Is it safe to take ibuprofen and Tylenol together?

Ibuprofen and acetaminophen | Dosage | Side effects | Interactions | Which is safer | Mixing OTC pain relievers | Overdose

Over-the-counter (OTC) pain relievers are a great option to treat everyday aches and pains. They are widely available and help remedy mild to moderate pain from a variety of conditions: sore throats, menstrual cramps, toothaches, sprains, muscle aches, abdominal pain, minor aches, headaches, arthritis pain, and most acute pain. Some of the most popular pain medications are ibuprofen and acetaminophen.

You might know acetaminophen by its brand name, Tylenol. Ibuprofen is also a generic pain reliever branded as Advil and Motrin. 

“Acetaminophen is a medication that is usually metabolized by the liver,” says Sasan Massachi, MD, a primary care physician in Beverly Hills, California. “Ibuprofen is an NSAID (nonsteroidal anti-inflammatory drugs) that causes inhibition in a specific enzyme within the body. ”

 Both acetaminophen and ibuprofen reduce fevers and pain effectively. However, ibuprofen also reduces inflammation and has antiplatelet effects. As an antiplatelet, ibuprofen reduces blood clots and may increase the risk of bleeding.

RELATED: Acetaminophen details | Ibuprofen details

Can you take Tylenol and ibuprofen together?

It is safe to use acetaminophen and ibuprofen together in the recommended amount. A 2019 Cochrane Review found ibuprofen plus paracetamol (another name for acetaminophen) provided better pain relief than either drug alone and reduced the chance of needing additional pain relievers over approximately eight hours. 

Although it is safe to use these pain relievers together, Dr. Massachi only recommends taking acetaminophen and ibuprofen simultaneously in rare cases. “Sometimes we have patients alternate by taking ibuprofen or Tylenol specifically as a fever reducer, so we are able to get the benefits of both medications without the risk of side effects,” he says.

How much ibuprofen and acetaminophen can I take together?

Ibuprofen and acetaminophen can be safely used together, but they should always be used at the lowest possible doses to achieve relief and the recommended daily dose should not be exceeded.

“The usual safe doses for ibuprofen is up to [a maximum of] 800 milligrams (mg) per dose every eight hours and acetaminophen 650 mg every six hours if taken together, assuming normal kidney and liver functions,” according to Dr. Massachi.

There are a variety of doses for ibuprofen and acetaminophen. The standard dosage for OTC ibuprofen is 200-400 mg every six hours. Adults should not take more than an absolute maximum of 3,200 mg of ibuprofen per day. Given the potential for adverse effects with higher doses in many patient populations, patients should take the smallest dosage needed to alleviate pain. Patients should start with lower doses, achieving doses no greater than 1,200 mg per day, prior to pushing doses to the absolute maximum daily dose of 3,200 mg per day. It is important to pay close attention to the package labels when taking OTC ibuprofen or acetaminophen. It is especially important to pay attention to the age of the person taking the medication. Children have different recommended dosages than adults. It is a good idea for parents with concerns to talk to a pharmacist or pediatrician when unsure of what dose to give a child.

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Acetaminophen is typically available in strengths of 325-650 mg. A single dose is usually two 325 mg pills taken every six hours. The maximum amount of acetaminophen is no more than 1,000 mg at one time or 3,000 mg within 24 hours. In rare scenarios, a healthcare professional may advise a patient it is safe to take up to 4,000 mg of acetaminophen in 24 hours. Do not use more than the recommended amount of acetaminophen, especially for prolonged periods of time and if not under the advice of a healthcare professional, because it can be harmful to the liver and cause permanent damage.

Always ask a healthcare professional, such as a doctor or pharmacist, if you’re ever unsure how much medicine to take. They can also help you determine which other OTC medications may include “hidden” similar ingredients, such as flu and cold medications.

Side effects of ibuprofen and acetaminophen

It is safe to take these two OTC pain relievers together in the recommended doses. Both pain relievers also come with side effects, and they can be harmful in cases when an overdose occurs.

