Acetaminophen vs Ibuprofen: Which Painkiller is Best for You?

You probably have a bottle of over-the-counter (OTC) pain relievers in your medicine cabinet right now. 

OTC pain reliever use is incredibly common, with one survey citing that 83% of people had used an OTC pain reliever in the last year.

There are several types of pain relievers you can choose from to ease minor aches and pains. 

Two of the more common OTC pain relievers are acetaminophen and ibuprofen, which are widely available worldwide.

While they’re both used to help relieve minor pain, acetaminophen, and ibuprofen do have their differences. 

We’ll review the common uses, side effects, safety information, and much more for acetaminophen vs ibuprofen in this article.

What is acetaminophen?

Acetaminophen is an analgesic medication, which means it works to reduce pain and can reduce fevers. (It is also considered an antipyretic medication, which means it helps reduce fever.)

Acetaminophen is not considered an NSAID, which stands for non-steroidal anti-inflammatory drug. 

Instead, it’s classified as a “miscellaneous” and non-narcotic analgesic and is available over the counter without a prescription. 

One of the most well-known brands of acetaminophen is Tylenol, but there are many others, which we’ll review later in this article.

The strength of acetaminophen tablets varies, ranging from 80 milligrams to 650 milligrams per tablet or capsule. 

Acetaminophen is available in regular and extended-release tablets and capsules, liquid suspensions, chewable tablets, and disintegrating tablets. 

The daily dose of acetaminophen shouldn’t exceed 4,000 milligrams per day for adults.

Acetaminophen was approved by the United States Food and Drug Administration in 1950 and has been available over-the-counter since 1955.

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What is ibuprofen?

Ibuprofen is a non-steroidal anti-inflammatory drug (NSAID) used to reduce pain, and like acetaminophen, it can be used as a fever-reducer. The most well-known brand name of ibuprofen is Advil.

Ibuprofen is available in strengths ranging from 100-400 milligrams each (tablets and capsules), with higher strengths available through prescription (up to 800 milligrams each). 

Like acetaminophen, ibuprofen is available in tablets, capsules, chewable tablets, and liquid oral suspension.

Ibuprofen has been available over-the-counter in the United States since 1984. The maximum recommended dose of ibuprofen for adults is 3,200 milligrams per day.

Brand name versions 

There are several different brand names for both acetaminophen and ibuprofen. Each contains the active ingredient of either acetaminophen or ibuprofen. 

These are common brand names in the United States; brand names in other countries may vary.

Acetaminophen vs ibuprofen

The below sections compare acetaminophen vs ibuprofen, including uses, side effects, safety profile, benefits, cost, availability, differences, and similarities. 

Uses

Acetaminophen

Acetaminophen is most commonly used to treat minor pain, including:

• Headache
• Backache
• Minor pain from arthritis
• Toothache
• Muscular aches
• Premenstrual and menstrual cramps. 
• Temporary fever-reducer

Additionally, acetaminophen is preferred among patients who shouldn’t take NSAIDs because it is not an NSAID. 

For instance:

• If you have a history of stomach problems (including stomach ulcers), you shouldn’t take NSAIDs since they can weaken the lining of your stomach and lead to more bleeding.

• If you’re on aspirin therapy, you shouldn’t take NSAIDs and should opt for acetaminophen. 

• For those with kidney problems, acetaminophen may be easier on your kidneys and better to take.

• If you’re on an anticoagulant medication (blood thinning medication), your healthcare provider might suggest that you take acetaminophen instead of ibuprofen to reduce the risk of serious stomach bleeds.

Acetaminophen may be preferred over ibuprofen to treat children. This is because it’s known for having fewer side effects, including potential stomach upset from ibuprofen.

Acetaminophen may be a better choice for seniors, especially those prone to stomach bleeding or who have certain health conditions like kidney or heart disease.

Acetaminophen can be used in children as young as two months old. It’s also considered safe during all trimesters of pregnancy (category B).

Ibuprofen

Ibuprofen has similar uses as acetaminophen, including:

• Reducing fever
• Relieving minor aches and pain from:
  • Headaches
  • Muscle aches
  • Arthritis
  • Menstrual periods
  • The common cold
  • Toothaches
  • Backaches

Additionally, ibuprofen may be a better choice for reducing pain related to inflammation, such as arthritis and muscle strains, compared to acetaminophen. 

