Acetaminophen vs. Ibuprofen: Which Works Better?

Over-the-counter painkillers have earned their spot in your medicine cabinet. You reach for them to lower a fever, banish a headache or ease those monthly cramps.

Both acetaminophen (such as Tylenol®) and ibuprofen (Advil® or Motrin®) are used to treat fevers and pain. But they’re not exactly interchangeable. Which should you choose? Here family medicine specialist Matthew Goldman, MD, discusses what you should know about which med makes the most sense for your aches and pains.

Ibuprofen basics

Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID). As the name suggests, it tends to be most helpful for discomfort that goes hand in hand with inflammation, which can include redness, swelling, heat, pain and/or loss of function at the site or source. That makes it a smart pick for pain such as:

• Back and neck pain.
• Earache.
• Menstrual cramps.
• Muscle sprains and strains.
• Sinus infections.
• Toothache.

Acetaminophen basics

Acetaminophen is a type of drug called an analgesic. Translation: It reduces pain signals within the nervous system and not at the site itself. That makes it a good choice for pain such as:

• Headaches.
• Joint pain/arthritis.
• Sore throat.

Pain medication side effects

Both acetaminophen and ibuprofen carry a risk of side effects, so follow the dosage info on the labels. Here’s what to look out for when you’re taking these painkillers.

Ibuprofen side effects

Common side effects of ibuprofen include:

• Constipation.
• Heartburn.
• Nausea.
• Stomach pain (so it’s important to take with food).

Taking ibuprofen for a long time or at high doses can also increase the risk of more serious side effects, such as:

• Blood clots.
• Heart attack.
• Kidney damage.
• Stomach bleeding (ulcers).
• Stroke.

Acetaminophen side effects

Side effects of acetaminophen are minimal, but some people experience problems including:

• Nausea.
• Vomiting.
• Headache.

Ibuprofen is metabolized by the kidneys and therefore is not a great option for those with kidney issues. Acetaminophen is metabolized by the liver and is not a great option for those with liver issues. For those who have neither kidney nor liver issues, sometimes we alternate acetaminophen and ibuprofen to avoid overdosing as well as attacking pain and inflammation from two different approaches.

Acetaminophen can also be hiding in several over-the-counter medicines, including cough and cold medications. If you’re taking more than one medication, read drug labels carefully so that you don’t go over the recommended dosage. For example, it may not be safe to take cold medicine and Tylenol at the same time.

Which painkiller should you pick?

So which pain med reigns supreme? While there’s no right answer, these pointers can help you decide.

Fever

Most research suggest acetaminophen and ibuprofen have similar results in controlling fevers, so pick what works for you.

Stomach trouble

If you have a sensitive stomach or find that ibuprofen causes heartburn or nausea, give acetaminophen a whirl.

Period pains

Ibuprofen reduces your body’s production of prostaglandins. These are the chemicals that trigger the uterus to contract and start periods each month. Ibuprofen can ease menstrual cramps and may also make menstrual bleeding lighter.

Other meds

Both ibuprofen and acetaminophen can interact negatively with some prescription and over-the-counter drugs. If you’re taking medication, talk to your provider doctor or pharmacist before reaching for the painkillers.

Persistent pain

If you’re taking painkillers over several days, consider alternating ibuprofen and acetaminophen to lower the risk of side effects.

Kids

Both ibuprofen and acetaminophen can control pain in kids. But ibuprofen tends to work better as a fever reducer. Be sure to follow the dosage guidelines on the label for your little one’s age and weight.

What’s the takeaway? When used responsibly, ibuprofen and acetaminophen are safe choices for turning down the dial on fever and pain. And isn’t it good to have options?