The first line of defense for your aches, pains and general unrest is the medicine cabinet. Once you start feeling under the weather, you pop a pill or two of acetaminophen, ibuprofen or naproxen. And before you know it — relief!
It’s such a habitual reaction, that you probably don’t even think about your choice. You take whatever’s on hand and wait for it to kick in. Tylenol, Advil, Motrin, Aleve, store brand generic — it’s all the same, right?
Not at all, actually. While these over-the-counter drugs provide similar results, they are not the same. As you’ve surely seen plastered on every package of Tylenol, acetaminophen is a pain reliever and fever reducer. Ibuprofen and naproxen can do both those things, but they are anti-inflammatory drugs designed to reduce inflammation and swelling.
Which little tablet should I take?
The lines are blurred. Acetaminophen, ibuprofen and naproxen have different chemical makeups, but the choice between them is not always clear. Depending on your condition, one is typically better suited than the other. When in doubt, use this guide to help you figure out which medicine to take.
| When you have... | You should take... |
|---|---|
| Headache | Acetaminophen (Tylenol). It provides quick pain relief and is safer to take more for longer periods if your symptoms last. |
| Inflammation | Ibuprofen (Advil, Motrin) and Naproxen (Aleve). The most common of the non-steroidal anti-inflammatory drugs (NSAIDS), ibuprofen or naproxen inhibits the chemicals that cause inflammation in the body. It’s the pick for things like sinus infections, arthritis, earaches and toothaches. |
| Fever | Either. Some people find relief from acetaminophen, others from ibuprofen. If your fever is accompanied by an upset stomach, take acetaminophen. Ibuprofen and naproxen may make your stomach feel worse. |
| Muscle aches or strains | Ibuprofen (Advil, Motrin) and Naproxen (Aleve). Its anti-inflammatory properties are better for muscle soreness and body aches that typically stem from inflammation. |
| Cold or sore throat | Acetaminophen (Tylenol). Some studies show that acetaminophen relieves cold symptoms and a sore throat better than ibuprofen or naproxen. |
| Pain | Either. Acetaminophen is a pain reliever. Ibuprofen or naproxen acts on inflammation, which can be the root of your pain. Take the one that provides you comfort and try the other pill if your pain persists. |
| Menstrual cramps | Ibuprofen (Advil, Motrin) and Naproxen (Aleve). NSAIDs inhibit the production of prostaglandins, hormone-like lipids that cause your cramps. Acetaminophen only relieves the pain and doesn’t reduce your levels of prostaglandins. |
“In general, pain that is associated with inflammation, like swelling or acute injury, is better treated with ibuprofen or naproxen,” says Matthew Sutton, MD, a Family Medicine physician at The Iowa Clinic’s West Des Moines campus. “There's evidence that acetaminophen is specifically not effective for low back pain and knee osteoarthritis, so ibuprofen or naproxen are probably better bets for these.”
Naproxen and ibuprofen also have their differences. Naproxen provides long-acting relief, so doses are taken just twice a day. Ibuprofen is a short-acting anti-inflammatory that can be taken every six to eight hours — the same dosing schedule as acetaminophen. So if you’re taking naproxen, be careful not to accidentally take an incorrect dose out of error or habit.
Whatever You Take, Call Us in the Morning
These pills are great in a pinch. Your provider is better for long-term problems.
Should I worry about side effects?
Although acetaminophen, ibuprofen and naproxen are all over-the-counter medications, they are not entirely risk-free. Every medication can present a problem or two.
“Acetaminophen has very few side effects. Ibuprofen and naproxen can both cause an upset stomach, kidney damage, high blood pressure and inflammation or bleeding in the stomach. They can also increase the risk of heart attack in some patients,” Dr. Sutton says. “That being said, most people can take them at lower doses for short time periods for minor pains and injuries without any serious consequences.”
Always check the labels for a list of all potential side effects. And be wary of signs of allergic reactions to a drug — which you may not find on a warning label. Those symptoms are just as important as the ones you’re trying to resolve. If you experience any of these signs after taking acetaminophen, ibuprofen or naproxen, you should get medical help right away:
- Itching or hives
- Wheezing or trouble breathing
- Tightness in your chest
- Swelling of your face, hands, lips, mouth or throat
Acetaminophen is the safest of the three drugs. But in rare cases, especially in people who drink alcohol routinely, too much acetaminophen can lead to liver damage. So it’s important to keep your total daily dose under 4,000 milligrams — unless advised by your provider.
