Tylenol versus Motrin

Katherine asks a question that comes up a lot in practice: “I am wondering when it is best to use Motrin and when to use Tylenol with my children. I brought my son to the doctor recently for a virus causing a bad sore throat with low grade fever. I told the doctor I had been using Tylenol and she said I should be using Motrin. Is Motrin/ibuprofen better for pain relief? If so, in which situations should I should be using Tylenol? Also I have heard about switching between the two drugs – is there any merit to that?”

First, to clear up the names: Tylenol is the most common brand name of acetaminophen; Motrin and Advil are two brands of ibuprofen. Any brand or generic is fine. Avoid the “combo” products, like “Motrin Cold” or “Tylenol with Vodka.”*  These are confusing to use, and are very rarely helpful.

Both ibuprofen and acetaminophen are effective at relieving both pain and fever. For pain, ibuprofen is probably a little more effective; for fever, they work equally well. However, ibuprofen lasts longer, about six hours against acetaminophen’s four. That might make a big difference in the middle of the night.

Ibuprofen should not ordinarily be used in a baby under six months of age. Acetaminophen is safe at any age, even newborns.

For fever, remember that the reason you’re treating fever is to help the child feel better. Fever itself is not harmful. But often children with fever feel achy and miserable, and treatment with acetaminophen or ibuprofen can help them feel better.

Some people suggest “alternating” ibuprofen and acetaminophen. There is one study from Israel that did show using them alternating every three hours seemed to provide better relief than using one medicine alone; but in that study the doses were different from what’s typically used in the United States, so it’s hard to know for sure. If you do alternate the meds, you ought to keep a chart so you and other caretakers don’t end up giving extra doses of the wrong medicine.

Acetaminophen and ibuprofen are both quite safe if dosed correctly. Be especially careful if you’re using both medicines together, using them for more than a few days, or if your child is dehydrated. Any of these circumstances will increase the risk for dangerous side effects.

I like to keep things simple. In my home, since all of my children are over six months, I use generic ibuprofen for pain or fever. IF a child has a return of these symptoms and it hasn’t been six hours since the last dose of ibuprofen, I use acetaminophen as a “pinch hitter” to give an early dose, then resume the ibuprofen if symptoms come back again.

* – OK, I made this one up. But it sounds like a good idea for parents with headaches. I ought to patent that….

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3 Comments on “Tylenol versus Motrin”

  1. Jack Says:

    I thought alcohol with Acetaminophen was to be avoided as its really hard on the liver? Or is that just an ‘old wive’s tale’?

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  2. Dr. Roy Says:

    Jack, acetaminophen can be tough on the liver, especially in overdose. In otherwise healthy people, acetaminophen is well-tolerated if taken correctly. Chronic liver disease is rare in children, but it’s probably a good general rule to avoid acetaminophen in people with liver disease, including alcohol-related cirrhosis or hepatitis.

    Non-steroidals like ibuprofen should be avoided as a general rule in children with kidney disease like chronic proteinuria.

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  3. Jack Says:

    Thanks for letting me know. I was mostly referring to your tongue-and -cheek Tylenol and vodka suggestion for the grown-ups. 🙂

    Not sure where I heard that it was better to take ibuprofen for a headache if alcohol was going to be consumed. Will try to search the memory banks for that one.

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