Myth #8: Tylenol is better than Motrin for fever reduction…
This is part 8 of a 10-part series where I will be busting what I consider to be the top 10 myths involving pediatric fever.
To start our topic of different antipyretics, let’s first look at how dosage instructions are presented to the public
Yin HS, et al., 20101
- This study is absolutely astonishing
- They evaluated 200 pediatric liquid over the counter medications making up 99% of available meds on the market and made 5 very interesting observations.
- 148 had measuring devices
- 146 had inconsistencies on their measuring devices.
- Nearly 25% had missing markings
- Over 80% had superfluous markings
- And nearly 6% had atypical units of measurement
Here is an example. There are dosing recommendations on the package in tablespoons and on the packaged measuring cup…they list teaspoons.
Another example. Dosing on the package is in teaspoons. However, on the cup, they list ounces, cc’s, mL and tablespoons. Pretty much everything BUT teaspoons.
Third example. Markings on measuring device isn’t even listed in the dosing directions.
So, which antipyretic is best?
Kauffman RE, et al., 19922
- Study of 37 febrile children ages 2-12 years old
- Looked at Tylenol vs Motrin vs Placebo
- They found that Motrin had greater fever decrement and lasted longer than Tylenol
- No adverse effects in any group
Perrott DA, et al., 20043
- Meta-analysis of 17 studies published in the Archive of Pediatric Adolescent Medicine
- All patients were less than 18 years of age
- Motrin had better fever decrement compared to Tylenol
- Motrin and Tylenol were equal in regards to pain and safety
Walson PD, et al., 19894
- 127 febrile children, each given a sing dose of antipyretic
- They either received 5 mg/kg of Motrin, 10 mg/kg of Motrin or 10 mg/kg of Tylenol
- Motrin won AGAIN with better fever control
- Again, safety was equal between the two with no significant lab abnormalities.
Pierce CA, 20105
- Meta-analysis of 85 studies of children and adults.
- 35 had antipyretic data and 66 had safety data
- Equal pain and fever control with Tylenol vs Motrin as well as an equal safety profile.
How about combining doses of Tylenol and Motrin?
Purssell E, 20116
- This 2011 systematic review of 7 studies published in the Archive of Disease of Children did just that.
- They found a limited benefit to combined Tylenol and Motrin for fever in the first 4 hours and marginal benefit for fever after 4 hours
- There was marginal benefit for pain
- And no evidence of toxicities and no evidence of greater side effects
Vyas FI, et al., 20147
- They looked at a dosing 15 mg/kg Tylenol alone (the blue line) vs 10 mg/kg Motrin alone (the red line) vs combination Tylenol plus Motrin (green line)
- Measured hourly percent reduction of fever
- Mean reduction at 4 hours was pretty equal in all groups
How about alternating antipyretics?
Kramer LC, 20088
- 38 outpatient visits of children age 6 mo – 6 yrs
- Given Tylenol alone vs alternating Tylenol and Motrin
- Mean temps were checked at 0, 3, 4, 5 and 6 hours
- There was a significant decrease in fever at hour 4-5 in the alternating group
- However, and this is probably the most important aspect of this study…PARENTS DID NOT PERCEIVE A DIFFERENCE IN EFFICACY.
Nabulsi MM, et al,. 20069
- 70 febrile children
- Motrin alone vs alternating with Tylenol at 4 hours
- The alternating regimen had a nearly 1 C further reduction in fever after 8 hours
Paul IM, et al,. 201010
- 60 febrile episodes in children
- Assessed Motrin alone (top line on chart) vs Motrin combined with Tylenol (middle line) vs Motrin alternating with Tylenol (bottom line)
- Temperatures were measured hourly for 6 hours
- They found that the alternating doses showed greatest reduction of fever at 6 hours
Sarrell EM, 200611
- 464 febrile children ages 6 – 36 months
- They looked at Tylenol alone vs Motrin alone vs Alternating doses
- Primary data included fever reduction and was favored in thee alternating regimen.
