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 drug) 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 using these pain relievers together is safe, 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 of ibuprofen and acetaminophen. The standard dosage for OTC ibuprofen is 200 to 400 mg every six hours. Adults should not take more than an absolute maximum of 3,200 mg of ibuprofen daily. Given the potential for adverse effects with higher doses in many patient populations, patients should take the smallest dose needed to alleviate pain. Patients should start with lower doses and not exceed 1,200 mg per day, before pushing doses to the 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.

Acetaminophen is typically available in strengths of 325 to 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 your primary care provider 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 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 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 people should be aware of before taking ibuprofen and acetaminophen, as well as medications that interact with them. Ibuprofen and acetaminophen should be avoided or taken at a reduced dose when 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 the effectiveness of ACE inhibitors and diuretics)
• Lithium (ibuprofen may increase the risk of Lithium toxicity)
• Methotrexate (ibuprofen may increase risk of methotrexate toxicity)
• Corticosteroids (may increase the risk of stomach ulcers or bleeding)
• Tobacco (may increase the risk of stomach ulcers or bleeding)
• Alcohol (may increase the risk of stomach ulcers or bleeding)
• History or risk of stomach ulcers
• History of high blood pressure
• Renal disease
• Being 65 or older or having other health conditions that may increase the risk of stomach ulcers or bleeding
• History of allergic reaction to NSAID or aspirin
• 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).

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). Only take the recommended dosages when combining ibuprofen and acetaminophen for acute pain management.

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 immediately. It is especially important to urgently seek help for 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 the risk of overdose, avoid high doses. The maximum daily 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 immediately. Severe liver damage caused by acetaminophen sometimes takes 48-72 hours to take effect and may not be evident at first.