However, you may find that you prefer one drug over the other to treat your minor pain.

Ibuprofen can be used in children as young as six months old. It is considered safe in pregnancy during the first and second trimesters (safety category B) but isn’t safe to take during the third trimester (category D).

Differences

• Acetaminophen isn’t an NSAID drug, and ibuprofen is. This means that ibuprofen may be better at treating inflammatory-related pain.
• Acetaminophen can be used in younger patients (two months vs six months for ibuprofen.
• The maximum daily dose is different (4,000 milligrams for acetaminophen vs 3,200 for ibuprofen).
• Acetaminophen is considered safer for certain patients compared to ibuprofen (history of GI bleeds, aspirin therapy, kidney problems, pregnancy, etc.).

Similarities

• Both acetaminophen and ibuprofen are available as over-the-counter pain relievers and fever reducers.
• The drugs are used to treat similar conditions (backache, toothache, etc).
• Both drugs come in various forms (tablets, capsules, liquid suspensions, etc).

Side effects and risks 

Acetaminophen 

Some potential side effects of acetaminophen are:

• Constipation
• Diarrhea
• Dizziness
• Headache
• Itchiness
• Nausea
• Sweating
• Tiredness
• Vomiting

If you take too much acetaminophen (high doses for prolonged periods), the main risk is liver damage. 

Some signs of liver damage include:

• Yellowing of your skin or eyes
• Pain in your abdomen
• Nausea and vomiting
• Loss of appetite
• Fatigue
• Excessive sweating
• Dark urine and stools
• Pale skin color
• Unusual bruising
• Unusual bleeding

Ibuprofen

Some potential side effects of taking ibuprofen include:

• Abdominal pain
• Constipation
• Diarrhea
• Nausea
• Stomach upset (belching, bloating, heartburn, indigestion, gas, etc.)
• Vomiting

The main risk of taking too much ibuprofen is an increased risk of stomach bleeding. This is because ibuprofen is an NSAID medication known to irritate the protective lining of your stomach, which can predispose you to tears in your stomach, esophagus, or intestine (a gastrointestinal bleed).

Signs of a gastrointestinal bleed to be aware of when taking ibuprofen include:

• A black or tarry stool
• Bright red blood in vomit
• Cramps in your abdomen
• Dark or bright red blood mixed with stool
• Dizziness or faintness
• Feeling tired
• Paleness
• Shortness of breath
• Vomit that looks like coffee grounds
• Weakness

If you develop any of these symptoms while taking ibuprofen and suspect a GI bleed, you should stop taking ibuprofen and notify your healthcare provider immediately.

Cost and availability

Both medications are widely available across the world as OTC medications. They are both relatively inexpensive.

Acetaminophen

30 tablets of 325-milligram acetaminophen tablets cost around $8-$10 in the United States.

Ibuprofen

30 tablets of 400-milligram ibuprofen tablets cost around $8-$12 in the United States.

Interactions

Acetaminophen

Taking acetaminophen with other drugs might cause safety concerns. Some of the drugs and substances that might negatively interact with acetaminophen are:

• Prescription medications phenobarbital, phenytoin (Dilantin), and carbamazepine (Tegretol) (may increase the risk of liver damage when taken with acetaminophen)
• Warfarin
• Isoniazid
• Other drugs containing acetaminophen, which might lead to an unintentional overdose

In addition, drinking large amounts of alcohol while taking acetaminophen can increase the risk of liver problems, so you should avoid excessive alcohol intake while taking it.

Ibuprofen

You should consult your healthcare provider or pharmacist if you’re taking any prescription medications to determine if ibuprofen is safe. 

Ibuprofen might interact with certain medications, such as:

• Antibiotics such as ciprofloxacin, levofloxacin, moxifloxacin, norfloxacin, or ofloxacin
• Antidepressants such as citalopram, fluoxetine, fluvoxamine, venlafaxine, paroxetine, or sertraline
• Anti-inflammatory painkillers such as aspirin, diclofenac, mefenamic acid, or naproxen
• Blood thinners/anticoagulants such as warfarin, among several others
• Diabetes medicines such as gliclazide, glimepiride, glipizide, or tolbutamide
• High blood pressure medications
• Steroid medicines such as betamethasone, dexamethasone, hydrocortisone, or prednisolone

Like acetaminophen, avoid drinking large amounts of alcohol while taking ibuprofen. 

