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Is it safe to take Ibuprofen (Advil) with acetaminophen (Tylenol)?

Medically reviewed by Carmen Fookes, BPharm. Last updated on Nov 3, 2020.

Official Answer

by Drugs.com

Yes, it is safe to take ibuprofen (Advil) and acetaminophen (Tylenol) together if you need to for extra pain relief. Taking ibuprofen and acetaminophen together is quite an effective combination for pain relief because they work in different ways and have different side effects.

But you should only take them together if you need to, and only if it is safe to do so. Some people should not take ibuprofen because they are taking other medications that interact or they have medical conditions, such as stomach ulcers, that make it unsafe to take it. Some people should not take acetaminophen if they have medical conditions such as liver disease, or take other medications that may interact.

If you do take ibuprofen and acetaminophen together then do not exceed the recommended daily dose of each one. Only take them together for a short period – no longer than two or three days unless your doctor has told you to take them for longer.

Is there any evidence to support taking acetaminophen and ibuprofen together?

Research does support taking ibuprofen and acetaminophen in combination as being more effective than taking either one alone.

Ibuprofen 200 mg/paracetamol 500 mg and ibuprofen 400 mg/paracetamol 1000 mg were significantly more effective in providing sustained pain relief in adults with moderate to severe acute dental pain than comparable doses of ibuprofen or paracetamol alone.1

The combination of ibuprofen and acetaminophen was just as effective as oxycodone, hydrocodone, or codeine in combination with acetaminophen in a trial of 416 patients in moderate to severe pain (baseline score of 8.7).2,3

What is ibuprofen?

Ibuprofen is a pain-relief medicine that can be brought over the counter from a supermarket, drug store, or gas station. Brand names include Advil and Motrin.

Ibuprofen works by blocking COX enzymes which are needed to make prostaglandins, which are involved in inflammation (redness and swelling). By blocking these enzymes, ibuprofen decreases inflammation.

Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID).

What is the dosage of ibuprofen?

The usual dosage of ibuprofen for adults is 200 to 400 mg orally (one or two 200mg tablets) every 4 to 6 hours as needed. The maximum dosage for ibuprofen brought over the counter is 1200mg. If you get ibuprofen prescribed by your doctor, he may put you on a higher dosage but if you are buying it over the counter you should never take more than 1200mg per 24 hours (which is 6 x 200mg tablets).

Children weighing less than 11kg or younger than 12 years will need a lower dosage.

What is acetaminophen?

Acetaminophen is another pain-relief medicine that can be brought over the counter. Brand names for acetaminophen include Tylenol. In some countries, acetaminophen is called paracetamol.

Acetaminophen has a unique way of working, although it is still thought to work by inhibiting certain COX enzymes.

What is the dosage of acetaminophen?

The usual adult dosage of acetaminophen (Tylenol) is two 500mg tablets every 6 hours a maximum daily dose of 8 tablets a day (or a total dosage of 4000mg in 24 hours, although a total daily dosage of no more than 3000mg is considered safer). Children and adults weighing less than 50kg will need a lower dosage.

Be aware that some OTC medications contain acetaminophen in a variety of doses, usually 325 mg, 500 mg, or 650 mg. It may be listed as APAP on the label.

Examples of medicines that also contain acetaminophen include DayQuil, Dimetapp, Excedrin, Midol, NyQuil, and Sudafed. Always read the product label for hidden acetaminophen as you should not take more acetaminophen than recommended.

Taking ibuprofen and acetaminophen together.

Ibuprofen and acetaminophen can be taken together, and they are often prescribed together. But you need to pay close attention to the dosage of each medicine that you are taking, and you should only take them both together if your pain is not being relieved by either one alone.

How much ibuprofen and acetaminophen can I take?

The key to safely taking acetaminophen and ibuprofen is not exceeding the recommended dosage of each one. There are three different ways you can take ibuprofen and acetaminophen:

  • Both at the same time. For example, every six hours you take a recommended dose of ibuprofen and one of acetaminophen. Your dosing schedule may look something like this: 6am ibuprofen 400mg/acetaminophen 1000mg; 12pm ibuprofen 400mg/acetaminophen 1000mg; 6pm ibuprofen 400mg/acetaminophen 1000mg; 12am ibuprofen 400mg/acetaminophen 1000mg
  • Alternating doses: This allows you to spread the dosage more evenly throughout the day and is good for people still experiencing breakthrough pain or stomach pain while taking the combination: 6am ibuprofen 400mg; 9am acetaminophen 1000mg; 12pm ibuprofen 400mg; 3pm acetaminophen 1000mg; 6pm ibuprofen 400mg; 9pm acetaminophen 1000mg; 12am ibuprofen 400mg; 3am acetaminophen 1000mg
  • Alternating days: This decreases the total amount of medicine you are taking and may help people who have constant chronic pain. Your dosing schedule may look something like this: Ibuprofen on Monday, acetaminophen on Tuesday, ibuprofen on Wednesday, acetaminophen on Thursday, and so on.

Of course, if you are asleep or you are not experiencing pain, you do not need to take a dose of either acetaminophen or ibuprofen just because it is the right time to take it.

Some people may experience stomach or abdominal pain when taking ibuprofen and acetaminophen together. In this case, it may be best to take alternating doses of the medicines or to only take one of them.

Can I mix acetaminophen and ibuprofen with other OTC pain relievers?

It starts to get confusing if you start mixing acetaminophen or ibuprofen with other OTC pain relievers, such as naproxen or diclofenac. Generally, you should always talk to your doctor or pharmacist before you mix your pain relievers. While acetaminophen can be taken with naproxen or diclofenac, ibuprofen cannot, and you may increase your risk of serious side effects if you take ibuprofen with other pain relievers such as naproxen or diclofenac.

Can you overdose on acetaminophen and ibuprofen?

If you exceed the recommended daily dosage of either acetaminophen or ibuprofen then it is possible to overdose. Contact your health provider immediately if you experience any of the following:

  • Abdominal or stomach pain
  • Blurred vision
  • Convulsion
  • Diarrhea
  • Dizziness
  • Heartburn
  • Indigestion
  • Nausea or vomiting
  • Rash
  • Sweating
  • Tinnitus (ringing in the ears).
References
  1. Mehlisch DR, Aspley  S, Daniels  SE, Southerden  KA, Christensen  KS. A single-tablet fixed-dose combination of racemic ibuprofen/paracetamol in the management of moderate to severe postoperative dental pain in adult and adolescent patients: a multicenter, two-stage, randomized, double-blind, parallel-group, placebo-controlled, factorial study. Clinical therapeutics 2010; 32(6): 1033‐1049.
  2. Ibuprofen and Acetaminophen Combo As Effective as Opioid Analgesia for Acute Pain. Nov 9, 2017. Trends in Medicine. Harvard Medical School https://trends.hms.harvard.edu/2017/11/09/ibuprofen-and-acetaminophen-combo-as-effective-as-opioid-analgesia-for-acute-pain/
  3. Effect of a Single Dose of Oral Opioid and Nonopioid Analgesics on Acute Extremity Pain in the Emergency Department. A Randomized Clinical Trial. Andrew K. Chang, MD, MS; Polly E. Bijur, Ph.D., et al. JAMA. 2017;318(17):1661-1667

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