Chances are you’ve reached for acetaminophen (Tylenol) or ibuprofen (Advil, Motrin), two of the most common over-the-counter (OTC) pain relievers, at some point in your life. These medications can alleviate pain and fever, and ibuprofen is also helpful for lowering inflammation.
But is taking acetaminophen and ibuprofen together more effective than taking one alone? And is it safe? Sometimes, yes. Combining or alternating these two OTC medications may provide stronger pain and fever relief than taking either alone. But to avoid harm, it’s important to get the dosing schedule right.
Can You Combine Acetaminophen and Ibuprofen?
Yes, many adults and children can safely take acetaminophen and ibuprofen at the same time, or alternate them every few hours. Whether this is the right choice for you depends on several personal factors like age, other medications you’re taking and any health conditions you have.
How Do Acetaminophen and Ibuprofen Work? Why Is Combining Them Effective?
Even after decades of use, it is still unclear exactly how acetaminophen works for treating pain. We know it mostly works in the brain and spinal cord, affecting chemicals that contribute to pain and fever, like prostaglandins, cannabinoids and serotonin.
Ibuprofen also blocks the production of prostaglandins, chemical compounds that contribute to fever, pain and inflammation. But ibuprofen acts in the brain and at the site of injury and inflammation. This is what makes ibuprofen an effective anti-inflammatory, while acetaminophen is not. Ibuprofen belongs to a group of medications called nonsteroidal anti-inflammatory drugs (NSAIDs). Other NSAIDs include naproxen (Aleve, Naprosyn), aspirin and meloxicam.
Because acetaminophen and ibuprofen work differently, taking them together may provide more substantial relief than using either medication alone, says Xueduan (Ray) Liu, PharmD, CSP, a pharmacist at the University of California, Los Angeles. And since these medications don’t interact with each other directly, combining them is usually safe, as long as you use the correct dose and don’t have health reasons to avoid either medication.
What Are the Advantages and Disadvantages of Combining Acetaminophen and Ibuprofen?
Combining these two medications can sometimes give better pain or fever relief than taking either alone. It may also allow you to use lower doses, says Roxann Engle, D.O., a family medicine physician at University of California, Irvine Health. And if your healthcare provider recommends taking acetaminophen and ibuprofen at the same time, they’re now available OTC as a single pill, which can simplify dosing.
Alternating acetaminophen and ibuprofen can get complicated, Dr. Engle notes. For fever in children, she often recommends alternating the two every three hours so one is always working at its peak. But it’s crucial to track doses carefully to avoid taking too much by inadvertently repeating one. For ongoing conditions like chronic pain, she usually suggests taking them together instead, which makes the schedule easier to follow.
Another possible disadvantage is that combining them exposes you to the potential side effects of each, notes Dr. Liu. While these medications are often well-tolerated, potential side effects include nausea or stomach upset, which are commonly associated with ibuprofen. Acetaminophen is generally safe and free of side effects when taken at recommended doses, though excessive or long-term use has been linked to liver injury.
What The Evidence Says About Combining Acetaminophen and Ibuprofen (And What It Doesn’t)
Many studies have examined the combination of acetaminophen and NSAIDs like ibuprofen, including a 2025 review of more than 75 studies. Much of this research involved short-term use, tested only one or a few doses, and included a small number of participants.
Below, we’ll dive into the details of the evidence for combining acetaminophen and ibuprofen, but here are some key takeaways:
- The combination of acetaminophen and ibuprofen may be more effective for certain types of pain, such as pain after dental surgery.
- Using both together may reduce the need for opioids in treating short-term pain.
- For fever in children, the evidence is mixed. The combination of acetaminophen and ibuprofen may work better than acetaminophen alone. But high enough doses of ibuprofen may be just as effective as taking the two medications simultaneously.
- Combining acetaminophen and ibuprofen generally doesn’t cause more side effects than using either medication alone.
Pain
In a review of three studies involving more than 1,600 participants, two trials found that the combination of ibuprofen and acetaminophen provided greater pain relief after dental surgery than placebo (a pill with nothing in it), and one trial found it was more effective than ibuprofen alone.
