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Is It Safe to Take Tylenol (Acetaminophen) with Advil or Motrin (Ibuprofen)?

by Dr. Sharon Orrange on July 21, 2015 at 9:40 am

It’s a question that comes up a lot: Is it safe to take acetaminophen with ibuprofen?

Yes, you can take them together, and in fact they even work better in combination than separately. Several large studies have shown that ibuprofen (Advil, Motrin) and acetaminophen (Tylenol) together work well to relieve pain, with few side effects. In fact, for many things like dental pain, they work better than many of the opioid-containing pain meds (like Vicodin or Norco).

Why is the combination safe?

Acetaminophen is cleared by the liver, while ibuprofen is cleared by the kidneys. Each medication works differently and they are broken down differently so there is minimal concern here.

How are acetaminophen and ibuprofen different?

  • Anti-inflammatory effects: Acetaminophen is a pain reliever and fever reducer but not an anti-inflammatory. Ibuprofen is all three.
  • The stomach: Ibuprofen inhibits prostaglandin and prostacyclin—this is how it works as an anti-inflammatory—but this may also result in irritation of your stomach and esophagus. Acetaminophen doesn’t do this (remember, it isn’t an anti-inflammatory) so it is safe on the stomach, while ibuprofen can cause gastritis and gastrointestinal bleeding when used long term.
  • The liver: Acetaminophen (Tylenol) is broken down almost completely by the liver, so the kidneys hardly do any of the work. Acetaminophen is safe on the kidneys. Ibuprofen, on the other hand, is very liver-safe because it is hardly processed by the liver at all.
  • The kidneys: Again, the liver does most of the work breaking down acetaminophen so it is very safe on the kidneys. With ibuprofen this is not the case. With ibuprofen, the anti-inflammatory properties that can irritate your stomach also cause dilated blood vessels leading to the kidneys, which may lead to acute kidney injury. However, kidney injury from ibuprofen is rare if it’s taken at normal doses for short periods of time.

How much acetaminophen can I take?

The recommendation is 325 mg to 650 mg every 6 hours, or 1000 mg (2 extra strength tablets) every 8 hours or twice a day.

The maximum dose is 4 grams per day, which would be 8 extra strength Tylenol (500 mg each) or 12 regular strength (325 mg) tablets. Don’t take more than that.

How much ibuprofen can I take?

For the treatment of mild to moderate pain, 200 mg to 400 mg of ibuprofen will work. Generally taken every 6 to 8 hours, the maximum dose of Ibuprofen is 2400 mg per day which is 12 over-the-counter tablets.

Especially in light of the recent FDA recommendations, be sure not to take more ibuprofen or acetaminophen than you need to relieve your pain. Always ask your doctor or pharmacist if you aren’t sure of the right dose for your situation.

Dr O.

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