From the Research
Acetaminophen (Tylenol) is the preferred medication over ibuprofen for managing symptoms of infectious mononucleosis (mono) due to its safer profile, particularly in relation to splenic complications. For adults, the recommended dosage is 325-650 mg every 4-6 hours as needed for fever and pain, not exceeding 3,000 mg in 24 hours, as supported by recent evidence 1. For children, dosing should be based on weight according to package instructions. The preference for acetaminophen stems from the potential of ibuprofen and other NSAIDs to increase the risk of splenic complications in mono patients, as infectious mononucleosis can cause spleen enlargement, and NSAIDs' anti-platelet effects could theoretically increase bleeding risk if splenic rupture occurs 1. Additionally, there's a small theoretical risk that NSAIDs might mask symptoms of splenic injury. While the evidence for these concerns isn't definitive, many healthcare providers recommend acetaminophen as the safer option during the acute phase of mono, particularly during the first 3-4 weeks when splenic enlargement is most common. Key considerations include:
- The risk of hepatotoxicity with acetaminophen is rare among adults who use it as directed, including those with cirrhotic liver disease 1.
- Putative epidemiologic associations of acetaminophen use with kidney or cardiovascular disease, hypertension, gastrointestinal disorders, and asthma largely reflect confounding biases and are of doubtful relevance to short-term use (<14 days) 1.
- Acetaminophen is a suitable first-line analgesic for mild to moderate acute pain in many adults with liver, kidney or cardiovascular disease, gastrointestinal disorders, asthma, and/or who are older, with no evidence supporting routine dose reduction for older people unless in specific circumstances requiring individualized dosing in consultation with a physician 1.