The People's Perspective on Medicine

Don’t Mix Motrin And Tylenol In Tykes

Doubling up on pain or fever medicines like Motrin and Tylenol doesn't speed kids' recovery and may expose them to danger.
Kid child boy secret

In the middle of cold and flu season, parents are no doubt desperately searching for medications to help their sick children get better faster. Those who suspect their youngsters have the flu should be in touch immediately with their pediatricians and follow the doctor’s advice. A number of children have already died from influenza this season. However, too many households are cavalier about giving kids OTC fever reducers like Motrin and Tylenol. Here is one pediatrician’s perspective:

A Warning About Motrin and Tylenol:

Q. I am a pediatrician concerned about parents’ use of two over-the-counter medications. I often feel like a “one-woman army” trying to combat simultaneous use of acetaminophen (Tylenol) and ibuprofen (Motrin, etc) for children with fever.

Parents sometimes alternate doses as often as every two hours. Some parents are giving these medications together to bring down a fever.

Clearly, fever is a physiologic function that helps the body fight infections. I try to educate parents about this, but there seems to be an almost irrational fear of fever in our culture.

Recent case reports of kidney failure in children who had received this combination alarm me. I am very concerned that as this practice spreads, so will the incidence of kidney failure.

Fighting Fever Phobia:

A. “Fever phobia” is a concern of many pediatricians. A mild elevation in temperature is part of an immune reaction to infection. Lowering such a fever may be counterproductive.

There is no evidence that alternating acetaminophen and ibuprofen or administering both drugs together lowers fever faster or helps children recover more quickly. You are not the only pediatrician who worries that this combination may result in toxicity, such as kidney damage. In fact, nonprescription medicines including Motrin and Tylenol have been associated with pediatric poisonings (Hines, Pediatric Annals, Dec. 1, 2017).

Moreover, medication errors involving such pain relievers are still common (Eluri et al, Pain Medicine, Nov. 23, 2017). Such dosing mistakes can occasionally have tragic results.

Revised 1/29/18

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    About the Author
    Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.” .
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    I was also told by an ER Dr. to give my 4 yr. old grand daughter Tylenol and Motrin at the same time. I’m not a Dr. or Pharmacist but the idea of doing this scares me. I am giving her only Motrin as my instincts tell me taking both together does not sound safe. Motrin has worked best for her in taking down her fever.

    I am disappointed to see your unreferenced opinion on the combination of a NSAID like ibuprofen with acetaminophen or using them in an alternating fashion. No question these medications can be deadly when misused and those warnings are valid. However, you have not referenced that a combination or altering doses is not more effective. Nor have you referenced enhanced toxicity when they are used in these manners. Altering them may be less toxic because the dose of each would be reduced by perhaps 50% over the course of a day. If there are actual references, from peer reviewed sources, please provide them.

    Hi Howard, here is a study showing no advantage to the combination: https://www.ncbi.nlm.nih.gov/pubmed/24150660
    Similar findings in a more recent randomized trial: https://www.ncbi.nlm.nih.gov/pubmed/28523589
    This Cochrane style review says the evidence is inconclusive: https://www.ncbi.nlm.nih.gov/pubmed/25236310

    Dr.said rotate tylenol and ibroprofen but if they fall at same time which should i give had convoltion fever flew up 102

    I have two children- ages 6 & 7. They are healthy, active children. Occasionally they’ll bring home a bug from school or something will spike a fever (new teeth, the once in a blue moon ear infection… things come up.)

    Tylenol and Ibuprofen work Completely differently within the human body. If you will read about these medications and educate yourselves you will see that an initial dose of both Ibuprofen along with Tylenol to treat a ‘hard to break’ fever is very effective, and when used correctly there is no damage to the liver or anything else. Instead you have a child that no longer has to deal with the uncomfortable, sometimes awful side effects of a fever.

    If the combination of the two does not bring the fever down, then your child needs to see a medical professional to rule out other things.

