Clash of the Titans: Tylenol* vs Advil*

In the epic battle of pain relievers, which should you take? Tylenol*( in this case meaning any brand of acetaminophen)? or Advil* (meaning any brand of Ibuprofen)?

The answer is BOTH, or at least, “it depends”.

Acetaminophen (common brand name Tylenol) and ibuprofen (common brands Advil or Motrin) are two very different products that work in different pathways within the body. Tylenol’s mechanism is still poorly understood, but one persisting theory is that it works by blocking the central nervous system’s production of prostaglandin, a substance that plays a key role in transmitting pain and causing fever. Ibuprofen or “advil”-type products (known collectively as Non Steroid Anti Inflammatory Drugs or “NSAIDs”) also block production of prostaglandins, but they do this in both the central and peripheral nervous systems, giving them the added benefit of reducing inflammation.

Therefore, tylenol works help relieve pain and lower fevers, but does not reduce swelling.

NSAIDs work to lessen pain and fevers, AND to reduce swelling.

So why would you use tylenol, if it does less? A couple reasons:

  • NSAIDs can irritate the stomach lining, so in the case of gastritis, stomach ulcers or nausea, tylenol would be a better choice
  • NSAIDs may slow down blood clotting (increasing risk of bleeding) so for surgical patients or patients on blood thinners, tylenol would be a better choice
  • If there are kidney problems* (NSAIDs can potentially harm the kidneys, but not the liver, whereas tylenol can potentially harm the liver, but not the kidneys)

When are NSAIDs better?

  • High fevers often respond better to NSAIDs
  • Muscle aches/sprains or swollen joints
  • If the liver is inflamed or damaged*

But wait, there’s more!

One lesser known medical trick is to use BOTH, together (when there is not a medical reason to avoid using either one). Yes, at the same time. No, not for routine aches or pains. Evidence-based studies such as this Cochrane review on post-op pain medications have shown that using a combination of acetaminophen and an NSAID such as ibuprofen provide superior pain relief to either used alone. I tend to use two OTC ibuprofen pills along with two OTC extra strength acetaminophen for severe aches and pains such as an intense headache, severe pain from an injury, or for a high fever. The idea is that this combination packs a therapeutic punch as strong as a narcotic like codeine, but without the mind-altering sedation.

Lastly- name brand or generic? In my opinion, this is purely an individual “cosmetic” decision. The name brand preparations often have coatings that make them easier to swallow vs. the generic, but otherwise I feel the generics have equivalent effectiveness overall.

BOTTOM LINE: Know the advantages and disadvantages of OTC pain relievers such as Advil (ibuprofen) and Tylenol (acetaminophen), and consider a combination dose for more intense pains. Talk with your doctor about the best choice for you!

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