Tylenol Vs Advil
These drugs are the most widely available over the counter analgesics* on the market for relief of pain and fever. But how are they different and why does it matter?
In collaboration with Sunset Ridge Pharmacy, let’s break down the differences between these two “Go To” medications and when you might consider grabbing for one verses the other.
Tylenol (Acetaminophen, Paracetamol)
How it works:
Acetaminophen has two main actions: pain reduction and normalizing body temperature. How the drug produces these effects in the body is unclear, but it is thought that acetaminophen reduces pain signals within the brain through serotonergic pathways. It's effect on temperature also appears to occur in the brain, where it “resets” the body’s thermostat to a normal 37*C.
Best for:Although Acetaminophen may not be the strongest over-the-counter pain killer, it is often the drug of choice for managing mild-moderate pain because it is an incredibly safe medication. Acetaminophen’s low risk of side effects (and small number of drug-drug interactions) makes it most useful in treating people with osteoporosis, patients at risk of a gastrointestinal bleeds, patients taking anti-coagulants, children, pregnant women, and patients with renal (kidney) disease. Acetaminophen generally works well for relief of mild-moderate pain when inflammation is absent.
How your body processes it:When being used at normal therapeutic doses, Acetaminophen is metabolized by the liver. A small amount is metabolized by a specific enzyme which creates a very reactive product. The liver quickly soaks up this small amount of product, which creates a non-toxic molecule. When too much acetaminophen is taken, this can cause a large amount of damage to the liver cells. This process has made people believe that acetaminophen is “toxic” to the liver. In fact, when used at normal therapeutic doses, acetaminophen is extremely safe and poses no risk to the liver.
Maximum Daily Dose:
Adults:
Immediate-release:
Regular strength: 650 mg every 4 to 6 hours; maximum daily dose: 3250 mg daily unless directed by health care provider; ONLY under health care provider supervision, daily doses ≤ 4000 mg may be used.
Extra strength: 1000 mg every 6 hours; maximum daily dose: 3000 mg daily unless directed by a health care provider; ONLY under health care provider supervision, daily doses ≤ 4000 mg may be used.
Extended-release:
1300 mg every 8 hours; maximum daily dose: 3900 mg daily
With the elderly or individuals with a history of hepatic (liver) concerns, lower dosages in the 2000-3000mg/day range should be used. Individuals with a history of alcohol abuse should also be limited to 2000-3000mg/day.
Children:
Weight-based dosing:
10 to 15 mg/kg every 4 to 6 hours as needed
* do not exceed 5 doses in 24 hours; maximum daily dose: 75 mg/kg/day
(not to exceed 4000 mg daily)
Note: Acetaminophen is present in many other products used to treat coughs and colds, allergies, pain and sleep disturbances other than those branded as Tylenol. Always check labels for acetaminophen. If acetaminophen is present in multi-symptom products you take, include that amount in your daily maximum total. If you are unsure, ask your pharmacist – they’re happy to help.
Side Effects:Taking too much Acetaminophen can be damaging to your liver. You should not take it if you have had 3 or more alcoholic drinks in a day. Most experts would prefer to limit acetaminophen if alcohol abuse is present, but short-term therapy with up to 2 grams per day is generally safe.
Advil (Motrin, Ibuprofen)
Advil comes in Regular (200mg) tabs. Liquid Gel tabs are intended to provide a faster onset of action. Advil also comes in a Pediatric liquid form (100mg/5ml) and chewable (100mg) tabs
How it Works:Ibuprofen prevents the body from releasing inflammatory signals from cells that have had damage. When these signals are allowed to be released, the body responds with swelling, redness and pain. These same signals are used by the body to increase body temperature. Thus, by blocking these signals, ibuprofen is able to reduce fever, pain and swelling.
Best For:Ibuprofen works better than acetaminophen for any process that has underlying inflammation such as muscle or ligament injuries (for example: sprains), or menstrual pain. Overall, when being used for short-term pain relief, ibuprofen is often considered superior to acetaminophen. It does, however, come with a long list of side effects when used long term. Ibuprofen also works well for controlling a fever.