Other small studies examining pain after anterior cruciate ligament (ACL) knee surgery, acute muscle pain after injury and acute non-injury-related lower back pain found that combining acetaminophen and ibuprofen wasn’t more effective than ibuprofen alone.
Some studies also showed that combining acetaminophen and ibuprofen for short-term pain treatment may decrease opioid use. However, a study of over 500 people found that ibuprofen alone may be as effective as combination treatment at reducing opioid use in the first 24 hours after hip replacement surgery.
Fever
Research on combining ibuprofen and acetaminophen in adults with fever is limited. The evidence is more robust in children.
A review of 31 randomized controlled trials, including more than 4,000 children, found that ibuprofen plus acetaminophen was more effective than acetaminophen alone at reducing fever. But ibuprofen alone (7.5 mg/kg to 10 mg/kg per dose) was as effective as the combination.
In this review, researchers found that in the first few hours of treatment, children taking both medications at once fared slightly better than those who alternated them. But by six hours, there was no difference between these dosing methods.
Importantly, when comparing combination treatment to using one medication alone, temperature reduction differences are often modest. So even if the results of combination treatment appear better on paper, the temperature reduction might not be large enough to make a noticeable difference in how your child feels.
Weighing Risks Versus Benefits: When Combining Acetaminophen and Ibuprofen Makes Sense, And When To Avoid It
Whether combining acetaminophen and ibuprofen is right for you depends on several factors. Often, checking in with a healthcare provider is the best first step. Combining these medications isn’t one-size-fits-all, says Dr. Engle. Here are key questions to consider:
- Have you tried either medication alone? If a single medication is enough to control your symptoms, there may be no need to add the second.
- How old is the person being treated? For adults over 65 years old, ibuprofen carries an increased risk of side effects. In children, ibuprofen use is usually limited to ages six months and older. Whereas acetaminophen alone is recommended for younger infants. Still, manufacturers of acetaminophen suggest talking to a healthcare provider before giving it to children under 2 years old.
- Do you have any health conditions or personal factors that make either medication unsafe? Acetaminophen may not be the best choice if you have liver disease or drink a lot of alcohol regularly. And ibuprofen may be risky if you have kidney issues, a history of stomach bleeding or heart-related conditions, including high blood pressure. And acetaminophen is generally considered safer than ibuprofen during pregnancy, especially after 20 weeks.
- Do you take other medications? Prescription and OTC medications may contain acetaminophen or ibuprofen, especially combination products like DayQuil Cold & Flu. Taking more than one product with the same ingredient can make it easier to take too much, increasing your risk of side effects and overdose. Additionally, certain medications may interact with acetaminophen or ibuprofen, increasing the risk of side effects.
A Practical Checklist For Combining Acetaminophen and Ibuprofen
If you’ve decided to take acetaminophen and ibuprofen together, here are practical tips to do it safely:
- Know the correct dosing schedule. The recommended doses for OTC acetaminophen and ibuprofen products are listed on the package label. Whenever possible, children’s doses should be based on their weight, not their age, says Dr. Liu. Use a dosing chart from your pediatrician (or the product label).
- Measure doses correctly. Always use the syringe or dropper that comes with the medication, says Dr. Liu. Ask the pharmacy for additional measuring tools if needed. Don’t use kitchen spoons or other household utensils because they’re not standardized to deliver the correct dose
- Use the correct formulation. Acetaminophen and ibuprofen are available in both infant and children’s formulations. Those made specifically for infants are more concentrated. This means they contain a higher dose of the medication in the same volume. Double-check the label for the correct dose before administering the medication.
- Track your doses. Keep a written log or use an app if you have a smartphone, says Dr. Liu. This helps prevent accidental double-dosing.
- Share your medication list. Give your healthcare provider or pharmacist a list of all prescription medications and OTC products that you take or administer to your child. This will help them check for drug interactions and whether you take other medications containing acetaminophen or ibuprofen without realizing it.
- Know how long to take both medications before reaching out to a healthcare provider. Don’t combine acetaminophen and ibuprofen for more than two to three days without talking to a healthcare professional. Dr. Engle also advises parents to pause after 24 hours of scheduled combination treatment to see if their child still needs it.
