When I was just a toddler, I took Baby Aspirin for feverish earaches, not knowing I was allergic to aspirin. I was sick for days after, wheezing, coughing, and stomach aches when Baby Aspirin should have taken 1 hour at most to take away the pain in my ear.
My mother didn’t know and neither did the doctor until I went to the circus full of animal dander at 13-years-old, wheezing and coughing, and it was then I was tested for allergic reactions, and yikes! There were many that showed up, aspirin being among the lot of them.
Acetaminophen (like Tylenol) and ibuprofen (like aspirin and other nonsteroidal anti-inflammatory drug (NSAIDs)) are over-the-counter (OTC) pain relief medicines. But there’s a difference!
- Acetaminophen helps relieve fever.
- Ibuprofen is an NSAID, which means it can help reduce fever and inflammation.
The most common side effects of NSAIDs affect the stomach. They range from minor problems like indigestion and stomach ache to more serious problems like gastritis, ulcers and bleeding in the stomach or bowel. The risk of complications can be significantly reduced by using other medication to protect the stomach. But over-the-counter painkillers very rarely lead to serious side effects if they are taken for a short time only.
Several analyses of studies in recent years have also shown that certain NSAIDs increase the risk of cardiovascular (heart and blood vessel) disease. But that is mainly if you take high doses over a long period of time. Still, it may be a good idea for people who are at higher risk of cardiovascular disease, or already have cardiovascular disease, to take low doses of ibuprofen.
People may take acetaminophen to ease the symptoms of cold and flu. Folks may take ibuprofen for body aches, headaches, or chronic health conditions, such as arthritis or lupus.
People can safely take acetaminophen and ibuprofen together though always consult a doctor before giving acetaminophen or ibuprofen to a child under 2 years of age.
A number of personal factors increase the likelihood of NSAIDs causing problems. The risk of developing stomach or bowel problems is greater if you:
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are over the age of 65
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currently have a stomach ulcer or gastritis, or had one of them in the past
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have chronic inflammatory bowel disease (Crohn’s disease or ulcerative colitis)
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take several different NSAIDs at once, or are already taking low-dose acetylsalicylic acid for the prevention of complications following a heart attack or stroke
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are taking anticoagulant (anti-clotting) medication, steroid medication, or SSRI antidepressants
NSAIDs also increase the risk of heart attacks or strokes, particularly in people who have already had one. These complications are more likely if you already have other kinds of cardiovascular disease or if you have risk factors such as high blood pressure. In people who have decreased kidney function, taking NSAIDs can increase the risk of acute kidney failure. It is especially important for them to avoid taking too high a dose.
Caution: NSAIDs can cause stomach irritation, ulcers, and bleeding. They should generally be taken with food. Long-term or high-dose use can also affect the kidneys and, in some cases, increase the risk of heart problems. Aspirin is generally not recommended for children and teenagers due to the risk of Reye’s syndrome, a rare, life-threatening condition that affects the brain and liver.
OTC drugs containing acetaminophen include:
- Tylenol
- Excedrin
- paracetamol
- Panadol
- Sudafed
OTC drugs containing ibuprofen include:
- Aspirin
- Advil
- Motrin
- Midol IB
- Genpril
ACETAMINOPHEN
In a single dose, the maximum amount of acetaminophen (also called paracetamol outside the US and Japan) an adult can take is 1,000 milligrams (mg). A person should not take more than 4,000mg in 24 hours.
According to the National Health Service (NHS), the typical dose is 1 or 2 tablets of 500 mg up to four times a day. A person should leave at least 4 hours between each dose. Those with chronic pain, which may need higher doses of acetaminophen, should check with their doctor first.
People with liver conditions should avoid taking acetaminophen. This is because the liver breaks it down, and it can cause liver disease.
The U.S. Food and Drug Administration (FDA) warns that acetaminophen can cause rare but dangerous reactions of the skin. Skin reaction symptoms include:
- redness
- rash
- blisters
- the top layer of the skin coming away
Symptoms of an acetaminophen overdose include the following:
- nausea and vomiting
- stomach pain
- sweating
- confusion
- loss of appetite
- dark urine
- yellowing of the skin and eyes
Some research has highlighted gastrointestinal concerns with chronic use of acetaminophen, and people should discuss these with their doctor.
