Over-The-Counter Pain Relievers – What’s the Difference?

March 12, 2024

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Harrison A. Linder, M.D., is a Board Certified pain management specialist with The Center for Interventional Pain Medicine at Mercy Medical Center in Baltimore, Maryland. Dr. Linder was recently asked to respond to questions from U.S. News & World Report regarding the differences between pain relievers Advil, Aleve and Tylenol. Here are his responses:

1. Could you say a little about how Advil, Aleve and Tylenol are the same and different? Advil (ibuprofen), Aleve (naproxen), and Tylenol (acetaminophen) are all common over-the-counter medications, frequently used for the treatment of various aches and pains. However, there are some differences between them. Advil and Aleve belong to a class of drugs called NSAIDs, which stands for nonsteroidal anti-inflammatory drugs. NSAIDs stop your body from producing certain chemicals that cause inflammation, which helps relieve swelling and inflammation, contributing to pain relief. As far as anti-inflammatories go, Advil and Aleve have almost identical attributes. The main discriminating factors between the two are the active duration of each dose; Aleve is advertised as lasting almost four hours longer than Advil. In contrast to Advil and Aleve, Tylenol is not an NSAID or anti-inflammatory drug, and has independent effects results in pain relief.

2. When is it best to use each type of medication (Advil, Tylenol or Aleve) - in other words for what type of ache or pain is each one best suited for?

In general, any of these medications can potentially be helpful for common aches and pains. Tylenol is typically suggested for the treatment of issues like isolated fever, headaches, or sore throats, where inflammation is not thought to be a source of discomfort. In contrast, in situations like muscle strains, trauma, or arthritis, where there is a component of inflammation and swelling, NSAIDs like Advil or Aleve may be more effective.

3. Can you take any of these medications at the same time, such as Advil and Tylenol together or Aleve and Advil together? Why or why not?

Advil and Aleve should not be taken together. As they are both the same type of medication, nonsteroidal anti-inflammatory drugs, taken these types of medications together would essentially be like take “super doses” of the medication and can predispose someone to unwanted and dangerous side effects. However, as Tylenol is not an NSAID, it can be combined with Advile or Aleve safely. Some people find taking both an NSAID and Tylenol increases the pain relief experienced, while others prefer to alternate between Tylenol and an NSAID with each subsequent dose.

4. If one of these doesn't seem to work for a particular pain, is it okay to try one of the other one?

As with all medications, everyone responds and reacts differently to each unique formulation. Even within the same class (NSAIDs), if someone doesn’t respond to Advil, it certainly may be worthwhile to switch to Aleve to see if it is able to offer better relief. In much the same way, if NSAIDs are not offering relief, it is certainly okay to try Tylenol instead, or vice versa.

5. Are there any specific side effects these may have that you'd like to point out?

Tylenol has very few side effects, however, at doses higher than 4 grams per day, it can cause liver toxicity. Advil and Aleve (and all NSAIDs) can cause an upset stomach, kidney damage, high blood pressure and inflammation or bleeding in the stomach. They can also increase the risk of heart attack in some patients.

6. What precautions would you like to share about any of these meds?

All of these medications can be used safely and effectively. However, just because they are available over-the-counter, does not mean they are completely safe or without side effects. Patients should read all information on the packaging and make sure they are taking the medication correctly and at proper doses.

7. Is there anyone who should avoid one or all of these medications (I know the answer might differ for each medication)?

As Tylenol can affect the liver, 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 with GI disorders, chronic kidney disease, cardiovascular disease, and those on chronic anti-coagulation therapy shoulder avoid NSAIDs, like Advil and Aleve.

8. At what point should someone using these pain-relieving meds see a health care provider if they haven't already?

OTC medications like Tylenol, Advil, and Aleve are a great first-line treatment of simple aches and pains. However, if there is severe pain that limits the ability to function, then proper medical care should be sought. Additionally, if symptoms persist, despite treatment, for more than 7-10 days, patients should seek their doctors for more thorough care to find the true source of their discomfort.

Board Certified in Anesthesiology, Dr. Harrison Linder provides treatments to address chronic pain of the limbs (complex regional pain syndrome or CRPS) and back, even when previous surgical repair has failed to provide relief (post-laminectomy syndrome). At The Center for Interventional Pain Medicine, Dr. Linder and his colleagues, Dr. David Maine, Dr. William Raoofi and Dr. Teresa Tang, work closely with patients diagnosed with cancer and orthopedic disorders to reduce the need for pain medications and alleviate chronic pain.

About Mercy

Founded in 1874 in Downtown Baltimore by the Sisters of Mercy, Mercy Medical Center is a 183-licensed bed, acute care, university-affiliated teaching hospital. Mercy has been recognized as a high-performing Maryland hospital (U.S. News & World Report); has achieved an overall 5-Star quality, safety, and patient experience rating (Centers for Medicare and Medicaid Services); is A-rated for Hospital Safety (Leapfrog Hospital Safety Grade); and is certified by the American Nurses Credentialing Center as a Magnet™ hospital. Mercy Health Services is a not-for-profit health system and the parent company of Mercy Medical Center and Mercy Personal Physicians.

Media Contact
Dan Collins, Senior Director of Media Relations
Office: 410-332-9714
Cell: 410-375-7342
Email: dcollins@mdmercy.com

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