Side effects of ibuprofen

• Gas or bloating
• Diarrhea
• Constipation
• Ringing of the ears
• Dizziness
• Nervousness
• Increased blood pressure

Side effects of acetaminophen

• Nausea
• Headache or lightheadedness
• Trouble urinating
• Dark stool
• Itching

Rare but serious adverse events of ibuprofen and acetaminophen include allergic reactions (rash, hives, swelling), hoarseness, difficulty breathing or swallowing, and chest pain. Too much ibuprofen can cause gastrointestinal bleeding, and it can worsen stomach ulcers. Severe liver damage may occur with the overuse of acetaminophen. Rare, but serious skin reactions may occur with acetaminophen, such as Stevens-Johnson Syndrome (SJS), toxic epidermal necrolysis (TEN), and acute generalized exanthematous pustulosis (AGEP). These symptoms require medical attention. You should call 911 or seek out an emergency department as soon as possible.

Ibuprofen and acetaminophen: Interactions

There are some risk factors that should be used with caution with ibuprofen and acetaminophen, as well as medications that interact with them. Ibuprofen and acetaminophen should be avoided or taken at a reduced dose when any of these risk factors or medication interactions are present. A healthcare provider should be consulted when there is uncertainty about taking ibuprofen or acetaminophen. 

Interactions with ibuprofen

• Other NSAIDs
• Aspirin
• Blood thinners (warfarin)
• Blood pressure medications (ibuprofen may decrease effectiveness of ACE-inhibitors and diuretics)
• Lithium (ibuprofen may increase risk of Lithium toxicity)
• Methotrexate (ibuprofen may increase risk of methotrexate toxicity)
• Corticosteroids (may increase risk of stomach ulcers or bleeding)
• Tobacco (may increase risk of stomach ulcers or bleeding)
• Alcohol (may increase risk of stomach ulcers or bleeding)
• Pregnancy: ibuprofen should never be taken while pregnant without consulting a healthcare provider first. It should especially be avoided in the third trimester due to heart risks of the fetus (closure of the ductus arteriosus)
• History or risk of stomach ulcers
• History of high blood pressure
• Renal disease
• Elderly or debilitated patients (may increase risk of stomach ulcers or bleeding)
• History of allergic reaction to NSAID or aspirin

Interactions with acetaminophen

• Alcohol
• Disulfiram (alcoholism treatment)
• Acetaminophen-containing OTC products
• Liver disease or liver failure
• History of allergic reaction to acetaminophen
• History of Stevens-Johnson Syndrome (SJS), toxic epidermal necrolysis (TEN), and acute generalized exanthematous pustulosis (AGEP)

RELATED: OTC painkillers with alcohol | OTC painkiller while pregnant

Which is safer: ibuprofen or acetaminophen? 

“One isn’t safer than the other,” says Dr. Massachi. “They both have their own issues and potential for side effects and abuse and must be taken with caution and in appropriate quantities to ensure they are effective while also being non-hazardous. But one isn’t more effective than the other per se, and choosing which drug to take should align with the patient’s symptoms (e.g., fever versus joint pain).”

Mixing OTC pain relievers

Make sure you safely combine OTC pain relievers to avoid complications.

Ibuprofen is an NSAID and should not be combined with other NSAIDs. NSAIDs use the same mechanism in the body. They are all eliminated by the same mechanisms, through the kidneys, and can lead to overdose and severe side effects when combined.

Acetaminophen is not an NSAID and can be safely mixed with NSAIDs such as Advil, Motrin, Aspirin, or Aleve (naproxen). When combining ibuprofen and acetaminophen for acute pain management, only take the recommended dosages.

Be mindful of OTC products that may include NSAIDs and/or acetaminophen as combination formulations, such as medications for cough and cold symptoms or sleep assistance Always ask a pharmacist or healthcare professional if you are unsure of the ingredients of any product.

How do I know if I’ve taken too much? 

If too much ibuprofen or acetaminophen has been ingested, get help right away. It is especially important to urgently seek help in the case of an acetaminophen overdose because it can be fatal. In general, the recommended dose should be taken as the least amount of medication needed should be taken for the least amount of time. These medications should be taken as directed per the package dosage instructions or instructions from a prescriber. To avoid unwanted effects and risk of overdose, high doses should be avoided or used minimally. The daily maximum dosage should never be exceeded.