Alcohol can irritate the lining of your stomach, which can increase the risk of GI bleeding from ibuprofen.

Which medication is safer?

• According to a review of 85 studies, ibuprofen and acetaminophen were considered equally safe.
• Acetaminophen is considered safer for people at risk of GI bleeds, including those taking anticoagulant medications.
• Ibuprofen may be preferred for people with a history of liver disease since acetaminophen can be harder on your liver.
• Acetaminophen is preferred over ibuprofen during the third trimester of pregnancy.
• Acetaminophen is safer to use in younger babies (it can be used at 12 weeks vs 6 months for ibuprofen).

Benefits

• Both medications are non-narcotic pain relievers, which are widely available as OTC medications.

• Both medications are considered safe to use. There is very little difference in their safety profiles when reviewed in scientific studies.

• Both medications may help ease symptoms of the common cold.

• Acetaminophen is preferred for patients who are at risk of gastrointestinal bleeds, who have kidney problems, and during all trimesters of pregnancy.

• Ibuprofen is preferred for patients with a history of liver problems.

Can you take acetaminophen and ibuprofen together?

Yes. You can take acetaminophen and ibuprofen together. 

The best way to do so is to alternate the medications, such as taking acetaminophen and then a dose of ibuprofen 4-6 hours later. 

You should be sure not to exceed the recommended daily dose for either medication, which would be difficult to do if you’re taking it as prescribed and spacing the doses out.

Which medication lasts longer?

How long acetaminophen and ibuprofen last can depend on factors like strength and duration. For instance, a higher-strength tablet will last longer than a lower-strength tablet, and extended-release tablets are known to last much longer than immediate- or regular-release tablets.

Extra-strength versions of acetaminophen and ibuprofen should be spaced out more than lower-strength versions since they last longer.

Ibuprofen and acetaminophen have similar dosing schedules every 4-6 hours. This means that neither medication is known to last longer than the other. 

For comparison, Naproxen lasts around 12 hours, so you’d only take two doses each day compared to several doses of either acetaminophen or ibuprofen.

Which is more effective, acetaminophen or ibuprofen?

According to studies, ibuprofen may be more effective at lowering fevers in both children and adults. 

In addition, ibuprofen is more effective at treating pain related to inflammation, such as arthritis, postoperative pain, trauma, etc.

However, acetaminophen is considered an effective pain reliever that is considered safer in certain populations, so it comes down to what you’re using the medication for, as well as your personal medical history.

How to take them safely

• Take acetaminophen and ibuprofen as prescribed, being careful not to exceed the recommended maximum dose.

• Space out the doses of each medication as advised by your healthcare provider or the product label. Taking doses too close together can increase the likelihood of side effects and potential health problems like GI bleeds and liver problems.

• Ask your healthcare provider or pharmacist if you’re taking any medications known to interact with acetaminophen or ibuprofen. When in doubt, always check, especially for prescription medications.

• Avoid drinking large amounts of alcohol while taking acetaminophen and ibuprofen (they can cause liver or stomach bleeds, respectively).

• If you have a history of health problems like heart, liver, or kidney disease, ask your healthcare provider for specific guidance on which medication to take and how much.

• Be careful not to mix multiple OTC medications at once. This can increase the risk of serious side effects and may contribute to drug toxicity.

• Use the medication that is best suited to treat your symptoms. 

Conclusion

Acetaminophen (common brand name Tylenol) and ibuprofen (common brand name Advil) are both over-the-counter pain relievers and fever reducers.

The main differences between acetaminophen vs ibuprofen are their safety profiles for certain health conditions, such as liver disease, kidney disease, a history of stomach bleeds, etc.

Acetaminophen and ibuprofen can be used to treat similar conditions, though ibuprofen is more effective at treating pain related to inflammation since it’s an NSAID (non-steroidal anti-inflammatory drug).

Both medications are considered equally safe, though ibuprofen may be more effective as a fever-reducer.

You should consult your healthcare provider to assess which medication is best for you, given your health history, current health status, and any other medications you’re taking.

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