IB or Not IB: Ibuprofen or Acetaminophen before Vaccines
As parents, we naturally want to ease any discomfort our child might experience, especially when it comes to shots. You may have heard advice to give acetaminophen (Tylenol) or ibuprofen before vaccines to prevent fever or fussiness. But here’s what current research and experts are saying:
Don’t Medicate Before the Shot
Vaccines work by helping the body produce antibodies – the white blood cells that fight off viruses and bacteria. This immune response is what creates long-term protection against illnesses.
However, giving acetaminophen or ibuprofen before a vaccine may reduce the number of antibodies the body produces, especially in children. That means your child might not get the full protection the vaccine is designed to provide.
While some studies suggest that giving Tylenol or ibuprofen beforehand might reduce side effects like fever, the benefits are unclear. Many of these children also received medication after the vaccine, so it’s hard to say if pre-dosing really helps at all.
What’s more, there's no evidence that giving medicine beforehand helps with pain from the shot itself.
What the Experts Recommend
The CDC’s Advisory Committee on Immunization Practices (ACIP) does not recommend routine use of fever reducers like Tylenol or ibuprofen before vaccines. If your child develops symptoms like fever or discomfort afterward, that’s the time to offer medication.
Try These Comfort Tips Instead
Non-medication strategies are safe and effective ways to help your child feel calmer before, during, and after vaccination:
Breastfeeding during or after the shot
Gentle cuddles and soothing voices
Distraction tools like toys, songs, or bubbles
Numbing creams (ask your provider if appropriate)
Transparency Alert!
A 2014 review took a closer look at 13 studies that originally suggested Tylenol or ibuprofen given before vaccines could reduce the body’s antibody response. Interestingly, the review pointed out that many of those studies didn’t actually report how many antibodies were produced just that there was a decrease.
So in both 2014 and again in a 2020 follow-up, researchers dug deeper. What they found was reassuring in some ways: in most cases, children still produced enough antibodies to gain full protection from the vaccine even if they had taken medication beforehand.
However, there’s a big “but”:
Some children didn’t reach protective antibody levels when given medication before their shots. And here’s the challenge: there’s no way to predict which children will have a reduced response and which won’t.
What Should Parents Do?
Because of that uncertainty, most experts, including pediatricians and organizations like the CDC, still recommend avoiding pre-vaccine medication just to be safe. If your child develops symptoms like fever, discomfort, or irritability afterward, then it’s absolutely fine to treat with Tylenol or ibuprofen at that point.
As always, open dialogue with your pediatrician (or MPF!) is encouraged. Every child is different, and your provider can help guide what’s right for yours.
References
Prymula R, Siegrist CA, Chlibek R, et al.
Lancet (London, England). 2009;374(9698):1339-50. doi:10.1016/S0140-6736(09)61208-3.
Leading Journal
A Randomized Study of Fever Prophylaxis and the Immunogenicity of Routine Pediatric Vaccinations.
Wysocki J, Center KJ, Brzostek J, et al.
Vaccine. 2017;35(15):1926-1935. doi:10.1016/j.vaccine.2017.02.035.
Das RR, Panigrahi I, Naik SS.
PloS One. 2014;9(9):e106629. doi:10.1371/journal.pone.0106629.
Rose MA, Juergens C, Schmoele-Thoma B, et al.
BMC Pediatrics. 2013;13:98. doi:10.1186/1471-2431-13-98.
MMWR. Recommendations and Reports : Morbidity and Mortality Weekly Report. Recommendations and Reports. 2011;60(2):1-64.
Leading Journal
Doedée AM, Boland GJ, Pennings JL, et al.
PloS One. 2014;9(6):e98175. doi:10.1371/journal.pone.0098175.
Saleh E, Swamy GK, Moody MA, Walter EB.
Clinical Pediatrics. 2017;56(5):435-442. doi:10.1177/0009922816675116.
Effect of Antipyretic Analgesics on Immune Responses to Vaccination.
Saleh E, Moody MA, Walter EB.
Human Vaccines & Immunotherapeutics. 2016;12(9):2391-402. doi:10.1080/21645515.2016.1183077.
Brown, Chase DO; Daly, Sarah DO, FAAFP. Do prophylactic antipyretics reduce the efficacy of vaccinations in children?. Evidence-Based Practice 23(2):p 44-46, February 2020. | DOI: 10.1097/EBP.0000000000000629
Eden, L. M., Lind, M. G., Luthy, K. E., & Macintosh, J. L. B. (2017). Best practice for prevention of vaccination common problems with antipyretic/analgesic medications. The Journal for Nurse Practitioners, 13(7), 462–467. https://doi.org/10.1016/j.nurpra.2017.05.005
Shah, Vibhuti FRCPC, MD, MSc; Taddio, Anna BScPhm, MSc, PhD; McMurtry, C. Meghan PhD, C Psych; Halperin, Scott A. MD; Noel, Melanie PhD; Pillai Riddell, Rebecca PhD, C Psych; Chambers, Christine T. PhD, RPsych HELPinKIDS Team. Pharmacological and Combined Interventions to Reduce Vaccine Injection Pain in Children and Adults: Systematic Review and Meta-Analysis. The Clinical Journal of Pain 31():p S38-S63, October 2015. | DOI: 10.1097/AJP.0000000000000281