Aim: The aim of this study was to compare the efficacy of ibuprofen and paracetamol in fever management in patients with sepsis and septic shock and to evaluate their effects on body temperature and treatment outcomes. Materials and Methods: This randomized, parallel-controlled, double-blind study was conducted at Ankara Bilkent City Hospital. Patients aged 18 years and older diagnosed with sepsis or septic shock and presenting with a fever of ≥38.3 °C were randomly assigned to receive either intravenous ibuprofen (400 mg) or paracetamol (1 g). Body temperature was measured before treatment and at 30, 60, and 120 minutes after treatment. The primary outcomes were changes in body temperature and the proportion of patients achieving a body temperature <38.3 °C. Secondary outcomes included rates of adverse effects, complications, and comparisons of severity scores (qSOFA, NEWS2, MEWS). Results: After excluding patients with incomplete data, a total of 113 patients (64.6% female) were analyzed. Both groups demonstrated a reduction in fever at 30, 60, and 120 minutes. No significant differences were observed between the groups in demographic characteristics, clinical parameters, or severity scores (p>0.05). The most common source of infection was pulmonary, followed by urinary system infections. No significant difference in the distribution of infection sources was identified between the groups (p>0.05). Conclusion: Although a significant effect favoring ibuprofen was observed at 30 minutes, both ibuprofen and paracetamol effectively reduced fever in patients with sepsis and septic shock, with no significant difference in efficacy between the two drugs over time.