Acetaminophen vs Ibuprofen: Which Should You Take?

When you reach for a pain reliever, you're typically choosing between acetaminophen (Tylenol) and ibuprofen (Advil, Motrin). Both are effective, widely available without a prescription, and generally safe when used correctly — but they work differently, treat different types of pain better, and carry distinct risks.

Understanding which one to use isn't just about what's in your medicine cabinet. The right choice depends on your symptoms, medical history, and what else you're taking. Here's everything you need to know to make the best decision.

How They Work: The Key Difference

Acetaminophen (Tylenol)

Acetaminophen works primarily in the brain and spinal cord. It blocks pain signals and lowers your temperature set-point in the hypothalamus, making it excellent for fever. However, it does not reduce inflammation — it won't help with swelling, redness, or inflammatory conditions like arthritis.

Ibuprofen (Advil, Motrin)

Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID). It works by blocking enzymes called COX-1 and COX-2, which produce prostaglandins — chemicals that cause inflammation, pain, and fever. Because it targets inflammation at the source, ibuprofen is better for conditions involving swelling and tissue damage.

Quick Comparison Table

When to Use Acetaminophen

Best for:

• Headaches — especially tension headaches
• Fever — first-line treatment for reducing temperature
• Minor aches and pains without swelling
• Post-surgery pain when NSAIDs are contraindicated
• Children — widely used for pediatric fever and pain

Choose acetaminophen if you:

• Have a sensitive stomach or history of stomach ulcers
• Take blood thinners (warfarin, aspirin)
• Have kidney disease or heart problems
• Are pregnant (considered safer than NSAIDs in pregnancy)
• Are over 65 and taking multiple medications

When to Use Ibuprofen

Best for:

• Muscle pain and soreness — post-workout, injuries, sprains
• Arthritis and joint pain — targets inflammation
• Menstrual cramps — reduces prostaglandins that cause uterine contractions
• Dental pain — especially after extractions or procedures
• Back pain — works better than acetaminophen for musculoskeletal pain
• Inflammatory conditions — tendinitis, bursitis, gout flares

Choose ibuprofen if you:

• Have swelling, redness, or inflammation
• Need relief from sports injuries or muscle strains
• Have chronic inflammatory conditions (arthritis)
• Can take it with food (reduces stomach irritation)

Who Should Avoid Ibuprofen?

• History of stomach ulcers or GI bleeding
• Heart disease, recent heart attack, or stroke
• High blood pressure (NSAIDs can raise BP)
• Kidney disease (NSAIDs can worsen kidney function)
• Taking blood thinners (warfarin, Eliquis, Xarelto)
• Third trimester of pregnancy
• Scheduled for surgery within 1-2 weeks (bleeding risk)

Can You Take Both Together?

Yes, but carefully. Because acetaminophen and ibuprofen work through different mechanisms, they can be taken together for more effective pain relief. This is sometimes recommended for conditions like severe dental pain, post-surgical pain, or migraine.

Always consult your doctor or pharmacist before combining medications, especially if you're taking other drugs or have medical conditions.

Side Effects Comparison

Acetaminophen Side Effects

• Common: Generally very few — nausea (rare), rash (rare)
• Serious: Liver damage (with overdose or chronic high doses), severe skin reactions (rare)

Ibuprofen Side Effects

• Common: Stomach upset, heartburn, nausea, dizziness, bloating
• Serious: Stomach ulcers/bleeding, heart attack, stroke, kidney damage, high blood pressure, allergic reactions

Drug Interactions

Acetaminophen Interactions

• Alcohol: Greatly increases liver damage risk
• Warfarin: May increase bleeding risk with regular acetaminophen use
• Other acetaminophen products: Easy to accidentally overdose

Ibuprofen Interactions

• Aspirin: Ibuprofen may reduce aspirin's heart-protective effects
• Blood thinners: Increased bleeding risk
• Blood pressure medications: NSAIDs can reduce their effectiveness
• SSRIs/antidepressants: Increased bleeding risk
• Corticosteroids: Increased stomach ulcer risk

Special Populations

Pregnancy

Acetaminophen is generally considered safe during pregnancy (all trimesters). Ibuprofen is safe in the first and second trimesters but should be avoided in the third trimester due to risks to the baby's heart and kidneys.

Children

Both are widely used in pediatrics. Acetaminophen (infant Tylenol) can be given from birth. Ibuprofen (infant Advil/Motrin) is approved for babies 6 months and older. Always use weight-based dosing and consult a pediatrician.

Older Adults (65+)

Acetaminophen is generally preferred for seniors due to lower risk of drug interactions, kidney problems, and cardiovascular events. If NSAIDs like ibuprofen are needed, use the lowest effective dose for the shortest time.

The Bottom Line

Both medications are safe and effective when used as directed. The key is matching the drug to your symptoms and medical history. When in doubt, ask your pharmacist or doctor — they can help you choose based on your specific situation and other medications you're taking.