How your body processes it:
Ibuprofen is metabolized by the liver through oxidation pathways to create products that are excreted by the kidneys.
Maximum Daily Dose:
Adults:
Over the counter (OTC), the max is 1200mg/day
Children:
Over The Counter (OTC)- 10mg/kg (max 400mg) 3x/day to a max of 1,200mg/day.
Side Effects:
Prolonged use of Ibuprofen can lead to kidney damage, heart attack and stroke. It should be avoided before and after surgery. The risk of bleeding is increased for those over age 60 and for people with ulcers. Be cautious taking Ibuprofen if you also take steroids, blood thinners or other NSAIDs, or if you consume more than three alcoholic beverages a day. This medication have potential to cause gastrointestinal irritation, blood clotting disorders, renal impairment and bronchoconstriction (tightening of the airways).
Older patients, people with type 2 diabetes or those with a history of stomach ulcers, kidney problems or heart disease, are more likely to suffer from complications.
Alternating Pain Medications
Alternating pain medications can help achieve better pain control throughout the day. This, however, must be done carefully to ensure medications are taken correctly. Some practitioners recommend against alternating pain medications, particularly in children, due to the risk of overdosing on the medications.
Advil is dosed every 8 hours while Tylenol is dosed every 4 to 6 hours. This difference in dosing times means that it is important to remember what was taken and when – and care given to ensure that maximum daily doses are not exceeded.
Pros: Alternating may provide better pain relief, as you are able to take medications more often. However, the additional relief is usually minimal.
Cons: Alternating can be complicated to keep track of what was taken and when, and special care must be given to ensure the daily maximum for each medication is adhered to.
Conclusion: Review of Similarities and Differences
- Tylenol controls pain and fever but does not control inflammation so for conditions such as muscle sprains and cramps, Advil will be more effective.
- Advil is not suitable for everybody and can cause Gastointestinal (stomach) side effects, cardiovascular (heart) effects, and kidney toxicity. This risk is low if no more than 1200mg of Advil is taken per day.
- Check with your pharmacist or physician if you take prescription medications to ensure there are no drug interactions with Advil or Tylenol.
- Any medication used for pain relief should be taken at the lowest effective dose for the shortest possible time.
Blog Terms:
Analgesic: a class of medications used to treat pain
Antipyretic: a class of medications to treat fever
Gastrointestinal: relating to the stomach and the intestines.
Cardiovascular: relating to the heart and blood vessels.
Serotonergic: a nerve ending that releases and is stimulated by serotonin (a "feel good" hormone)
Renal: refers to the kidney
Disclaimer: When treating severe pain, never take more than the recommended dose. If you find the use of over the counter pain medications is not effective at managing your pain, seek medical attention. Although this blog content is referenced, it should be seen as a matter of opinion and not be taken as medical advice. Cochrane Emergency Training Services and Sunset Ridge Pharmacy cannot be held liable for the content presented in this blog. For questions on appropriate dosing always follow the label instructions or consult with a pharmacist.
** ASA (Aspirin) should NOT be given to children or infants due to its link to the development of Reye’s Syndrome, a serious medical condition affecting the brain and liver.
References
- Efficacy and Safety of Acetaminophen vs Ibuprofen for Treating Children’s Pain or Fever; David A. Perrott, PhD; Tiina Piira, MPsychol; Belinda Goodenough, PhD; G. David Champion, MD. ARCH PEDIATR ADOLESC MED/ VOL 158, JUNE 2004
- Comparing the efficacy of NSAIDs and paracetamol in children, B.J. ANDERSON, 2004 Blackwell Publishing Ltd,Pediatric Anesthesia, 14, 201–217
- Laura Dean, MD. Comparing NSAIDs. Pubmed Clinical Q & A. http://www.ncbi.nlm.nih.gov/books/NBK45590/
- Acetaminophen [Package Insert] Revised 03/2011 Remedy repack INC. https://www.drugs.com/pro/acetaminophen-tablet.html