Nicoy asked
I was wondering which is stronger: Tylenol (Acetaminophen) or Motrin IB (Ibuprofen)?
Answer
Most studies indicate that acetaminophen (brand name Tylenol) and ibuprofen (brand names Advil, Motrin) have similar efficacy in regard to their pain relieving and fever reducing effects. However, in the few studies that do show that one is superior to the other, ibuprofen generally comes out on top.
In addition to evaluating the efficacy of acetaminophen and ibuprofen, it is important to take into considered safety concerns and contraindications of each.
Below, we discuss acetaminophen and ibuprofen in more detail and look at evidence regarding which is "stronger".
Acetaminophen
Acetaminophen is an analgesic that can be taken for a wide variety of acute and chronic pain ailments. Acetaminophen has a half-life of 2-3 hours. Acetaminophen gets absorbed at 85-98% and reaches peak concentrations within 30-60 minutes.
Typically, acetaminophen can start working within 15 minutes. Taking this medication with food slightly decreases the peak effect. Benefits for acetaminophen over NSAIDs include less likelihood to cause GI issues, bleeding, and kidney dysfunction. Acetaminophen can have negative impacts on the liver, especially at higher doses for an extended period of time.
Ibuprofen
Ibuprofen is an NSAID (non-steroidal anti-inflammatory drug) and has a half-life of around 2-4 hours. Ibuprofen is absorbed well in the GI tract with about 80% of the drug being absorbed.
The peak effect of ibuprofen takes place in about 2 hours with tablets, 1 hour with chewable tablets, and 45 minutes with suspension. The pain relief effects typically begin within 30 minutes to 1 hour. Taking ibuprofen with food can decrease the absorption slightly.
Tylenol (Acetaminophen) Vs. Advil (Ibuprofen): What Do The Studies Say?
A study, one of the largest meta-analyses on the subject of comparing acetaminophen to ibuprofen, found that acetaminophen and ibuprofen are similar in most aspects. However, in studies that did find one was superior to the other, ibuprofen was the medication that generally provided better efficacy.
Eighty-five studies were included in the meta-analysis and the following results were reported:
Pain In Adults
Twenty-six studies in the meta-analysis concluded that ibuprofen was superior to acetaminophen for pain relief in adults while ten reported that there was no significant difference between the medications. Specifically, ibuprofen was associated better pain relieving ability for:
- Dental surgery
- Orthopedic surgery
- Abdominal surgery
- Musculoskeletal injury
Pain In Children
Six studies in the meta-analysis concluded that ibuprofen was superior to acetaminophen for pain relief in children while eleven concluded that there were no significant differences between the drugs. Similar to pain relief in adults, ibuprofen more often was shown to be more beneficial for certain indications such as after dental surgery.
Fever In Adults
Three studies in the meta-analysis concluded that ibuprofen was more effective for reducing fever in adults than acetaminophen while two reported no difference. Other studies, outside this meta-analysis, report that both acetaminophen and ibuprofen have very similar efficacy, but ibuprofen may be slightly superior for fever reduction.
Fever In Children
Fifteen studies in the meta-analysis concluded that ibuprofen was more effective for reducing fever in children than acetaminophen while fifteen studies reported no significant difference between the two medications.
Oxford Table For Analgesic Efficacy
Safety Concerns
- Caution must be used in those taking certain blood pressure medications from the ACE-Inhibitor class, such as lisinopril as the combination could decrease kidney function.
- Ibuprofen generally should not be used in individuals with certain GI problems such as a history of ulcers.
- Ibuprofen must be used cautiously or avoided all together in those taking blood thinners or in those with a history of high blood pressure or heart problems (e.g. prior heart attack, congestive heart failure).
Acetaminophen
- Acetaminophen needs to be used cautiously in those with liver impairment or problems with alcohol abuse.
In many situations where acetaminophen or ibuprofen need to be utilized, the decision comes down to the individual they are going to be used in and their medical history.
Summary
Both acetaminophen (brand name Tylenol) and ibuprofen (brand names Advil, Motrin) have similar efficacy when it comes to their pain relieving and fever reducing effects. However, in studies that do indicate one is better (i.e. "stronger") than the other, ibuprofen is generally the medication that comes out on top.
As both acetaminophen and ibuprofen have similar pain relieving and fever reducing effects, the side effects and precautions for each drug need to be considered for the best analgesic choice.
