Over-the-counter pain relievers come in handy for headaches, fever, chronic pain, and more—and when you’re down for the count, you may find yourself wondering if it’s possible to self-treat with a combination of them. The two most popular pills are Tylenol and Advil, a.k.a. acetaminophen and ibuprofen.
Meet the Experts: Richard Watkins, M.D., an infectious disease physician and a professor of internal medicine at the Northeast Ohio Medical University; John Sellick, D.O., an infectious disease expert and professor of medicine at the University at Buffalo/SUNY in New York; Jamie Alan, Pharm. D., Ph.D., associate professor of pharmacology at Michigan State University; and David Cennimo, M.D., associate program director of the internal medicine and pediatrics residency program at Rutgers New Jersey Medical School.
Can you take the two together? It’s a great question, and one worth asking any time you find yourself reaching into the medicine cabinet, just to be safe. Below, doctors weigh in on the topic and share their insights on taking ibuprofen and acetaminophen together. Here’s what you need to know.
About ibuprofen and acetaminophen
Ibuprofen (i.e. Advil, Motrin IB) is a non-steroidal anti-inflammatory drug (NSAID) that’s often used in its nonprescription form to reduce fever, swelling, and minor pain from headaches, muscle aches, arthritis, menstrual cramps, and the common cold or flu, according to the U.S. National Library of Medicine. Ibuprofen works by inhibiting your body’s production of substances that can cause pain, fever, and inflammation.
Acetaminophen (i.e. Tylenol) is essentially used for the same reasons as ibuprofen—it’s just in a different class of medications called analgesics (pain relievers) and antipyretics (fever reducers). The exact mechanism for how acetaminophen works isn’t entirely understood, but it helps cool down the body while altering the way your body senses pain.
Can you take ibuprofen and acetaminophen together?
If you’re having minor pain or discomfort from a respiratory virus, injury, or chronic condition, it’s best to start by taking just one medication to see if it helps, says Richard Watkins, M.D., an infectious disease physician and a professor of internal medicine at the Northeast Ohio Medical University.
You should always read the label to find out how much you should take. If the recommended dosage of ibuprofen or acetaminophen doesn’t help, you could try alternating the two. This is “an old trick of family doctors and pediatricians to decrease fever, since it allows more drug to be taken within the dosing limits,” says John Sellick, D.O., an infectious disease expert and professor of medicine at the University at Buffalo/SUNY in New York.
It’s safe to do this, as long as you carefully follow the dosing instructions on the bottle (or talk to your pharmacist beforehand to ensure you’re cycling properly). Here’s how it works: “Once you take a dose, you have a rise in the levels [of the particular drug] in your body and then a gradual fall in the levels,” explains Jamie Alan, Pharm. D., Ph.D., associate professor of pharmacology at Michigan State University. “Once the levels start to fall, symptoms of fever may re-emerge. However, the levels of the drug [in your body] have not fallen enough to safely take another dose.”
However, taking a different medication—acetaminophen if you took ibuprofen first or vice versa—will help “ward off the symptom using a different mechanism,” Alan says. “By the time you are set to take the first medication again, the levels have fallen to a safe dose, and the cycle continues.”
How much ibuprofen and acetaminophen can you take together?
“You should not exceed the maximum daily dose of either product because of risks of toxicity,” explains David Cennimo, M.D., associate program director of the internal medicine and pediatrics residency program at Rutgers New Jersey Medical School. “People sometimes forget that acetaminophen can be in other things—like cough/cold medications—so they inadvertently take too much.”
The standard dosage for OTC ibuprofen is 200 milligrams (mg) per pill. That for acetaminophen varies—it can come in 325 mg, 500 mg, and 650 mg extended-release pills. It’s important that you note which one you’re taking before establishing a dosage schedule. If you’re unsure, ask your doctor.
For an adult, an alternating schedule between the two medications could look like this, according to the University of Connecticut’s Student Health Center:
*6:00 a.m.: Ibuprofen 200 mg, 2 tablets with food
*9:00 a.m.: Acetaminophen 500 mg, 2 tablets
*12:00 p.m.: Ibuprofen 200 mg, 2 tablets with food
*3:00 p.m.: Acetaminophen 500 mg, 2 tablets
*6:00 p.m.: Ibuprofen 200 mg, 2 tablets with food
*9:00 p.m.: Acetaminophen 500 mg, 2 tablets
Dr. Cennimo also notes that if your symptoms aren’t too bad, you don’t have to take medication at all, even if you have a fever. “In my personal practice, I only advocate treating fever if it is causing a deleterious effect or making the person uncomfortable,” he explains.
What about drugs that combine acetaminophen and ibuprofen? Are they safe?
There are drugs like Advil Dual Action that contain 250 milligrams of acetaminophen and 125 milligrams of ibuprofen. Before you try one, make sure you’re not already taking a drug (like OTC cold meds) that contains acetaminophen or ibuprofen since taking too much of either drug can be dangerous, says Dr. Alan.
If you have a fever or body aches and cycling through ibuprofen and acetaminophen in appropriate doses isn’t helping, you technically can take both medications at once as long as you “dose the drugs carefully and on the correct schedule so that toxicity will be minimized,” Dr. Sellick says. “Too much acetaminophen is liver toxic. Ibuprofen can be kidney toxic.”
Bottom line: Always read the labels on the bottle for dosing instructions. And when in doubt, talk to your prescribing doctor or pharmacist to ensure you’re taking all of your medications safely.
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