Should you take tylenol and ibuprofen together

My brother-in-law recently asked me if he could take Aleve (naproxen) and Motrin (ibuprofen, Advil) together. Apparently, he pulled a muscle while trying to relive the glory days of his college football playing.

When talking about painkillers, it’s important to understand the difference among products. There are four main types of oral analgesics that are available without a prescription: naproxen (brand name Aleve), ibuprofen (brand names Advil and Motrin), aspirin, and acetaminophen (brand name Tylenol).

Naproxen and ibuprofen work in the body the same and have the same side effects. Ibuprofen is typically taken every 6-8 hours; naproxen is taken every 12 hours. Aspirin works a little differently than ibuprofen and naproxen but has very similar side effects. The usual dose of aspirin is 500-1,000 mg every 4-6 hours. Acetaminophen works a little differently than naproxen and ibuprofen, has different side effects, and can be taken every 6-8 hours.

So, to answer my brother-in-law’s question… He could take his naproxen (Aleve) eight hours after taking ibuprofen (Motrin, Advil) or he could take ibuprofen 12 hours after taking naproxen. However, if he was not getting adequate pain relief from ibuprofen within the eight-hour period, he could take acetaminophen (Tylenol). I advised him to stay within the recommended dosage for both medicines.

The bottom line for weekend warriors is that you cannot combine ibuprofen and naproxen unless it is time for another dose of either medication. If you need additional pain relief, you can combine aspirin, naproxen, or ibuprofen with acetaminophen. However, do not take aspirin, naproxen, or ibuprofen within 8-12 hours of each other. Also, watch out for pain medications that might be included in combination products such as those used for cough and cold.

It is important to note that my brother-in-law is healthy and has no other medical problems. If you have other medical conditions, please consult your pharmacist to find out which pain medications are safe for you.

When your child is sick, you'll probably reach for one of two medicine cabinet mainstays: acetaminophen or ibuprofen. Both effectively relieve pain and reduce fever, but they operate differently, so it can be difficult to know which one to choose. As it turns out, depending on the severity of your child's symptoms, some pediatricians will advise you not to choose at all. That's because alternating between ibuprofen (Advil or Motrin) and acetaminophen (Tylenol) may be the best way to treat serious symptoms. Here's what parents should know.

Can You Take Acetaminophen and Ibuprofen Together?

It's generally safe to take acetaminophen and ibuprofen together, as long as you follow proper dosing instructions. That's because the medications work differently in the body. They're also eliminated by different organs—the liver for acetaminophen and the kidneys for ibuprofen—so you don't need to worry about excess organ strain. The two medications don't cause additional side effects when taken together (though some kids might get an upset stomach).

What's more, multiple studies have shown increased effectiveness when taking acetaminophen and ibuprofen together. One reason is they have different mechanisms of action at the cellular level, explains Bande Mangaliso Virgil, M.D., a pediatric hospitalist at Piedmont Columbus Regional Hospital. "They are both fever reducers (antipyretics) and are helpful for pain (analgesia). However, the key difference is ibuprofen is also a more potent anti-inflammatory medication, helpful for swelling that occurs with fevers."

When Might You Alternate Between Acetaminophen and Ibuprofen?

Dr. Virgil says switching between acetaminophen and ibuprofen can help with fevers that aren't responsive to one of the medications alone—especially when the fever causes great discomfort, irritation, confusion, or lethargy.

"This can happen with high fevers associated with ear infections, significant viral infections like influenza, and bladder infections, to name a few," Dr. Virgil says. "Generally, it's easier to keep up with single medication dosing, but in the circumstances mentioned above, switching between the two may provide greater comfort and symptom and fever control."

Dr. Virgil recommends starting with one medication and waiting 30 minutes to see if the symptoms improve. If not, you can add in the second medication, following the safety tips outlined below.

How to Safely Switch Between Ibuprofen and Acetaminophen

Doubling up on pain medications must be done carefully. Katherine Kazmier, M.D., a pediatrician with Seattle Children's Hospital, says it's generally safe to give both medications at the same time every six hours (always following dosing instructions on the bottle). Your child can also alternate between them, taking one every three hours. "Although acetaminophen can [usually] be given every four hours, when alternating with ibuprofen we usually give it every six hours because it's simpler to alternate medications every three hours," says Dr. Kazmier.

To use both of these medications safely, always follow the correct dosage—and only combine them for a short period of time. "Both medications can have adverse effects when used at higher doses, so check the dose for your child's age and weight carefully, and check with your child's doctor if you're unsure," says Dr. Kazmier. She recommends keeping a written log of medications given, including the dosage and timing, to avoid accidentally mixing them up.

If your child is still miserable after a day of double dosing, it's time to check with their health care provider. "Your child is more likely to have adverse effects from the medications if they are dehydrated or if they have a serious infection, so if they are not drinking fluids well, having severe pain, or acting more sick than a typical childhood illness, please call your child's doctor for advice," says Dr. Kazmier.

Lastly, keep in mind that fever is usually not harmful. "In fact, it may be a helpful part of the immune response to infection, so I only recommend using acetaminophen or ibuprofen for comfort and to make them feel well enough to drink fluids and rest," says Dr. Kazmier. If your child acts playful or happy during a fever, they may not need any medicine at all.

The Bottom Line

It can be safe to take acetaminophen and ibuprofen together. Always follow proper dosing instructions, and take the minimum amount possible to reduce symptoms. Talk to your child's doctor for more information on safely using these medications.

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