Acetaminophen vs. ibuprofen: Which should you take?

An older man about to take a pill: he is holding it in front of his mouth, and holding a glass of water with his other hand.

Summary

Acetaminophen and ibuprofen are effective pain relievers that work differently in the body and have different risks associated with their use. Acetaminophen is thought to change how the nervous system senses pain and also helps to reduce fever. Side effects include a risk of liver damage and, in some cases, high blood pressure. Ibuprofen blocks enzymes involved in the process that creates inflammation and pain. The medication’s risks include kidney damage, stomach irritation, bleeding or ulcers, and heart attack or stroke.

When taken over the counter, acetaminophen and ibuprofen can deliver much-needed relief when you’re hurt, sick, or in pain. But which one is the right choice for you, and when?

The answer depends on a number of factors: the severity of pain, the presence of fever (with or without pain), and the cause of your discomfort, along with your medical history and your tolerance for various side effects. “Each drug works differently and comes with different risks,” says Jigar Mehta, ambulatory clinical pharmacy manager at Harvard-affiliated Beth Israel Lahey Health.

Here’s what you should know about taking acetaminophen versus ibuprofen, and whether it’s ever okay to take both at the same time.

What is the difference between acetaminophen and ibuprofen?

Acetaminophen and ibuprofen are both available over the counter as pain relievers and for fever. Ibuprofen is also available in a range of doses by prescription. But they work differently in the body and manage pain and fever in different ways.

Ibuprofen (Advil, Motrin) is a nonsteroidal anti-inflammatory drug (NSAID) used to reduce pain, fever, and inflammation. It relieves pain by reducing COX-1 and COX-2 enzymes, chemical messengers that contribute to inflammation, pain and fever.

Acetaminophen (Tylenol, Mapap, others) can also reduce pain and fever, but it does not reduce inflammation. It’s thought to work by changing the regulation of pain and temperature in the brain.

Which is best for pain or fever?

Ibuprofen and acetaminophen both help relieve pain and fever. The one you choose depends on the type of pain you’re dealing with, whether fever is the main problem, and individual factors such as whether you have heart disease, liver disease, or take other medicines.

When taken for pain, “a simple rule of thumb is, if you have inflammation or visible swelling, reach for ibuprofen,” Mehta says. It’s a good choice for managing things like back pain, earaches, muscle injuries, menstrual cramps, sinus infections, and toothaches.

On the other hand: “If there’s no inflammation or swelling, or if you can’t have ibuprofen, take acetaminophen,” says Mehta. It’s a good choice for reducing pain caused by headaches and sore throat, for instance.

For reducing fevers in adults, studies show both pain relievers seem to work equally well. The one you choose may depend on whether you have other underlying health conditions or if you have concerns about certain side effects. Acetaminophen is usually the better choice for fever in the absence of pain or inflammation.

Which is better for inflammation?

Ibuprofen is an anti-inflammatory drug. That makes it a better choice for relieving pain that’s accompanied by inflammation or swelling — such as a sprained ankle or an inflamed bursa (a small, fluid-filled sac) in your hip.

Acetaminophen is not an anti-inflammatory drug. So, it may not work as well for easing pain that’s related to inflammation.

Which is safer for your stomach, liver, or kidneys?

Ibuprofen and acetaminophen are processed primarily by the liver. But their effect on the liver, stomach, and kidneys differs based on how each drug works.

Ibuprofen is generally easier on the liver and harder on the kidneys and stomach. That’s because one of the enzymes it blocks, COX-1, is involved in maintaining healthy blood flow to the kidneys and protecting the stomach lining. As a result, high doses or long-term use of ibuprofen can increase the risk for kidney damage and can lead to stomach irritation, bleeding, or ulcers.

Taking ibuprofen regularly in higher doses can pose other risks, too. It can increase the risk of having a heart attack or stroke. So, you should use it with caution if you already have cardiovascular disease.

Acetaminophen is generally easier on the kidneys and stomach, since it doesn’t block COX-1. But high doses can cause liver damage or lead to liver failure, especially if taken regularly for a long time. Acetaminophen doesn’t increase the chance for heart attack or stroke. However, regular use of a high dose has been shown to modestly raise blood pressure. That’s something to keep in mind if you already have high blood pressure or heart disease.

