Tylenol, Advil, Aleve, Aspirin - What's the Difference?

Tylenol, Advil, Aleve, Aspirin -
- What’s the Difference?
When to Use Acetaminophen Vs. Ibuprofen Vs.
Naproxen Vs. Aspirin

         Maria Guerra, Pharm.D., Yahoo Contributor Network
         May 8, 2013

 MORE:      Naproxen Reye's Syndrome Aleve Ibuprofen Advil

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Searching for the right medication can be overwhelming because there are so many options
for every possible health condition. Which one do you choose? Tylenol (acetaminophen),
Advil (ibuprofen), Aleve (naproxen), and aspirin all relieve pain and have the ability to
reduce a fever. However, that is about as far as the similarities go between these
medications. There are many factors to consider when deciding which over-the-counter
(OTC) medication would be best for you and your children. You must consider your
symptoms, age, and health conditions.

For example, if you want to reduce inflammation or swelling, acetaminophen will not work.
If you are older or have heart disease, it would be best to avoid non-steroidal anti-
inflammatory drugs (NSAIDs) like ibuprofen and naproxen. Ibuprofen and naproxen may
increase the risk of heart attack or stroke, while aspirin is used to decrease that very same
risk. Children under 16 years of age should not take aspirin if they have flu-like symptoms
or if they are recovering from viral infections, because they may end up with a deadly
condition called Reye's Syndrome.

I will be breaking down the information to help you decide which medication would be best
for you and your loved ones. If you fall into any of the special categories mentioned below, I
recommend speaking to your primary healthcare provider or pharmacist before using any of
these medications regularly.

Acetaminophen (Tylenol)
What It Does: Acetaminophen relieves pain and reduces fever.

Age Considerations:

   Older population. The American Geriatrics Society guideline recommends
   acetaminophen as first-line treatment of mild to moderate pain.
   Infants, toddlers, and children. Always use caution when treating this population.
   There is a wide variety of acetaminophen products and you must always read the label
   to view the age restrictions on each product. If you are not sure, ask your pharmacist.

Examples of acetaminophen age limits:

   Infant's Tylenol drops: Infant must be at least 2 months old
   Tylenol Regular Strength (325 mg): child must be at least 6 years or older
   Tylenol Extra Strength (500 mg): child must be at least 12 years or older

Health Considerations:

   Liver disease. Overuse of acetaminophen could cause hepatic (liver) failure, so avoid
   this medication or consult with your physician first if you have liver problems.

Warning:

   Daily Limit. To avoid liver damage and other side effects, do not use more than 3000
   mg of acetaminophen each day. (The limit was 4000 mg in the past, but in recent years
   it has been reduced to 3000 mg, see New Tylenol Dosing Instructions)
   Many prescription and OTC products contain acetaminophen. Examples
   include Excedrin (acetaminophen, aspirin, caffeine) and Norco or Vicodin
   (hydrocodone and acetaminophen). The acetaminophen in these products count toward
   your daily limit, and you should avoid taking these acetaminophen-containing products
   together.
   Avoid Alcohol. Both alcohol and acetaminophen can cause liver damage. Taking both
   of these products will increase the risk of liver damage.

Ibuprofen (Advil, Motrin) and Naproxen (Aleve)
Ibuprofen and Naproxen are both NSAIDs with similar side effects and precautions.

Naproxen is longer acting in comparison to ibuprofen, which is why naproxen could be
taken less frequently during the day.

What It Does: Both relieve pain and reduce fever, swelling, and inflammation.

Age Considerations:

    Older population. Ibuprofen and naproxen are generally not recommended for older
    adults because they will have an increase in negative side effects. The American
    Geriatric Society states that NSAIDs should not to be used in this patient population,
    and they should only be considered by a primary care physician if initial therapy (with
    acetaminophen) fails.
    Infants, toddlers, and children. Always use caution when treating and read the
    labels. If you have any questions, ask your pharmacist.

