Acetaminophen Does NOT Have Anti-Inflammatory Activity
Acetaminophen (paracetamol) is not considered to have clinically significant anti-inflammatory properties, making "anti-inflammatory" the correct answer to this question. 1
Core Pharmacologic Functions of Acetaminophen
Acetaminophen possesses three established pharmacologic actions:
Analgesic (pain relief): Acetaminophen is effective for mild to moderate pain through mechanisms involving the central nervous system, likely via cannabinoid receptor activation and serotonergic pathways 2, 3, 4
Antipyretic (fever reduction): The drug effectively reduces fever through central COX inhibition and thermoregulatory mechanisms 3, 5, 4
Note: "Anti-pyretic" and "fever reducer" in the question are synonymous terms, both describing the same pharmacologic function 3, 4
Why Acetaminophen Lacks Anti-Inflammatory Activity
Although acetaminophen shares some biochemical characteristics with NSAIDs, including action on the cyclooxygenase pathway, it is explicitly not considered an anti-inflammatory agent. 1
Key Distinguishing Features:
Weak peripheral COX inhibition: Acetaminophen is a weak inhibitor of both COX-1 and COX-2 in vitro, with insufficient potency to produce meaningful anti-inflammatory effects in peripheral tissues 4, 6
Central vs. peripheral action: The drug primarily acts in the central nervous system rather than at peripheral sites of inflammation 1, 2, 4
Clinical evidence: Unlike NSAIDs, acetaminophen does not reduce prostaglandin synthesis in blood platelets or stomach mucosa, and it does not provide the superior pain control seen with true anti-inflammatory agents in inflammatory conditions 1, 6
Direct Comparison with NSAIDs:
NSAIDs provide superior outcomes: In patients with arthritis and inflammatory musculoskeletal conditions, NSAIDs demonstrate superior pain control and functional outcomes compared to acetaminophen, precisely because of their anti-inflammatory properties 1
Acetaminophen occupies a unique position: It is "almost unanimously considered to have no antiinflammatory activity" and does not produce the gastrointestinal damage or cardiorenal effects associated with NSAIDs 2
Clinical Implications
When inflammation is a significant component of pain, acetaminophen alone is insufficient. 1
For low-grade inflammatory conditions, patients derive greater benefit from anti-inflammatory and analgesic combinations than from analgesics alone 1
Acetaminophen remains first-line for non-inflammatory pain states, fever, and in patients where NSAIDs are contraindicated (aspirin-sensitive asthmatics, those at risk for GI complications, elderly patients) 3
The drug's lack of anti-inflammatory activity is not a limitation but rather defines its specific clinical niche with an excellent safety profile when used appropriately 2, 3