Acetaminophen vs. Ibuprofen for Pain (Differences between Side Effects adn Dosage)

  • Medical Reviewer: John P. Cunha, DO, FACOEP
    John P. Cunha, DO, FACOEP

    John P. Cunha, DO, FACOEP

    John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.

Acetaminophen vs. ibuprofen for pain quick comparison of differences

What is acetaminophen (Tylenol)? What is ibuprofen (Advil)?

Acetaminophen belongs to a class of drugs called analgesics (pain relievers) and antipyretics (fever reducers). Acetaminophen is believed to work by reducing the production of prostaglandins in the brain. Prostaglandins are chemicals that cause inflammation and swelling. Acetaminophen relieves pain by elevating the pain threshold, that is, by requiring a greater amount of pain to develop before a person feels it. It reduces fever through its action on the heat-regulating center of the brain by telling the center to lower the body's temperature when the temperature is elevated.

Ibuprofen belongs to a class of drugs called nonsteroidal anti-inflammatory drugs (NSAIDs). Other members of this class include aspirin, naproxen (Aleve), indomethacin (Indocin), and nabumetone (Relafen), among others. These drugs are used for the management of mild to moderate pain, fever, and inflammation. Ibuprofen blocks the enzyme that makes prostaglandins (cyclooxygenase), resulting in lower levels of prostaglandins. As a consequence, inflammation, pain and fever are reduced.

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What are the uses for acetaminophen vs. ibuprofen?

Acetaminophen uses

Acetaminophen is used for the relief of fever as well as aches and pains associated with many conditions. Acetaminophen relieves pain in mild arthritis but has no effect on the underlying inflammation, redness, and swelling of the joint. If the pain is not due to inflammation, acetaminophen is as effective as aspirin.

Acetaminophen is as effective as the non-steroidal anti-inflammatory drug ibuprofen (Motrin) in relieving the pain of osteoarthritis of the knee. Unless directed by a physician, acetaminophen should not be used for longer than 10 days.

Ibuprofen uses

Ibuprofen is used for the treatment of mild to moderate pain, inflammation and fever caused by many and diverse diseases. It is used for treating menstrual cramps (dysmenorrhea), osteoarthritis, rheumatoid arthritis, and juvenile idiopathic arthritis.

What are the side effects of acetaminophen vs. ibuprofen?

Acetaminophen side effects

When used appropriately, side effects with acetaminophen are not common.

The most common side effects are rash, nausea, and headache.

Other important side effects include:

  • Hypersensitivity reactions
  • Serious skin reactions
  • Kidney damage
  • Anemia
  • Reduced number of platelets in the blood (thrombocytopenia)

Chronic alcohol use may also increase the risk of stomach bleeding. The most serious side effect is liver damage due to large doses, chronic use or concomitant use with alcohol or other drugs that also damage the liver.

Ibuprofen side effects

The most common side effects from ibuprofen are:

NSAIDs reduce the ability of blood to clot and therefore increase bleeding after an injury.

Ibuprofen may cause ulceration of the stomach or intestine, and the ulcers may bleed. Sometimes, ulceration can occur without abdominal pain; and due to bleeding, the only signs or symptoms of an ulcer may be black, tarry stools, weakness, and dizziness upon standing (orthostatic hypotension).

Sometimes, ulceration can occur without abdominal pain, due to the bleeding, and the only signs or symptoms of an ulcer are:

NSAIDs reduce the flow of blood to the kidneys and impair function of the kidneys. The impairment is most likely to occur in patients who already have impaired function of the kidney or congestive heart failure, and use of NSAIDs in these patients should be cautious.

People who are allergic to other NSAIDs, including aspirin, should not use ibuprofen.

Individuals with asthma are more likely to experience allergic reactions to ibuprofen and other NSAIDs.

Other serious side effects associated with NSAIDs are:

NSAIDs (except low- dose aspirin) may increase the risk of potentially fatal heart attacks, stroke, and related conditions in people with or without heart disease or risk factors for heart disease. The increased risk of heart attack or stroke may occur as early as the first week of use and the risk may increase with longer use and is higher in patients who have underlying risk factors for heart and blood vessel disease. Therefore, NSAIDs should not be used for the treatment of pain resulting from coronary artery bypass graft (CABG) surgery.

What is the dosage for acetaminophen vs. ibuprofen?

Acetaminophen dosage

  • The dose for adults is 325 to 650 mg every 4 hours or 500 mg every 8 hours when using immediate release formulations.
  • The dose for extended release caplet is 1300 mg every 8 hours.
  • The maximum daily dose is 4 grams.
  • The oral dose for a child is based on the child's age and weight. If less than 12 years old the dosing is 10-15 mg/kg every 6-8 hours not to exceed 2.6 g/day (5 doses). If older than 12 years of age the dose is 40-60 mg/kg/day every 6 hours not to exceed 3.75 g/day (5 doses).

