Paracetamol (Panadol, Tylenol, Calpol) and ibuprofen (Nurofen, Advil) treat most everyday pain and fever. They work differently, can be taken together by most adults, and each has its own limits. This guide compares them with aspirin, diclofenac and naproxen, and shows who should avoid which.
The short answer
- Paracetamol is the gentlest first choice for headache, fever and most aches: adults take 500 mg–1 g every 4–6 hours, never more than 4 g in 24 hours.
- Ibuprofen also reduces inflammation, so it suits period pain, sprains, toothache and back pain: adults take 200–400 mg every 4–6 hours with food, no more than 1,200 mg a day without a doctor’s advice.
- Most adults can take both together or alternate them. Never take two anti-inflammatories (ibuprofen, aspirin, diclofenac, naproxen) at the same time.
Which painkiller for which kind of pain?
For most short-lived pain, paracetamol and ibuprofen work about equally well. The choice depends less on strength than on what is causing the pain and on your own health. Inflammation (swelling, heat, a sprained ankle, period cramps, an inflamed tooth) responds better to an anti-inflammatory such as ibuprofen. If you have a sensitive stomach, kidney problems, heart disease or are pregnant, paracetamol is usually the safer starting point.
| Type of pain | Usual first choice | Why |
|---|---|---|
| Tension headache | Paracetamol or ibuprofen | Both work; paracetamol has fewer side effects |
| Migraine | Ibuprofen, or aspirin 900 mg (adults) | Higher anti-inflammatory doses work better than paracetamol alone; take early |
| Fever (adults) | Paracetamol | Effective and kind to the stomach |
| Period pain | Ibuprofen, naproxen or mefenamic acid | Anti-inflammatories reduce the prostaglandins that cause cramping |
| Sprains, strains, back pain | Ibuprofen (tablets or gel) | Inflammation is part of the pain; topical gels suit one painful joint |
| Toothache, after dental work | Ibuprofen + paracetamol | The combination outperforms either alone in dental studies |
| Osteoarthritis | Topical NSAID gel, then paracetamol | Long-term oral NSAIDs carry stomach, kidney and heart risks |
| Pain in pregnancy | Paracetamol | Ibuprofen and other NSAIDs should be avoided unless a doctor advises them |
If a single painkiller at the full label dose doesn’t control the pain, combining paracetamol with ibuprofen is the usual next step before anything stronger. Codeine and other opioids add side effects for relatively little extra relief in everyday pain.
Paracetamol (Panadol, Tylenol, Calpol)
Paracetamol, called acetaminophen in the US and Canada, relieves pain and lowers fever, but it has almost no anti-inflammatory effect. It doesn’t irritate the stomach and is safe for most people, including in pregnancy and while breastfeeding, which is why it is usually recommended first.
Adult doses
| Product | Paracetamol per unit | Usual adult dose | Maximum in 24 hours |
|---|---|---|---|
| Panadol, Tylenol Extra Strength, generic tablets | 500 mg | 1–2 tablets every 4–6 hours | 8 tablets (4 g) |
| Tylenol Regular Strength (US) | 325 mg | 2 tablets every 4–6 hours | Follow the US label (lower daily caps are printed on many packs) |
| Panadol Osteo (modified release, AU) | 665 mg | 2 caplets every 6–8 hours, swallowed whole | 6 caplets (3.99 g) |
| Liquid 250 mg/5 mL | 50 mg per mL | 10–20 mL every 4–6 hours | 4 doses |
Adults who weigh under 50 kg, drink heavily, are malnourished or have liver disease may need a lower dose; ask a pharmacist. Unless a doctor advises otherwise, don’t take paracetamol for more than a few days in a row for the same pain.
Hidden paracetamol: cold and flu sachets, many Lemsip and Codral products, Panadeine, Maxigesic, Nuromol and many prescription painkillers already contain paracetamol. Add up every product before you take a second one. An overdose can damage the liver without any early symptoms, so if you have taken too much, contact a poisons information service or emergency department immediately, even if you feel well.