Symptoms of ibuprofen overdose

• Upset stomach
• Gastrointestinal bleeding
• Kidney damage
• Depressed mood
• Apnea (difficulty breathing)
• Metabolic acidosis
• Life-threatening hypokalemia (low potassium)
• Thrombocytopenia (low platelet level)

Symptoms of acetaminophen overdose

• Nausea
• Vomiting
• Excessive sweating
• Malaise
• Liver toxicity
• Hypoglycemic coma
• Thrombocytopenia (low platelet level)

Remember, if an overdose is suspected, it is important to get medical help right away. Severe liver damage caused by acetaminophen sometimes takes 48-72 hours to take effect and may not be evident at first. 

References

• Ibuprofen and acetaminophen for postoperative pain, Cochrane Review published on the National Institutes of Health (NIH)
• Ibuprofen and Acetaminophen combination as effective as opioids, Harvard
• Use caution with pain relievers, Food and Drug Administration (FDA)
• Motrin package insert, Food and Drug Administration (FDA)
• Acetaminophen package insert, Food and Drug Administration (FDA)
• Ibuprofen toxicity, National Institutes of Health (NIH)

Can You Take Tylenol and Ibuprofen Together? Dosage and More

Acetaminophen and ibuprofen are two of the most popular over-the-counter (OTC) medications available.

These medications are used to relieve body pain, ease fevers, and can reduce inflammation. 

Acetaminophen (the generic name for Tylenol) and ibuprofen (the generic name for Advil or Motrin) belong to different medication classes, and they work differently.

While ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID), acetaminophen is an analgesic, and does not help reduce inflammation. 

Often, people use these medications separately.

But you may have wondered if you can take acetaminophen and ibuprofen together for better results or to help ease multiple symptoms.

This guide will help you make that decision.

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Maximum Acetaminophen and Ibuprofen Dosage

Patients frequently use acetaminophen and ibuprofen for headaches, colds, and fevers.

They are also used to soothe lower back pain and all-around body pain. 

While you may already be familiar with these medications, it’s worth knowing the maximum acceptable dosage to prevent overdose and severe side effects. 

Acetaminophen dosage

The typical adult dose for acetaminophen is 325-650mg, to be taken every 4-6 hours within 24 hours.

However, the total daily dose for adults should not exceed 4000mg (4g).

Recommended doses for children depend on their weight.

If you’re giving OTC acetaminophen to children, stick to the recommended dosage on the label or consult a pediatrician.  

Infants and smaller children should be given their medicine with droppers.

These droppers ensure that your child gets a more precise dose; if your child’s medicine comes with a dropper, do not administer the medication with a spoon or any other tool besides the dropper. 

If you’re giving your child acetaminophen alongside other medications, check to see if the other medications contain acetaminophen to avoid administering more than the recommended dose.

Ibuprofen dosage

Ibuprofen dosage will vary depending on what you’re taking it for.

For adult use, the dosage is based on the condition you’re treating or the severity of your pain. 

For pain, you can take 200-400mg every 4-6 hours, as needed, for the following conditions: 

• Menstrual cramps
• Mild to moderate pain
• Fever
• Minor pains of arthritis 

You don’t get more pain relief at higher doses, but do get more anti-inflammatory effect.

For that reason, the dosage for osteoarthritis and rheumatoid arthritis is 1200-2400mg per day divided into 3-4 equal doses and taken orally.  

For children, the recommended ibuprofen dosage is based on body weight.

A liquid form is available for infants and smaller children, and chewable tablets are available for older children.

Ibuprofen should not be used for infants under 6 months old. 

Follow the dosing on the package, or check with your pediatrician for the correct dose for your child. 

Taking Acetaminophen and Ibuprofen at the Same Time 

Given that ibuprofen and acetaminophen are both used for pain and fevers, you may be wondering if you can use them together to treat your pain and symptoms.

The short answer is yes, you can.