Ibuprofen dosage

  • For minor aches, mild to moderate pain, menstrual cramps, and fever, the usual adult dose is 200 or 400 mg every 4 to 6 hours.
  • Arthritis is treated with 300 to 800 mg 3 or 4 times daily.
  • When under the care of a physician, the maximum dose of ibuprofen is 3.2 g daily. Otherwise, the maximum dose is 1.2 g daily.
  • Individuals should not use ibuprofen for more than 10 days for the treatment of pain or more than 3 days for the treatment of a fever unless directed by a physician.
  • Children 6 months to 12 years of age usually are given 5-10 mg/kg of ibuprofen every 6-8 hours for the treatment of fever and pain. The maximum dose is 40 mg/kg daily.
  • Juvenile arthritis is treated with 20 to 40 mg/kg/day in 3-4 divided doses.
  • Ibuprofen should be taken with meals to prevent stomach upset.

What drug interact with acetaminophen vs. ibuprofen?

Acetaminophen drug interactions

Acetaminophen is metabolized (eliminated by conversion to other chemicals) by the liver. Therefore drugs that increase the action of liver enzymes that metabolize acetaminophen, for example, carbamazepine (Tegretol), isoniazid, rifampin (Rifamate, Rifadin, Rimactane), reduce the levels of acetaminophen and may decrease the effectiveness action of acetaminophen.

Doses of acetaminophen greater than the recommended doses are toxic to the liver and may result in severe liver damage. The potential for acetaminophen to harm the liver is increased when it is combined with alcohol or drugs that also harm the liver.

Cholestyramine (Questran) reduces the effect of acetaminophen by decreasing its absorption into the body from the intestine. Therefore, acetaminophen should be administered 3 to 4 hours after cholestyramine or one hour before cholestyramine .

Acetaminophen doses greater than 2275 mg per day may increase the blood thinning effect of warfarin (Coumadin) by an unknown mechanism. Therefore, prolonged administration or large doses of acetaminophen should be avoided during warfarin therapy.

Ibuprofen drug interactions

Ibuprofen is associated with several suspected or probable interactions that can affect the action of other drugs.

  • Ibuprofen may increase the blood levels of lithium (Eskalith, Lithobid) by reducing the excretion of lithium by the kidneys. Increased levels of lithium may lead to lithium toxicity.
  • Ibuprofen may reduce the blood pressure-lowering effects of drugs that are given to reduce blood pressure. This may occur because prostaglandins play a role in the regulation of blood pressure.
  • When ibuprofen is used in combination with methotrexate (Rheumatrex, Trexall) or aminoglycosides (for example, gentamicin) the blood levels of the methotrexate or aminoglycoside may increase, presumably because their elimination from the body is reduced. This may lead to more methotrexate or aminoglycoside-related side effects.
  • Ibuprofen increases the negative effect of cyclosporine on kidney function.
  • Individuals taking oral blood thinners or anticoagulants, for example, warfarin (Coumadin), should avoid ibuprofen because ibuprofen also thins the blood, and excessive blood thinning may lead to bleeding.
  • If aspirin is taken with ibuprofen there may be an increased risk for developing an ulcer.
  • Persons who have more than three alcoholic beverages per day may be at increased risk of developing stomach ulcers when taking ibuprofen or other NSAIDs.
  • Combining SSRIs or selective serotonin reuptake inhibitors (for example, fluoxetine [Prozac], citalopram [Celexa], paroxetine [Paxil, Paxil CR, Pexeva) with NSAIDs may increase the likelihood of upper gastrointestinal bleeding.

Are acetaminophen or ibuprofen safe to take if I am pregnant or breastfeeding?

Acetaminophen safety

  • Acetaminophen is excreted in breast milk in small quantities. However, acetaminophen use by the nursing mother appears to be safe.

Ibuprofen safety

  • There are no adequate studies of ibuprofen in pregnant women. Therefore, ibuprofen is not recommended during pregnancy. Ibuprofen should be avoided in late pregnancy due to the risk of premature closure of the ductus arteriosus in the fetal heart.
  • Ibuprofen is excreted in breast milk but the American Academy of Pediatrics states that ibuprofen is compatible with breastfeeding.

REFERENCE: FDA Prescribing Information.

Summary

Acetaminophen (Tylenol and many other brand names is an pain reliever (analgesic) and fever reducer (antipyretic ). Scientists do not know the exact mechanism of action of acetaminophen. Ibuprofen (Advil) is an NSAID (nonsteroidal inti-inflammatory drug) used for the treat inflammation, fever, and mild pain. Ibuprofen works in relieving mild pain, inflammation, and fever by blocking an enzyme that makes chemicals released in the body that promote inflammation (prostaglandins). Prostaglandins promote inflammation in the body.

Common side effects of both acetaminophen and ibuprofen include rash, nausea, and headache.

Side effects specific to acetaminophen include kidney damage, anemia, thrombocytopenia, serious skin reactions, and liver failure.

Side effects of specific to ibuprofen include tinnitus (ringing in the ears), dizziness, drowsiness, stomach pain, constipation, and heartburn.

Dosage depends upon whether the person using acetaminophen or ibuprofen.

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Reviewed on 12/11/2017
References
REFERENCE: FDA Prescribing Information.

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