- Secondary data also included fever reduction, but also fever recurrence, days absent from daycare, visits to the Emergency Department and all favored an alternating regimen
- It is also important to point out…that there was no difference in renal or liver screening labs between the groups.
Ok, quick side note….what about tepid sponging for fever control?
Thomas S, et al,. 200912
- This 2009 study of 150 children age 6 mo – 12 yr with fever of 101 looked at Tylenol alone vs Tylenol with Tepid Sponging for fever reduction
- Tepid sponging had a more rapid reduction at 15 minutes and caused more discomfort than Tylenol
- However, there was no change in fever reduction at 2 hours
Let’s summarize the evidence…
- I think Motrin actually wins for better fever control based on the evidence
- Motrin should not be used in children less than 6 months of age
- Both are pretty equal in regard to pain and safety
- Combined Tylenol and Motrin is safe and may decrease dosing mistakes at home. However, fever reduction was pretty similar to solo therapy with slightly better pain control
- Alternating antipyretics do seem to have better fever reduction with equal safety, but parents don’t really seem to notice much of a benefit in their child.
- Tepid baths cause a rapid reduction in fever with more discomfort. If literature suggests a rapid decrease in fever could play a factor in febrile seizures, I would use caution with this technique.
So, for our eighth myth questioning if Tylenol is better than Motrin for fever reduction…I would consider this one BUSTED!
References
- Yin HS, Wolf MS, et al. (2010). Evaluation of consistency in dosing directions and measuring devices for pediatric nonprescription liquid medications. JAMA. 304(23):2595-602
- Kauffman RE, et al., (1992). Antipyretic efficacy of ibuprofen vs acetaminophen. Am J Dis Child. 146(5):622-5
- Perrott DA, Piira T, et al., 2004. Efficacy and safety of acetaminophen vs ibuprofen for treating children’s pain or fever: meta-analysis. Arch Pediatr Adolesc Med. 158(6):521-6
- Walson PD, Galletta G, et al., 1989. Ibuprofen, acetaminophen, and placebo treatment of febrile children. Clin Pharmacol Ther. 46(1):9-17
- Pierce CA, Voss B, 2010. Efficacy and safety of ibuprofen and acetaminophen in children and adults: a meta-analysis and qualitative review. 44(3):489-506. doi: 10.1345/aph.1M332
- Purssell E. 2011. Systematic review of studies comparing combined treatment with paracetamol and ibuprofen, with either drug alone. Arc Dis Child. 96(12):1175-9
- Vyas FI, et al., 2014. Randomized comparative trial of efficacy of paracetamol, ibuprofen and parcetamol-ibuprofen combination for treatment of febrile children. Perspect Clin Res. 2014 Jan;5(1):25-31. doi: 10.4103/2229-3485.124567.
- Kramer LC, Richards PA,. 2008. Alternating antipyretics: antipyretic efficacy of acetaminophen versus acetaminophen alternated with ibuprofen in children. Clin Pediatr (Phila). 47(9):907-11
- Nabulsi MM, Tamim H, et al,. 2006. Alternating ibuprofen and acetaminophen in the treatment of febrile children: a pilot study. BMC Med. 2006 Mar 4;4:4
- Paul IM, Sturgis SA, et al,. 2010. Efficacy of standard doses of ibuprofen alone, alternating, and combined with acetaminophen for the treatment of febrile children. Clin Ther. 32(14):2433-40
- Sarrell EM, Wielunsky E, et al,. 2006. Antipyretic treatment in young children with fever: acetaminophen, ibuprofen, or both in a randomized, double-blind study. Arch Pediatr adolesc Med. 160(2):197-202
- Thomas S, Vjaykumar C, et al,. 2009. Comparative effectiveness of tepid sponging and antipyretic drug versus only antipyretic drug in the management of fever among children: a randomized controlled trial. Indian Pediatr. 46(2):133-6
Emergency Physician at Lake Michigan Emergency Specialists - Core faculty member at West Michigan EM Residency - Michigan State University COM Clinical Faculty - Founder of Banana Bag Blog
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