Acetaminophen is often an ingredient in many common over-the-counter medications for allergies, cold, cough and sleep. So check the labels of all products you’re taking to make sure you’re staying within the recommended dosage.
Certain conditions can lead to other side effects, too. For instance, if you’re on prescription blood thinners, you should not take an NSAID like ibuprofen or naproxen.
“There’s a widespread misconception — even among some doctors — that patients with liver disease can't take Tylenol,” says Dr. Sutton. “So it's always best to discuss it with your provider to make sure any medication — even over-the-counter drugs — are safe to take.”
Are acetaminophen, ibuprofen and naproxen all safe to give to my kids?
As an adult, it’s easy to understand the proper dosage of the medications you’re taking. It’s right on the side of the bottle. For children, there is no such blanket recommendation. The correct amount of medicine depends on the age and weight of your child. This information is not provided on adult bottles. Sometimes it isn’t even included with infant formula medications.
In the correct doses — and at the right ages — acetaminophen and ibuprofen are safe for kids. However, naproxen is not recommended for children younger than 12 years old.
“Naproxen is available over-the-counter at a dose of 220 milligrams and can be taken twice daily,” Dr. Sutton says. “But when it comes to children, proper dosage and usage should be directed by your physician.”
There’s no catch-all dosage for kids. Make sure to check the labels, product websites or dosage charts as your child grows. Or download these dosage charts developed by The Iowa Clinic to have handy for future reference.
Tylenol Dosage Chart for Infants and Children
Do not give acetaminophen to infants under 12 weeks of age.
If your baby has a fever, you should make an appointment with your pediatrician to see what’s wrong.
Once your baby is three months old, consult this chart to find the right dosage. Children can have a dose of Tylenol or acetaminophen every four to six hours, up to five times a day. But there are different versions of the medicine, so make sure you’re giving the right amount for your child’s weight.
Ibuprofen Dosage Chart for Infants and Children
Do not give ibuprofen to infants under 6 months old.
Unless recommended by your pediatrician, always use acetaminophen for babies ages 12 weeks to six months. After six months, it’s safe to give your baby Motrin or another brand of ibuprofen. Children can have ibuprofen every six to eight hours as needed. Use this chart to give your kid the right dosage for their age and weight.
These charts are good guides — and approved by The Iowa Clinic pediatricians — but you should always discuss dosage and medications with your pediatrician first. A quick call to the clinic can answer all your questions, and alert your pediatrician to health issues that may require a visit.
What if none of these medications work?
Acetaminophen and ibuprofen are short-term solutions. And while naproxen is longer-lasting, it still can’t get you through a full day. If you can’t shake your symptoms — or they get worse — stop taking the pills and head to the doctor.
This is especially important if you’re taking these medications to manage pain. Acetaminophen, ibuprofen and naproxen aren’t cures for the source of your pain; they merely mask it temporarily. Long-term use of these drugs can be dangerous.
“These medications are safe for the vast majority of people when taken at low to medium doses for limited periods of time,” says Dr. Sutton. “Long-term use — and even short-term use if you’re older or have underlying health problems like heart, kidney, liver or digestive issues — needs to be guided and monitored by your physician.”
For a quick fix, acetaminophen, ibuprofen and naproxen are go-to drugs for a reason. They are safe and effective. When none of these medications cut it, visit your doctor to decipher your set of symptoms and find the cure for what ails you.
“You should see your doctor any time you have pain that isn't going away as you would expect,” Dr. Sutton says. “Most minor pains and uncomplicated injuries will be better within one or two weeks. So if you're still taking pain medication beyond that, it could indicate a more serious issue.”
MatthewSutton , MD, FAAFP
Matthew Sutton, MD joined the Iowa Clinic because he wanted to work for an organization that prioritized the doctor-patient relationship. Practicing at The Iowa Clinic allows him to provide what he feels is the best care to his patients.
Dr. Sutton naturally has a variety of interests, making Family Medicine the perfect specialty for him. It allows him to provide care across the lifespan of a patient, from the very healthy to the very sick. Promoting wellness and building long-term relationships with patients and their families are what he finds most rewarding about being a physician He also enjoys the continuous learning and self-improvement that medicine requires.
Outside of the clinic, Dr. Sutton enjoys spending time with his kids, running, hiking, playing music, and working on home improvement projects.