Read on to learn more about why, and how to safely take acetaminophen and ibuprofen at the same time.

Is it safe? Why? 

Studies have shown that taking acetaminophen and ibuprofen at the same time is safe and even provides greater pain relief.

This is because acetaminophen and ibuprofen work differently in the body, and are eliminated by different organs.

The liver removes acetaminophen, while the kidneys eliminate ibuprofen. 

Since there are separate routes of elimination, taking these two medications at the same time would not overtax the same organ, making this a safe combination of pain relief.

The liver and kidneys share the workload, and pain relief is achieved without exceeding the daily dose limit of each medication.

Other OTC pain relievers 

Other common OTC pain relievers like naproxen and aspirin (which are other NSAIDs that work similarly to ibuprofen) can also be safely combined with acetaminophen.

However, never mix these medications with ibuprofen because they’re the same kind of drug, and a combination can cause kidney damage or other severe side effects.  

As a reminder, aspirin should never be given to children or infants.

Side Effects of Acetaminophen and Ibuprofen 

Despite being available over the counter, you still need to be cautious in your use of these medicines.

Like all medications, they can have potentially dangerous side effects if not used properly. 

Acetaminophen side effects 

Acetaminophen is very safe when used in recommended doses, but it’s still important to be aware of potential side effects.

Side effects that may occur when taking acetaminophen include:

• Nausea
• Stomach upset
• Loss of appetite
• Rash

Some people may develop Stevens-Johnson Syndrome in reaction to acetaminophen, a very rare but serious allergic reaction.

Seek help from your medical provider if you notice skin reactions like redness, blisters, rashes, itching, or swelling of the face, tongue, and skin. 

Another rare side effect of acetaminophen is that, because it’s cleared by the body through the liver, chronic use in high doses can cause liver toxicity.

However, you are unlikely to experience this side effect if you take the normal therapeutic dose. 

If you have an existing liver problem, talk to your doctor or health care provider before using acetaminophen.

Ibuprofen side effects 

Like other NSAIDs, ibuprofen can worsen existing stomach ulcers, and prolonged use of ibuprofen can lead to stomach ulcers. 

If you have a stomach ulcer, talk to your doctor or health provider before taking this medication.

They will likely prescribe a different type of painkiller or give you a proton pump inhibitor to help protect your stomach from ulcers. 

Other side effects  of Ibuprofen include:

• Bloating 
• Indigestion
• Diarrhea
• Itching skin

Long-term use of ibuprofen can also cause an increased risk of heart attacks. 

When taken together 

When taken together, acetaminophen and ibuprofen may provide better pain relief.

There is no evidence of higher risk or the occurrence of additional harmful side effects when they are used together. 

As long as you stay within the recommended dosages for both medications, you’re unlikely to experience any problems.

Any side effects you encounter are most likely from the individual medications and not caused by the combination. 

How to Know When You’ve Taken Too Much 

If you already combined acetaminophen with ibuprofen and you suspect that you’ve taken too much, don’t panic.

Your local poison control center (1-800-222-1222) can help you figure out if you’ve taken a dangerous amount.

Overdose symptoms 

A dangerous acetaminophen overdose may have no symptoms at all, but it is rare to take a dangerous amount of either ibuprofen or acetaminophen accidentally. 

Here are some symptoms to watch out for:

• Nausea and vomiting 
• Heartburn and stomach pain
• Dizziness 
• Diarrhea
• Sweating 
• Tinnitus (ringing in the ears) 
• Rash
• Blurred vision
• Convulsions

Talk to a doctor online

Refill medications and get certain necessary prescriptions.

Start now

When to See a Doctor 

Stop using acetaminophen and ibuprofen immediately and see a doctor if you notice any of these symptoms: 

• Difficulty breathing
• Serious abdominal pain
• Chest tightness 
• Swelling
• Skin rashes 
• Yellowing of the skin or eyes

Check with your doctor before using acetaminophen and ibuprofen if you: 

• Are pregnant 
• Have liver problems 
• Have kidney problems 
• Have a history of cardiovascular problems 
• Have stomach ulcers 
• Are taking other medications that might interact with acetaminophen or ibuprofen (such as other NSAIDs, for example)

How K Health Can Help

Did you know you can get affordable virtual primary care with K Health?

