Acetaminophen vs. ibuprofen: Which one to take when?

Navigating Healthcare

by Laura Salazar, MD

Sep 15, 2022

It’s not always easy knowing what to do when you or a loved one isn’t feeling well. While it’s always a good idea to consult your doctor about any over-the-counter (OTC) medications you’re considering taking, many people commonly turn to acetaminophen or ibuprofen for minor aches, pains and fevers.

But how can you know what to take when? And how much? Here’s your guide to acetaminophen, ibuprofen and the differences between them.

When to take acetaminophen (aka Tylenol)

Acetaminophen (Tylenol) is commonly used for:

  • Mild to moderate fever
  • Mild to moderate pain
  • Headache
  • Muscle ache
  • Toothache

It’s not quite well understood how it works, but it’s thought to act on pathways in our central nervous system to block pain and on the heat regulating part of our brain (the hypothalamus) to reduce fevers.

Side effects and risks

The most common concern people have about acetaminophen is its effects on the liver. It’s true that if taken in excess, acetaminophen can cause liver toxicity that can be severe enough to warrant a liver transplant. However, acetaminophen is actually quite safe when taken appropriately. 

How much to take

Always follow the dosing recommendations on the label or as prescribed by your doctor. In general, for adults with normal liver function, you can take up to 3 g/day (1000 mg every 8 hours) without any risk to the liver. For those with heavy alcohol use, malnutrition or low body weight, advanced age or liver disease, you can usually take up to 2 g/day without risk of liver damage. Children’s doses are based on their age and size—please consult your pediatrician for more information. 

The biggest thing to remember is more does not mean better. Taking more than the recommended doses does not mean it will provide more pain relief or reduce the fever more effectively. Higher than recommended doses actually have little to no benefit and come with risks to your health and safety.

One of the other things to remember with acetaminophen is that it is commonly found in other medications, both over-the-counter (OTC) and prescription. Make sure you read your labels to ensure you’re not overdosing on acetaminophen accidentally. For example, some cold remedies contain acetaminophen. If you’re already taking 3 g/day of acetaminophen and add NyQuil for a cold, you could unintentionally be taking higher than recommended doses of acetaminophen. Similarly, prescription pain medicines like acetaminophen with codeine (Tylenol #3) or hydrocodone with acetaminophen (Norco) need to be used with caution, especially when taken with OTC acetaminophen.

When to take ibuprofen (aka Advil or Motrin)

Ibuprofen is an anti-inflammatory medicine used for pain, fever and inflammation. It may be a good option when you’re experiencing things like:

  • Osteoarthritis
  • Sprains and strains
  • Swelling
  • Back pain
  • Gout
  • Menstrual cramps

Ibuprofen works on enzymes in our body (COX-1 and 2) which are important pathways involved in inflammation, pain and fever. It is classified in a category of medicines called NSAIDs (non-steroidal anti-inflammatory drugs), which includes other medicines that work similarly like naproxen, diclofenac, meloxicam and others.

Side effects and risks

Ibuprofen and other NSAIDs can have serious side effects and must be taken with caution. They can increase your risk of heart attack and stroke, serious gastrointestinal bleeding from ulcers or (very rarely) perforation of the stomach and intestines. NSAIDs can also prolong bleeding time, which can lead to significant hemorrhage, especially if someone is already taking a blood thinner. They can also cause kidney diseases like interstitial nephritis, renal papillary necrosis or even just acute kidney injury.

Because of these potentially serious problems, people who are on blood thinners or living with health problems like heart disease, kidney disease, history of gastrointestinal disease or bleeding disorders should not take NSAIDs at all. Always consult your doctor if you have health problems and are not sure if it would be safe to take ibuprofen.

Does this mean that everyone should avoid taking ibuprofen and NSAIDs for fear of developing a major health problem? No! When taken appropriately, ibuprofen can be very helpful and the risks can be minimized. For example, a healthy person with a fever should be able to take ibuprofen for 1-2 days without worrying about any risks.

However, you should always consult your doctor about whether ibuprofen is safe for you and for how long. Those with chronic pain or chronic health conditions like rheumatoid arthritis may require long-term use of anti-inflammatories and may need to be monitored with blood tests to ensure the NSAIDs are not causing any harm.

How much to take

Always follow the dosing recommendations on the label or as prescribed by your doctor. The maximum amount of ibuprofen for healthy adults is 800 milligrams per dose or 2400 mg per day (3 maximum doses). A child’s dose is based on the age and weight of the child, so consult your pediatrician about what dose is right for their needs.

So, what’s the difference between acetaminophen and ibuprofen?

The biggest difference between acetaminophen and ibuprofen is ibuprofen’s anti-inflammatory effects, which acetaminophen does not have. Therefore, pain that is caused by inflammation responds better to ibuprofen than it would to acetaminophen. 

Since acetaminophen works on the pain pathway, it still helps with these problems—but it may not work as well as ibuprofen. However, since acetaminophen is usually safer to take than NSAIDs, it is often recommended to try to use acetaminophen first. Oftentimes, if people find acetaminophen to not be as helpful as desired, I recommend taking both ibuprofen and acetaminophen together. If acetaminophen helps even a little, then maybe you won’t need to take as much ibuprofen.

For problems that might not be related to inflammation (fevers, headaches, etc.), always try acetaminophen first. It can work just as well as, if not better than, ibuprofen.

If you’re experiencing pain, fever or injury, talk to your doctor about the best pain management options for you. Find a doctor near you or get virtual care from home via MyBSWHealth.

About the Author

Laura Salazar, MD, is an internal medicine physician on the medical staff at Baylor Scott & White Clinic - Bee Cave and Baylor Scott & White Clinic - Horseshoe Bay.

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