor before giving acetaminophen to a child younger than 2 years to obtain the proper dosing instructions.
• Temperature in infants can be most accurately measured using a digital rectal thermometer.
• Before giving your child any medicines, make sure you know your child’s weight. Dosing is based on weight, not age.
• Make sure to read the package label very carefully for proper dosing.
• Acetaminophen is most commonly administered at a dose of 10 mg/kg to 15 mg/kg every four hours, whereas ibuprofen is usually administered at a dose of 10 mg/kg every six hours, so the pattern of alternating these two medicines may not be apparent to some.
• Always use the measuring device that comes with the medicine. Do not mix and match dosing devices.
• Don’t give aspirin to anyone under 12 years of age unless instructed by your doctor.
• Call your doctor if your child’s fever is not responding to treatment or lasts longer than one day.

Tricia Jean (TJ) Gold, M.D.

Dr. TJ Gold is a pediatrician in private practice at Tribeca Pediatrics in New York City, NY. As a pediatrician and a mother, she has devoted her life to keeping children safe and healthy.

Is it possible to combine paracetamol and ibuprofen at the same time?

Can paracetamol and ibuprofen be combined and will these drugs work better together? Or can the combined use of these drugs cause side effects and they cannot be combined? Let's find out why you need to use paracetamol and ibuprofen at the same time and how safe it is for health.

In this article, we will tell you if you can drink ibuprofen with paracetamol for colds and pain, and also explain what are their similarities and differences.

Let's start with a detailed review of the main properties of these drugs and find out: ibuprofen and paracetamol are the same or not.

Paracetamol: main properties and application features

Paracetamol is an analgesic and antipyretic agent. It is used to treat various kinds of pain: headache, muscle, dental, menstrual, back pain, joint pain, and arthritis. However, the main property of paracetamol is considered to be the relief of symptoms of fever (decrease in body temperature), as well as a decrease in pain and discomfort during colds and flu.

Advantages of paracetamol:

• its maximum concentration in the body is reached already 30-60 minutes after ingestion;
• this drug is not addictive;
• paracetamol effectively relieves pain localized in various parts of the body;
• this drug reduces fever, both that occurs with ARVI and influenza, and due to other diseases accompanied by an inflammatory process;
• it can be used by children and adults and is safer than ibuprofen for the elderly;
• This drug can be taken with many other cold medicines, as long as they are not combination medicines that also contain paracetamol;
• is available in several dosage forms, namely: solid and effervescent tablets, capsules, syrups, suspensions, rectal suppositories, injection solutions.

Disadvantages of paracetamol:

• the duration of action of the drug is shorter than that of ibuprofen and is about 4 hours;
• although paracetamol relieves pain of mild to moderate intensity in arthritis, it does not reduce inflammation and swelling of the joints;
• this drug does not affect inflammatory processes in the body;
• the drug is hepatotoxic (toxic to the liver), so its overdose can lead to impaired liver function;
• Improper use of paracetamol (off-label or in high dosage) may cause side effects, including nausea, vomiting, stool disturbance, breathing difficulties, insomnia, nervous overexcitation, skin reactions, headache.

Paracetamol is not recommended to be taken more than once every 4-6 hours, and its maximum daily dosage is 4000 mg (4 g). Before taking paracetamol, you should consult your doctor.

Attention! Read carefully the instructions for paracetamol and all the medicines that you take with it, because many combination cold remedies may also include paracetamol.

Such medicines include:

• Citramon;
• Coldrex;
• Theraflu;
• Combiflu;
• Amicitron;
• Solpadeine;
• Combispasm;
• Pharmacitron.

This is not a complete list, so be sure to pay attention to the instructions for the active ingredients of the drug. An overdose of paracetamol can lead to liver damage and liver failure!