Check your symptoms, explore conditions and treatments, and if needed, text with a healthcare provider in minutes.  

K Health’s AI-powered app is HIPAA compliant and is based on 20 years of clinical data.

Frequently Asked Questions

Are there risks of mixing Tylenol and Advil?

You only face risks combining these medications if you have pre-existing conditions that may not make these medications right for you (like liver issues or stomach ulcers), take them for a prolonged period, or take more than the recommended dose.

Can taking ibuprofen and acetaminophen together make you feel worse than before?

No, there is no evidence that suggests mixing Tylenol and Advil worsens your conditions. As long as you stay within the recommended dose, you should be fine.

Is ibuprofen or acetaminophen more effective for treating pain?

Research has shown that ibuprofen is more effective in treating pain than acetaminophen. It is also used in chronic pain conditions and for inflammation.

K Health articles are all written and reviewed by MDs, PhDs, NPs, or PharmDs and are for informational purposes only. This information does not constitute and should not be relied on for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.

K Health has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions,
and medical associations. We avoid using tertiary references.

• Managing your pain after surgery without opioids (2020)
  https://www. med.umich.edu/1libr/Surgery/MPOPeducation-ManagingPainWithoutOpioids.pdf

• An integrated safety analysis of combined acetaminophen and ibuprofen (Maxigesic®/Combogesic®) in adults (2019)
  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6371943/

• PharmGKB Summary: Ibuprofen pathway (2014)
  https://www. ncbi.nlm.nih.gov/pmc/articles/PMC4355401/

• Alternating Acetaminophen and Ibuprofen for pain in children (2012)
  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3374685/

• Efficacy and safety of ibuprofen and acetaminophen in children and adults: a meta-analysis and qualitative review (2010)
  https://www. ncbi.nlm.nih.gov/books/NBK79235

Mig 400 tab.bp 400mg No. 20 with free home delivery from VkusVill

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MIG® is a modern drug from Germany for getting rid of headaches and other types of pain. MIG® contains the active ingredient ibuprofen. Ibuprofen is recognized as a first-line treatment for headache and migraine attacks by a number of authoritative organizations – the British Association for the Study of Headache, the German Headache and Migraine Society, and the French Drug Authority. Ibuprofen is also on the WHO List of Essential Medicines. MIG® 400 is available in pharmacies without a prescription, it can be used in children over 6 years of age. One MIG® tablet contains 400 mg of ibuprofen. According to the results of foreign and domestic studies, drugs based on ibuprofen at a dose of 400 mg are first-line drugs for the treatment of tension-type headache (THN) and combinations of tension headache and migraine Oval film-coated tablets, white or almost white, with a double-sided risk for dividing and embossing on one side “E” and “E” on both sides of the risk.

Mig 400 tab.p.p.o. 400mg No. 20 / Pharmacy

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Description

MIG® is a modern drug from Germany to get rid of headaches and other types of pain. MIG® contains the active ingredient ibuprofen.
Ibuprofen is recognized as a first-line treatment for headache and migraine attacks by a number of authoritative organizations – the British Association for the Study of Headache, the German Headache and Migraine Society, and the French Drug Authority. Ibuprofen is also on the WHO List of Essential Medicines.
MIG® 400 is available in pharmacies without a prescription and can be used in children over 6 years of age.
One MIG® tablet contains 400 mg of ibuprofen. According to the results of foreign and domestic studies, drugs based on ibuprofen at a dose of 400 mg are first-line drugs for the treatment of tension-type headache (THN) and combinations of tension headache and migraine

Oval film-coated tablets, white or off-white, scored on both sides and embossed on one of the sides “E” and “E” on both sides of the score.

Indications for use

MIG® 400 is used for headache and toothache, migraine, painful menstruation, neuralgia, back pain, joint pain, muscle and rheumatic pain, as well as for fever with influenza and colds.

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INN/Active ingredient Dosage

400 mg

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