Advil vs. Aleve vs. Tylenol: What’s the Difference?

First, it helps to understand how these drugs work to relieve pain in the body. Then, consider the nature of the pain you’re feeling. And finally, take into account any underlying conditions you may have that could affect the safety of each type of medication.

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. 

In summary:

• Use NSAIDs like Advil or Aleve for chronic pain, pain from an injury or surgery, or other inflammatory pain like arthritis.
• Use Tylenol for mild pain like headache or to reduce fever. 
• Before choosing your preferred pain relief, consider the type of pain you want to relieve as well as any underlying health issues you may have.