Please note that the use of paracetamol and ibuprofen together can lead to a double burden on the liver. Also avoid :

• while taking these two drugs if you are allergic to paracetamol or ibuprofen;
• consumption of alcoholic beverages, as this may increase the risk of liver damage and liver failure. People who suffer from alcoholism or have cirrhosis of the liver should consult a doctor before taking these drugs;
• taking another NSAID (non-steroidal anti-inflammatory drug) because it increases the risk of side effects;
• taking other medicines containing paracetamol, because an overdose is possible, and this is fraught with impaired liver function;
• the use of paracetamol and ibuprofen in people with stomach ulcers and internal bleeding;
• taking a combination of these two drugs if you have bronchial asthma - this can lead to negative consequences;
• simultaneous use of paracetamol and ibuprofen during pregnancy and lactation without a doctor's prescription;
• taking ibuprofen with paracetamol if you have had a previous heart attack or stroke, cardiovascular surgery, or if you have chronic heart failure, coronary artery disease, or peripheral arterial disease.

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How to take paracetamol and ibuprofen correctly: at the same time or they need to be alternated

Of course, it is not recommended to drink ibuprofen and paracetamol together at the first occurrence of pain. They can only be combined if you have a high body temperature or pain for a long time.

Combining paracetamol with ibuprofen means that you first need to take a tablet of paracetamol in the dosage prescribed by the doctor or indicated in the instructions. Then, 6 hours later, take an ibuprofen tablet at your prescribed dosage.

You can take paracetamol and ibuprofen at the same time for no more than 3 days. In no case should you drink two tablets of these drugs at one time.

The use of paracetamol and ibuprofen not according to the above rules can lead to hepatotoxicity (toxicity to the liver, leading to its structural and functional disorders) and other side effects.

Side effects of from improper concomitant use of paracetamol and ibuprofen may include:

• nausea and vomiting;
• bloating, diarrhea or constipation;
• itching or rash;
• liver injury and liver failure;
• shortness of breath, shortness of breath;
• headache or stomach pain.

In individual cases, this list can be quite extensive, so it is best to ask your doctor for advice.

Attention! Paracetamol and ibuprofen should only be given to children if prescribed by a doctor and only in the form and doses indicated on the prescription.

Paracetamol and ibuprofen should be stored according to the instructions and out of the reach of children, and the drugs should be used only as directed.

Before combining these drugs, consult your doctor regarding individual tolerance, dosages, timing and duration of administration. Be healthy and do not self-medicate, as this can be harmful to your health.

Have you already packed your autumn first aid kit? If not, then we suggest you read a new article from which you can find out what to put in your first aid kit .

We also reveal the big secret of online pharmacies and not only them, namely, we tell what generic drugs are and why they are cheaper .

apteka24.ua is the first online pharmacy you can trust.

Sources

Paracetamol: not as safe as we thought? A systematic literature review of observational studies / Bmj.com

Non-steroidal anti-inflammatory drugs (NSAIDs): Making safer treatment choices / Bpac.org.nz

OARSI recommendations for the treatment of osteoarthritis of the hip and knee osteoarthritic / Oarsijournal.com

Disclaimer diagnosis and choice of treatment methods can only be carried out by your doctor! Self-medication may not be safe for your health. apteka24.ua is not responsible for possible negative consequences resulting from the use of information posted on the site by users of apteka24.ua.

How to properly bring down a child's temperature and why an ambulance should not be called

Parents often ask how to deal with a high temperature. Fedor Katasonov, a pediatrician at the GMS clinic and host of the popular Fediatry Telegram channel, wrote a detailed text on what to do if a child has a fever.

I hate to repeat what other respected doctors have already written so many times, but the principle of writing posts for Fediatry is simple: I answer a request. If the number of identical questions (gaps in the knowledge of parents) exceeds a critical mass, this gives rise to a post. Therefore, a post about fever reduction. Pardon his banality. Please save it somewhere and remember next time before asking me one of these questions.

How to measure temperature?