    Every doctor I have been to, and I have been ALL over this country, has nothing negative to say about combining the two for the initial treatment and then alternating medications every so many hours for a couple of days.

    From what I am reading here in the comments, sounds like these are very ill informed individuals. If you’re unsure- Ask a reputable doctor with good reviews. Go to Babycenter, Motherhood web sites, this is a tried and true remedy.

    My child has a fever of 102.9
    She seen the doctor today and he diagnosed her with sinus infection and prescribed her with cefdinir and he said she might have a cold with it
    He said I can give e her Tylenol and Motrin which I have been giving her but she keeps vomiting and won’t keep it down
    I keep putting her in the tub with lukewarm water and that seem to help for a little while then her temperature keeps going up
    What more can I do to help or do I need to take her to the emergency room?

    I have a daughter with 2 anomalies of the heart and a feeding tube who is running a fever of 102.6 how can I break her fever when Tylenol nor ibuprofen will work tried the shower trick need another idea please.

    My son is 1 year 5 months and has a fever of 103 axillary. Advice nurse said to combine Motrin with Tylenol but I’m to fearful to do so. I’m an lvn and although I have only 2 years experience as a nurse. My motherly instinct told me not too.

    Question: As a pediatric home health nurse, I work with medically fragile patients we often alternate Motrin and Tylenol some times for extreme fevers but mostly for pain. Recently we had a nurse give both at the same time to a patient, I have to tell you this concerned all the other nurses in the home. It was done several days in a row before it was caught?
    My question is even though we as rule we are alternating the drugs and it is not given for long periods of time maybe a couple of days when needed would that and what was done by the other nurse cause serious damage? Should we have pediatrician test for both liver and kidney damage?

    I have found with my son (3 1/2yrs) that ibuprofen works better at bringing down fever. I prefer ibuprofen in myself – maybe it is body type that seems to make it more effective? When I did switch between both acetaminophen & ibuprofen for my toddler I make sure to follow the dosing instructions and to not give at the same time. If you give full doses of both at the same time you will be overdosing!

    This is completely outdated information. Quite to the contrary alternating appropriate doses of Tylenol and Motrin every 3 hours is standard of care for treatment of high fevers. Low grade temps do not need treatment as it is correct that fever is part of the immune response that helps fight infection. However high fevers need to be treated if for no other reason for comfort! Giving both together for a particularly high fever is absolutely safe and effective. -An ER NURSE

    I’m not a very smart person in this field. I am I licensed Pharmacy Tech though, this scares me that parents will go and introduce drugs to their kids. The mixing of these 2 drugs can and will hurt the child.
    I give my kids teething gel from their Dr. If, there is a discrepancy with 2 Dr’s, get a third opinion! There’s no reason why 2 Dr’s should say 2 different things. Talk to a Pharmacist, they’re the ones with degrees in the field, and are the ones who MUST know what their talking about. Dr’s determine what’s wrong, Pharmacists know what dosages and how much, how often. Thanks!

    I have a niece that is 19 mths. old, I have told the parents not to give her tylenol and motrin at the sametime, they say it is o.k. the doctor said to. They give her both meds. when she even is teething. I have told them tell I am blue in the face the grandfather of the baby is a pharmacist and they tell me he says it is ok. My son sees the same doctor i asked him and he said noway.
    What else can I do or say to them.
    CR

    My baby is now 2 years old. she has a fever of 103 for 3 days now. i was told to do tylenol and motrin every 2 hrs. i’m afraid to do so. what should i do to bring her temp down

    My daughter (16 mnths) has febrile seizures (she has had 8 or 9 all together). We have been alternating the tylenol w/ motrin b/c it is fever induced… We just received infor. from Pediatric Dr. in the emergency room.. He prescribed Motrin only and use other methods, (eg. bath, cold compresses) to bring the fever down in between dosages. Also noticed that the tylenol does not seem to bring the fevers down. They don’t necessarily have to be very high.. Normally her temp is around 101.5 when she has a seizure.

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