Here, Vladimir Kramskiy, MD, a pain management specialist and neurologist at HSS, breaks down the difference between these drugs and explains when each is appropriate to use.
Advil (Ibuprofen) and Aleve (Naproxen)
Advil and Aleve belong to a class of drugs called NSAIDs (pronounced “n-saids”), which stands for nonsteroidal anti-inflammatory drugs. More than 20 different NSAIDs are available.
These drugs “are used worldwide to relieve ongoing pain, such as pain caused by arthritis, as well as to help people heal more quickly after an injury,” says Dr. Kramskiy.
People respond differently to different types of NSAIDs; if one (say, Advil) doesn’t work for you, it’s reasonable to switch to another (say, Celebrex, which is available only by prescription).
“In general, NSAIDs are relatively safe drugs and can be tolerated by most people without difficulty,” says Dr. Kramskiy. “However, like other medications, NSAIDs can cause side effects including upset stomach, ulcers and bleeding and hypertension, as well as liver and kidney damage. For this reason, it's important to take the lowest dose for the shortest time and not take two NSAIDs at the same time.”
Many NSAIDs are available over-the-counter (including Advil and Aleve). These same NSAIDs can also be prescribed by a doctor, usually at a higher strength, Dr. Kramskiy says, while other NSAIDs are available only by prescription.
As for risks of taking NSAIDs, “people with certain medical conditions, including stomach or intestinal ulcer, liver cirrhosis, prior history of bleeding in the gut, presence of coronary artery disease or stroke, should avoid NSAIDs or use them with care,” says Dr. Kramskiy. “NSAIDS are not generally recommended for pregnant women during the third trimester due to an increased risk of complications in the newborn,” though they are considered safe for use during breastfeeding, he adds. Several NSAIDs are available as creams and gels for use on the skin if the pill form is not an option and have been shown to have similar benefits.
Tylenol (Acetaminophen)
In contrast to Advil and Aleve, Tylenol is not an NSAID or anti-inflammatory drug. It is widely used for treatment of mild pain and fever. It is also available in an IV form, which may be an option for people who cannot take oral medications because of nausea or who have had gastrointestinal surgery.
“In general, Tylenol is most effective when taken as part of a regimen of multiple drugs, in combination with NSAIDs,” says Dr. Kramskiy. “This has been demonstrated in several large clinical trials.”
Tylenol is associated with few side effects when administered within the recommended dose, he adds. “However, at doses higher than 4 grams per day, Tylenol can cause liver toxicity, which is a serious concern and can even be life threatening.” Certain health issues like heavy alcohol use, malnutrition, low body weight, advanced age and pre-existing liver disease may increase the risk of liver toxicity. People taking Tylenol for a longer time should consider a lower maximum daily dose, or less than 3 grams per day, says Dr. Kramskiy.
Ever wonder which over-the-counter medicine to give a child experiencing muscle aches or pain from a mild injury? Tylenol, Advil, and Aleve are common pain relievers on drugstore shelves. While all three medications can help alleviate a child's discomfort, the active ingredient in each drug is different. In Tylenol, it's acetaminophen; in Advil and Motrin, it's ibuprofen; and in Aleve, it is naproxen.
Dr. Shevaun Doyle, a pediatric orthopedic surgeon at HSS, provides some general information and guidelines about acetaminophen, ibuprofen, and naproxen:
Acetaminophen (Tylenol)
- Provides pain relief.
- May be given to infants.
- Available as a pill, chewable tablet, liquid, and suppository.
- May not be used in children with liver abnormalities or medications affecting liver function.
- In children scheduled for surgery, it may be used right up until surgery.
Ibuprofen (Advil and Motrin)
- Provides pain relief.
- Works as an anti-inflammatory to reduce swelling.
- Longer-acting than Tylenol.
- Available as a pill, chewable tablet, and liquid.
- Needs to be taken with food or milk.
- Should not be taken if a child is vomiting, dehydrated, or not eating much.
- May not be used in children with gastrointestinal or kidney abnormalities or with medications affecting kidney function.
- May not be used 72 hours prior to surgery.
- May not be used in patients under six months old.
Naproxen (Aleve)
- Provides pain relief.
- Works as an anti-inflammatory.
- Longer-acting than acetaminophen and ibuprofen.
- Available over the counter in pill form and by prescription in liquid form.
- May not be used in children with gastrointestinal or kidney abnormalities or with medications affecting kidney function.
- Needs to be taken with food or milk.
- May not be used 72 hours prior to surgery.
- May not be used in patients under two years old.
Proper Dosage is Key
No matter which medication is used, Dr. Doyle advises parents to pay careful attention to dosing. For the liquid form, parents should use the dropper or dosing cup that comes with the product. Kitchen spoons should never be used since they're not uniform in size.
A study commissioned by the National Institutes of Health found that many parents had trouble measuring the proper dose and inadvertently gave their children too much medicine. The research supports the use of oral syringes rather than dosing cups, especially when small amounts of medication are given.
"Some parents mistakenly believe that because a medicine is sold over the counter, it's safer. That's not the case. An overdose can be very serious," Dr. Doyle said. In addition, she notes that the active ingredients in Tylenol and Advil are also found in other medications, such as cough and cold medicines. Parents are advised to read the list of ingredients in all medications a child is receiving to prevent double dosing.
Dr. Doyle also recommends that parents set up a schedule. "It's a good idea to write down the time a medication is given so it's easier to keep track of how much a child is receiving," she says. "If a parent has any questions about which over-the-counter medication to use or the proper dose, it's best to call the child's doctor."