What are the side effects of acetaminophen vs. ibuprofen?

The side effects of acetaminophen and ibuprofen are different. In general, you’re more likely to have side effects from ibuprofen. These can include diarrhea or constipation, nausea, heartburn, and stomach pain. Taking ibuprofen with food can help prevent or reduce stomach discomfort.

Some of the most common side effects of acetaminophen include nausea, vomiting, and headache, but most people have no side effects at all.

Who should avoid (or limit) use of acetaminophen?

Most people can safely take acetaminophen, especially if use is occasional and in recommended doses. But you should be cautious about taking acetaminophen if you

have liver disease
drink alcohol every day
have phenylketonuria and are taking a version of acetaminophen made with aspartame (such as chewable tablets).

Talk with your doctor before taking acetaminophen if you’re pregnant or breastfeeding. And if you’re taking acetaminophen regularly, check with your doctor or pharmacist about possible interactions with other drugs you are taking.

Who should avoid (or limit) use of ibuprofen?

People with certain health conditions should avoid taking NSAIDs, including ibuprofen. These conditions include

kidney disease
stomach ulcers
chronic acid reflux or gastroesophageal reflux disease (GERD)
inflammatory bowel disease
poorly controlled diabetes
high blood pressure
history of heart attack or stroke
heart failure
taking a blood thinner.

Pregnant people should avoid taking ibuprofen starting at 20 weeks of pregnancy, the FDA recommends. Earlier use may be okay, but talk with your doctor about the benefits and risks for you.

If you are taking ibuprofen regularly and have risk factors for serious side effects (such as age greater than 65 or drinking alcohol daily), talk with your doctor about whether taking ibuprofen is safe for you. And, as with any drug, check with your doctor or pharmacist about possible interactions with other medicines you are taking, especially if taking ibuprofen regularly.

Can you take acetaminophen and ibuprofen together?

It’s generally safe to take acetaminophen and ibuprofen together. That’s because they work differently in the body and don’t share the same major risks. In fact, the combination can be an effective way to manage severe pain while avoiding riskier medications like opioids, research suggests.

You can alternate doses of acetaminophen and ibuprofen or take them at the same time. If the combination is to be taken regularly, check with your doctor or pharmacist about a safe dosing schedule.

How much acetaminophen or ibuprofen can you take?

The maximum acetaminophen dosage for adults is 3,000 to 4,000 milligrams (mg) per 24-hour period. However, if taken regularly, it’s best to consider 3,000 mg per day as the maximum dose. For over-the-counter ibuprofen, the daily limit for adults is 1,200 mg. Always follow the label or your doctor’s instructions when deciding how much to take.

For both drugs, you should also check to see if either drug is used in any combination products you might already be taking and include that in your total daily dosage. Acetaminophen, for instance, is often found in over-the-counter cold medications. “It’s easy to accidentally exceed the daily limit,” Mehta says.

When should you talk to a doctor or pharmacist?

It’s a good idea to speak with a health care professional if you’re taking ibuprofen or acetaminophen for pain or fever that persists for more than a few days. The same is true if you have an underlying health condition that could be affected by over-the-counter pain relievers. It doesn’t take long to double-check with an expert, and the advice can help you avoid potentially serious side effects.

Frequently asked questions

Which is safer for your stomach?

Acetaminophen is safer than ibuprofen for your stomach. This is especially important if you have a gastrointestinal condition like GERD, ulcers, or inflammatory bowel disease. Acetaminophen is also less likely to cause side effects like stomach upset, nausea, or diarrhea. That’s because ibuprofen blocks certain enzymes that protect the lining of the stomach, so it can increase the risk for digestive problems.

Can you take acetaminophen or ibuprofen with alcohol?

Both acetaminophen and ibuprofen carry some risk when taken with alcohol. Combining acetaminophen with alcohol may impair your liver function. Mixing ibuprofen and alcohol, on the other hand, can increase the odds for stomach ulcers. The risks are greater with higher doses or regular use, so talk with your doctor to weigh the pros and cons for you.