Which is better for pain relief ibuprofen or acetaminophen

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.

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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?

• Acetaminophen is an analgesic and an antipyretic, which means that it is good for pain relief reducing fevers; whereas ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID), which works by reducing the amount of a hormone called prostaglandin and therefore reducing inflammation.
• Because of its anti-inflammatory properties, ibuprofen is better for people with arthritis.
• Both medications are effective at minor aches and pains, but ibuprofen works faster and has slightly better results in reducing fever. 

Acetaminophen and Ibuprofen are two of the most common over-the-counter drugs used for treating minor ailments like pain and fevers. Even though they serve the same functions, they belong to separate classes of drugs and work in different ways. 

Here are the major differences between the two and which might be better for you. 

The difference between acetaminophen and ibuprofen

Acetaminophen belongs to a class of drugs called analgesics. Analgesics are drugs used specifically for pain relief. 

It is also an antipyretic, which is a class of drugs that are used to reduce fevers. You might recognize acetaminophen at your pharmacy by its most popular brand name: Tylenol. It is also called paracetamol in some countries.

It's not completely clear how acetaminophen works, but research suggests that it helps to reduce pain and fevers by inhibiting the COX enzyme. The COX enzymes form prostanoids, which are responsible for our body's inflammatory reactions to certain conditions. 

On the other hand, ibuprofen belongs to a class of drugs called nonsteroidal anti-inflammatory drugs (NSAID). NSAIDs are drugs used to treat inflammation, fevers, and mild to moderate pain. Popular brand names of ibuprofen include Advil and Motrin.

Ibuprofen works by reducing the amount of a hormone called prostaglandin in the body, which is released when we are injured or ill and can cause pain and swelling. It does this by inhibiting cyclooxygenase (COX) enzymes, which are responsible for producing this hormone. 

One of the key differences is that ibuprofen is better at reducing inflammation and swelling. That's why it is typically recommended as a pain reliever for people who have arthritis. 

"While both can be used for fever and pain relief, ibuprofen should be chosen instead of acetaminophen for its anti-inflammatory properties when treating conditions such as osteoarthritis or rheumatoid," says Mike Martinez II, DO, a board-certified anesthesiologist and Assistant Professor at TCU and UNTHSC School of Medicine. 

Who can use acetaminophen and ibuprofen? 

While acetaminophen and ibuprofen are considered safe to use for most people, there are a few exceptions. For children who are under 6 months, ibuprofen is typically not recommended. 

People with certain medical conditions are also advised against taking both drugs. If you have a history of blood clots, kidney disease, or liver disease, talk to your doctor before taking either medication. Also, both medications should be avoided if you are a heavy drinker. 

According to Santosh Sanagapalli, MD, a gastroenterologist and physician in internal medicine at St Vincent's Hospital in Sydney, Australia, you should avoid acetaminophen if you:

• Drink heavily
• Have liver cirrhosis
• Are malnourished

Sanagapalli says you should avoid ibuprofen if you:

• Have liver cirrhosis
• Have an inflammatory bowel disorder, like Chron's disease
• Have a stomach ulcer
• Have kidney disease
• Have a history of severe heart failure or heart attack
• Have coronary artery disease 

The side effects of aspirin and ibuprofen 

Like with many medications, you might experience some side effects when using either ibuprofen or acetaminophen. Both drugs have minor side effects like nausea and vomiting. But they each have some side effects that are unique to them. 

Acetaminophen is relatively safe and most people experience no side effects when using the medication. However, you might experience: 

• Headaches
• Itching
• Hives or rash
• Some swelling in your face, throat, tongue or other body parts

If you experience any of the above side effects, you should stop taking acetaminophen and see your doctor. In rare cases, some people might also experience liver or kidney damage from using acetaminophen. This typically occurs when the drug has been used excessively. 

On the other hand, some common side effects you might experience with ibuprofen, but not with acetaminophen include: 

• Heartburn 
• Stomach ache
• Indigestion
• Diarrhea

In rare cases, ibuprofen might also cause more serious side effects like strokes, edema, and stomach bleeding. Overall, Martinez says that acetaminophen is typically considered to be safer than ibuprofen. 

Which one should you take?

Deciding which of these medications to take depends on several factors. Your age, illness, other conditions you might have, or medications you might be taking, play a big factor in determining which of the two pain relief medications will be better for you. 

For illness: Both acetaminophen and ibuprofen work great for illnesses that cause minor pains and fevers, like the cold or flu. "While both are useful for the treatment of mild to moderate pain and fever, some patients find that ibuprofen has a more powerful effect in reducing the intensity of these symptoms," says Sanagapalli.

For injuries: Ibuprofen is good for injuries that might result in both pain and inflammation. For example, if you strain a muscle, ibuprofen will be better for you, as it will help with the swelling and inflammation around the strained muscle. 

For pain relief: Both drugs are effective for treating pain and fevers. But while ibuprofen can help with inflammation and swelling, acetaminophen can't. A 2015 review found that when participants were given a standard dose of ibuprofen in different painful conditions, it was more effective at relieving acute pain, migraines, back pain, and osteoarthritis. 

When taken orally, ibuprofen takes about 20 to 30 minutes to work, while acetaminophen can take up to an hour. Both pain-relieving effects typically last for about 4 hours. 

For fever: Research suggests that ibuprofen might be better for treating fevers. In a 2004 meta-analysis comparing the effectiveness of acetaminophen to ibuprofen for treating children's fevers, scientists found that ibuprofen was more effective than acetaminophen for fevers at 2, 4, and 6 hours after it has been given.

Insider's takeaway 

Acetaminophen and ibuprofen are both effective medications used for pain relief and treating fevers. They both have side effects and deciding which is better for you comes down to what you are taking the medication for, what other medications you might be taking, and if you have any other conditions that might be aggravated by the drug. If you are unsure of what to take when in pain, acetaminophen is generally considered to be the safer option.

"Because of its safety, acetaminophen should be the first-line painkiller of choice for most people with mild to moderate pain," says Sanagapalli. "Ibuprofen should be reserved for symptoms not responding adequately to acetaminophen. If ibuprofen is used, it should be ideally limited to short periods. If prolonged use of ibuprofen is required, consult your doctor to discuss whether it is appropriate or if alternatives are available."

If you have any worries about being adversely affected by either medication, it's advisable to talk to your doctor before taking it. 

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• Aspirin vs. ibuprofen: The key differences and which one you should take
• How to recognize the symptoms of magnesium deficiency and effectively treat it
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Toketemu Ohwovoriole is a freelance writer for Insider. 

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