Dosage can vary, depending on the product type. People should always follow instructions on the label and consult their pharmacist or doctor if they are unsure.
IBUPROFEN
An adult can take OTC doses of 800–1,200 milligrams per day (mg/day) to treat minor pain, including:
- muscle aches
- toothache
- headache
- fever
- backache
- menstrual cramps
If a doctor prescribes ibuprofen, a person can typically take 1,800–2,400 mg/day to treat:
- osteoarthritis
- rheumatoid arthritis
- ankylosing spondylitis (chronic inflammatory disease that primarily affects the spine, causing stiffness, pain, and fusion of the vertebrae over time)
Ibuprofen can increase the risk of strokes and heart attacks. Those who have cardiovascular disease are at a higher risk. Ibuprofen may also cause damage to the kidneys. People with existing kidney conditions may need to consult their doctor before taking ibuprofen.
Taking ibuprofen daily over a long time may irritate the stomach and intestines, or increase the risk for gastrointestinal problems. Issues may range from an upset stomach to stomach bleeding or ulcers. For this reason, people should take ibuprofen with food to avoid any stomach upsets.
Other possible side effects of ibuprofen include:
- heart problems
- swelling of hands, feet, and lower legs, due to fluid retention
- rashes
- allergic reactions
- skin reactions, which can be very serious (see above)
Symptoms of an ibuprofen overdose include the following:
- nausea and vomiting
- stomach pain
- tiredness or feeling sleepy
- blood in vomit
- black feces
- ringing in ears
- difficulty breathing
- unusual change in heart rate
A person should seek medical help if they experience:
- blood in their vomit
- black colored stool
- symptoms of anemia, such as shortness of breath, pale skin, or exhaustion
Acetaminophen does not typically aggravate the lining of the stomach or the intestines in the way that NSAIDs can. This means acetaminophen may be suitable for people who have health conditions that affect the stomach or intestines. Side effects of acetaminophen are rare when people take the correct dosage.
Acetaminophen interactions:
- medication for epilepsy
- medication for tuberculosis
- blood thinners
People can also check with a doctor if they are taking other medications that may interact.
Ibuprofen interactions:
- aspirin
- any other NSAIDs, as this can cause an overdose
- blood thinners
- antihypertensives
- diuretics
- aldosterone antagonists
- direct renin inhibitors
- lithium
- some antidepressant
People should stop using medication and see a doctor immediately if they notice any of the following during or after taking acetaminophen and/or ibuprofen:
- skin rash or other reaction of the skin
- yellowing of the skin or eyes
- severe abdominal pain
- wheezing
- chest or throat feels tight or constricted
- swelling
- difficulty breathing
- liver problems
- kidney problems
- inflammatory bowel disease, including Crohn’s disease or ulcerative colitis
- cardiovascular problems, including high blood pressure or history of stroke or heart attack
- regularly consuming more than 14 units of alcohol a week
- any allergic reactions to acetaminophen or ibuprofen
Pregnant people, or those trying to get pregnant, should consult with their doctor before taking acetaminophen or ibuprofen.
The Food and Drug Administration (FDA) in September 2025 initiated a label change for acetaminophen citing research that associates use of acetaminophen during pregnancy with an increased risk of neurological conditions, including autism spectrum disorder (ASD), in children.
In a letter to physicians, the FDA recommends clinicians minimize the use of acetaminophen in pregnancy for low-grade fevers. However, the FDA also notes that acetaminophen use during pregnancy has not been proven to cause ASD, and that acetaminophen is the safest over-the-counter pain medication to take while pregnant.
In a statement, the American College of Obstetricians and Gynecologists (ACOG) described the FDA announcement as a “harmful and confusing message to pregnant patients” that is not backed by scientific evidence. ACOG also noted that pain and fever during pregnancy are “far more dangerous” than any potential risk from acetaminophen use.
Joyce, thanks for this helpful information!!
Very well written! You did your homework.