Idk if there’s a better comm for this, but.
Let’s say, purely for the sake of argument 
that I am currently on a super-cool prescription painkiller that works great. Let’s also say for the sake of argument that the bone/sinew structure that’s supposed to hold my ribs together is trying to kill me constantly by conspiring with the base of my skull to cause me unbearable chronic pain. If I skip more than like one day of the cool prescription painkillers, then even just walking around becomes challenging. But also, if I just keep taking the cool prescription painkillers, I’ll build up a tolerance. I’m on like 75mg a day right now and even that could be playing with fire.
I need something cool that’s gonna dummy out my pain receptors long term. What’s a good painkilling solution? I’ve tried cymbalta, taking way too much paracetamol and ibuprofen, and this cool highly addictive prescription thing. I’m game for any suggestions.
The difference in effective and toxic doses of paracetamol/acetaminophen ARE in fact huge. 3500-4000mg/day is generally considered borderline toxic for a healthy liver.
They really aren’t when compared compared to other common otc drugs. At least near me, they sell huge bottles with 500mg pills and say “take these 2 at a time every 6 hrs” (they also have a warning not to take more than 4000mg, but still, you get there pretty fast at the recommended dosage) You take them 4 times in one day instead of the recommended max of 3 and you’re in the toxicity zone.
ibuprofen has a much smaller dose, is more effective, and can be taken at the recommended dosage much longer without worrying about total daily intake coming into play.
the ratio between a toxic dose and an effective dose is more like 2:1 for acetaminophen vs like 5:1 for ibuprofen (maybe more?)
Just because the bottle tells you to take that much doesn’t mean that’s the least amount you need to be effective.
Ibuprofen has different toxicity concerns, primarily to do with kidney toxicity and dissolving the lining of your stomach. Some people need 800mg three times a day for pain relief which is more than half the recommended maximum daily dose.
Totally different drugs, but acetaminophen is safer than ibuprofen/NSAIDs full stop.
I am not basing it solely on the bottle, but I mentioned that because that’s the only info the average person is going to get.
regardless I stand by the therapeutic index being way worse for acetaminophen, and the evidence for its use as a broad spectrum painkiller very spotty. There are certainly issues with nsaids too, but there’s a reason acetaminophen is like a leading cause of liver failure
idk why I care, maybe you are right. But its not harmless like many people seem to think
Fair enough
spoiler
I do think a significant number of acetaminophen linked liver failures are due to people taking a bunch intentionally to attempt suicide, but just ending up destroying their liver.