I prefer a contact electronic thermometer, which is placed under the arm. After he squeaks, he must be held for another three or four minutes, but few people know about this, because they do not read the instructions. After that, the readings will be approximately equal to those on the standard - a mercury thermometer. I do not recommend non-contact thermometers and measurements in the mouth and in the anus.

Which thermometer to choose for a baby? We tell you how to measure the temperature even in a dream

Why measure temperature?

The measurement is primarily of diagnostic value. We have a slightly different approach to conditions where the temperature is above or below the conditional limit of 38 degrees Celsius. Since most fevers in our latitudes resolve on their own within three days, in the absence of threatening symptoms, I recommend observation within 72 hours after the first rise in temperature above 38.

whether this is a protracted virus (and we continue to observe) or more aggressive intervention is required. Thus, we measure temperature to determine treatment tactics, but not to resolve the issue of fever reduction.

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How do you decide if you need to lower the temperature?

The answer is simple, regardless of the reason for the temperature. It does not matter if it is associated with an infection or a post-vaccination reaction or teething or other reasons.

We lower the temperature when the child is sick.

There is nothing so useful in a rise in temperature that it is tolerated, and nothing so harmful that one should take medicines when one feels normal. Therefore, when solving the issue of fever reduction, we look not at the thermometer, but at the child. If he is unwell, he is breathing heavily, lethargic, his muscles or his head hurt - you even lower 37.8. But if you can't catch up with a child from 38.8 to pour medicine into him, then there is no need for him.

ARVI 6-8 times a year is normal: why preschool children often get sick

How to lower the temperature?

Since only parents of small children ask this question, I will not write about drugs for older children. Toddlers have only three home remedies to lower their temperature: the physical method, paracetamol (acetaminophen), and ibuprofen.

If the child's hands and feet are warm, undress him, hang him with wet towels, rub him with room temperature water, wrap his head in a wet handkerchief, or even put him in a cool shower. To give or not to give at the same time the medicine is your choice, you have the right to give and wait. (You can also give the medicine and not use the physical method.) Depends on the level of your panic and the child's behavior. Small children cool down perfectly on their own, sometimes it’s enough just to free them from their clothes.

If the hands and feet are cold - vasospasm has begun - the physical method is not recommended, and only medicines remain.

Which formulation should I use?

It's not very important. Syrups with paracetamol (Panadol, Calpol, Tylenol, etc. ) or ibuprofen (Nurofen, Advil) are easier to dose. Suppositories (Panadol, Efferalgan, Cefecon with paracetamol or Nurofen with ibuprofen) are good when the child cannot drink syrup (vomiting, allergic to additives). It seems to me that it is enough to have paracetamol suppositories at home for low temperatures (up to 39) and Nurofen syrup for more pronounced fevers.

How to dose them?

The easiest way to dose Nurofen: syrup dose (ml) = ½ weight (kg). This is based on a single dose of 10 mg/kg. On the box of Nurofen, however, some nonsense is written about the dosage by age. This is dangerous because children of the same age weigh very differently.

Properly dose drugs by weight or body surface area, not by age.

This single dose of Nurofen can be given no more than once every four hours, but preferably no more than three times a day. Paracetamol is dosed at 15 mg/kg, but the instructions for paracetamol preparations are more adequate than for Nurofen. It is quite possible to navigate them. If you dose the most common syrup - Panadol - you can multiply the child's weight in kilograms by 0.625. This will give you the number of milliliters of syrup for a single dose. Intervals and multiplicity are the same as for Nurofen.

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What to do if an hour has passed and the temperature does not drop?

First, assess how you feel. If it has improved, the numbers are not important to us. Secondly, even if the temperature has not dropped, the spasm must have gone away, and a physical cooling method can be connected. Thirdly, if the need for antipyretics still remains, one and a half to two hours after the first, you can give a second drug, for example, Nurofen after Panadol. However, an adequate dose of Nurofen reduces the temperature almost always.

When should I call an ambulance?

You don't need to call an ambulance.

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