Product age limits vary, here are examples of ibuprofen and naproxen age limits:

    Infants' Advil Drops: For infants between 6 to 23 months old
    Children's Advil Suspension: For children between the ages of 2-11 years
    Advil (ibuprofen) tablets: child must be at least 12 years old
    Aleve (naproxen) tablets: child must be at least 12 years old

Health Conditions:

    Allergies. Avoid ibuprofen and naproxen if you are allergic to NSAIDs or aspirin
    (salicylate allergy).
    Asthma. NSAIDs may cause severe bronchospasms which can be fatal. Consult your
    primary health care provider first.
    Heart Disease, Coronary Artery Bypass Graft surgery (CABG). If you have
    heart problems or are at a high risk for heart disease, you should avoid or limit NSAID
    use. Studies have shown NSAIDs cause an increased risk for cardiovascular thrombotic
    events such as heart attacks or strokes. The American Heart Association stated that if
    NSAIDs must be used, it should be the lowest dose needed to treat the patient's pain
    over the shortest period of time.
    Kidney disease. Since these medications may cause acute renal (kidney) failure, you
    should avoid these medications if you have kidney problems.

GI (gastrointestinal) bleeding. NSAID use can cause GI bleeding and ulcers.

Warning:

    Daily Limit. Ibuprofen's OTC maximum daily dose is 1200 mg. Naproxen's daily limit
    is 1500 mg.
    Avoid Alcohol. Both alcohol and NSAIDs increase GI bleeding risk. If these products
    are taken together you will have a higher risk of GI diseases such as Peptic Ulcer Disease
    (PUD).
    Blood thinners. If you are on anticoagulation medication (Warfarin, Plavix, etc.), you
    may be at an increased risk of bleeding if you take ibuprofen or naproxen. Notify your
    doctor if you take NSAIDs regularly.

Aspirin (Bayer)
Aspirin is an NSAID similar to ibuprofen and naproxen, but it has been separated for very
important reasons.

What It Does: Similar to the above mentioned NSAIDs, aspirin can used for pain, fever,
swelling, and inflammation.

In addition to this, aspirin has anti-thrombotic effects that prevent blood clots. This is why
aspirin is used to prevent or reduce the risk of heart attack and or stroke in patients who
have a history of heart disease. It has also been recommended to chew an aspirin tablet if
you are having a heart attack.

Age Considerations:

    Older population. Similar to other NSAIDs, the American Geriatrics Society does not
    recommend aspirin use. Only use after approval from your doctor.
    Infants, toddlers, and children. Aspirin manufacturers generally recommend that
    a patient must be at least 12 years old to use their products. However there is another
    important factor that parents must keep in mind, which is Reye's Syndrome.
    Reye's Syndrome. Do not use aspirin in children less than 16 years of age if they have
    flu-like symptoms or if they are recovering from a viral infection such as the flu or
    chickenpox. There has been an association between aspirin and Reye's Syndrome,
    which is a rare but serious illness. Changes in behavior, nausea, and vomiting may be an

early sign of Reye's Syndrome. For more information, read: What is Reye's Syndrome?

Health Conditions:

    Allergies, Asthma, GI bleeding, Blood thinners. See the ibuprofen and naproxen
    sections mentioned above.
    Viral Infections. If a child has flu-like symptoms, a viral infection (chickenpox,
    influenza), or is recovering from an illness do not use aspirin because of the risk of fatal
    Reye's Syndrome.
    Kidney disease. Aspirin should be used cautiously in patients with poor kidney
    function because overuse may worsen kidney function.

Warning:

    Daily Limit: The maximum daily amount of aspirin you could take is 4000 mg.
    Avoid Alcohol: Aspirin has the same precautions as the above mentioned ibuprofen
    and naproxen. Aspirin and alcohol will increase GI bleeding risk and will increase the
    risk of GI diseases such as PUD.
    Discontinue Aspirin Prior to Surgery. It is generally recommended that you
    discontinue aspirin one to two weeks prior to surgery to reduce the risk of excessive
    bleeding. Notify your physician or dentist if you are taking aspirin regularly, and they
    will let you know if you should continue or discontinue taking the medication.

The content this article provides is for informational purposes only. It is not medical
advice and should not be substituted for regular consultation with your health care
provider. If you have any concerns about your medication or health, please contact your
health care provider's office.

Sources:
AGS: Pharmacological Management of Persistent Pain in Older Persons (2009)
American Heart Association Adds Its Weight To NSAID Risk Message (2013)
Advil.com
Aleve.com
Bayer Aspirin
Tylenol.com

Published by Maria Guerra, Pharm.D.
 Maria Guerra is a pharmacist from Los Angeles, California. She earned her pharmacy doctorate in 2014 and
 specializes in prescription and over-the-counter drug therapies, women’s health, medication therapy... View
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