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.
Both acetaminophen and ibuprofen are generic names for over-the-counter pain relief drugs. They act differently in the body, though. Acetaminophen, which is packaged as Tylenol, relieves pain and reduces fever. Ibuprofen, popularly packaged as Advil or Motrin, is an anti-inflammatory medication that is used to treat moderate pain from conditions like arthritis and menstrual cramps. Because both are used as pain relievers, you might wonder
whether acetaminophen or ibuprofen is better. Acetaminophen comes as Tylenol and other brand names. It is a fever reducer (antipyretic) and pain reliever (analgesic). The most common way to use acetaminophen is oral, or by mouth. You should follow the dosage recommended by your doctor or as directed on the label. Acetaminophen is also present in some prescription medicines. Do not use the
over-the-counter form with medicines containing acetaminophen, as an overdose could be fatal. Ibuprofen is a painkiller that lowers inflammation in the body. It is related to aspirin and naproxen, which is the main ingredient in Aleve and Anaprox. The nonsteroidal anti-inflammatory drug (NSAID) reduces inflammation and pain in certain conditions, such as back pain, toothache, headache, menstrual cramps, minor
injuries, and arthritis. Use ibuprofen as directed on the label or recommended by your doctor. It is best to take the lowest dose of ibuprofen to treat your condition. Acetaminophen can cause an allergic reaction in your body. The signs of an acetaminophen allergy are swelling in the face, tongue, throat, and lips. You may also develop hives or have difficulty breathing. In some rare cases, the painkiller may have a lethal skin reaction. This is even possible if you have never had an adverse reaction to the drug in the past. If you experience blistering, rash, redness, or peeling on your skin, talk to your doctor right away and stop taking the medicine. Some other side effects of acetaminophen are: What Is Acetaminophen?
What Is Ibuprofen?
Does Acetaminophen Have Side Effects?
If you have heart disease, stomach ulcers,
asthma, or have had a heart attack, ask your doctor if you can take ibuprofen. Pregnant and breastfeeding women should also consult with their doctors before taking this drug. Like acetaminophen, you can also be allergic to ibuprofen. The signs of an allergic reaction are swelling in the throat or face. Some other ibuprofen side effects are: You should use acetaminophen for pain, but if you also have inflammation, consider taking ibuprofen instead. You can also take both of them together if you have pain and
inflammation. However, never take more than the recommended dosage. If you are confused between ibuprofen vs. acetaminophen usage, choose ibuprofen for inflammatory conditions and acetaminophen for just pain. Also, if you are pregnant, you can use acetaminophen since it is considered safe for breastfeeding and pregnant mothers. On the other hand, ibuprofen is not always safe to take during pregnancy. Using any form of NSAIDs in the last 20 weeks can result in kidney and
heart problems in the baby. Plus, it can complicate your pregnancy. Always talk to your doctor before using over-the-counter medicines if you are pregnant or have heart, kidney, or liver disease. Does Ibuprofen Have Side Effects?
Ibuprofen vs Acetaminophen: Which to Use?