Ibuprofen (Nurofen, Advil, Brufen)
Ibuprofen is a non-steroidal anti-inflammatory drug (NSAID). It blocks the COX enzymes that make prostaglandins, the chemical messengers of pain, swelling and fever. The same mechanism explains its side effects: prostaglandins also protect the stomach lining, help the kidneys regulate blood flow and influence blood pressure and clotting.
Adult doses
- Over the counter: 200–400 mg every 4–6 hours, with or after food, up to 1,200 mg in 24 hours (six 200 mg or three 400 mg tablets).
- On prescription: doctors may use up to 2,400 mg a day for inflammatory conditions, with closer monitoring.
- Fast-acting forms: Nurofen Express, liquid capsules and ibuprofen lysine are absorbed faster, so they start working sooner. They are not stronger and not gentler on the stomach.
- Gel: ibuprofen or diclofenac gel rubbed on a painful joint reaches far lower blood levels, which makes it a sensible option for older people and long-term joint pain.
Short courses at label doses are safe for most healthy adults. Stomach bleeding, kidney strain and raised blood pressure become more likely with higher doses, longer use, older age and certain other medicines. Our article on which ibuprofen is easiest on the stomach explains what actually lowers that risk.
Aspirin, diclofenac, naproxen and mefenamic acid
All of these are NSAIDs like ibuprofen. They share the same benefits and risks, so they must not be combined with ibuprofen or with each other.
| Medicine (brands) | Typical OTC strength | Best known for | Watch out for |
|---|---|---|---|
| Aspirin (Disprin, Aspro Clear, Bayer) | 300 mg; 75–100 mg low dose | Pain, migraine; low dose for heart and stroke prevention | Not for under-16s (Reye’s syndrome); bleeding risk; low dose is not a painkiller |
| Diclofenac (Voltaren Rapid, Voltarol) | 12.5–25 mg tablets; 1–2% gel | Back, joint and muscle pain | Higher heart-attack and stroke risk than ibuprofen at regular doses |
| Naproxen (Naprogesic, Aleve) | 220–275 mg | Period pain, longer-lasting relief (8–12 hours) | Stomach side effects; fewer doses a day |
| Mefenamic acid (Ponstan) | 250 mg | Heavy, painful periods | Diarrhoea; usually limited to a few days per cycle |
The difference between 100 mg and 300 mg aspirin matters: one thins the blood, the other treats pain. See low-dose vs high-dose aspirin. If you take low-dose aspirin for your heart, ask your pharmacist before using ibuprofen, because regular ibuprofen can interfere with aspirin’s protective effect.
Can you combine painkillers?
Paracetamol works mainly in the brain and spinal cord, while NSAIDs act where the inflammation is. Because they work by different routes, taking them together adds pain relief without adding to each other’s side effects. Two NSAIDs together, on the other hand, double the stomach and kidney risk without much extra benefit.
| Combination | OK for most adults? | Notes |
|---|---|---|
| Paracetamol + ibuprofen | Yes | Together or alternating; keep each within its own daily maximum |
| Paracetamol + aspirin | Yes (adults) | Aspirin is not for under-16s |
| Ibuprofen + diclofenac, naproxen or aspirin tablets | No | Two NSAIDs: more side effects, little extra relief |
| Ibuprofen tablets + NSAID gel on one joint | Check with a pharmacist | Gel absorption is low, but labels advise caution with other NSAIDs |
| Paracetamol + a cold and flu product | Often no | Most cold and flu products already contain paracetamol |
| Ibuprofen or paracetamol + codeine (prescribed) | Usually yes | Check the codeine product for hidden paracetamol or ibuprofen |
Ready-made combination tablets exist: Maxigesic (paracetamol 500 mg + ibuprofen 150 mg) and Nuromol (ibuprofen 200 mg + paracetamol 500 mg). They are convenient, but they count towards both daily limits. Nurofen Plus is different: it combines ibuprofen with codeine and contains no paracetamol. In the UK it is sold only in pharmacies, and in Australia all codeine products have been prescription-only since February 2018.
For the exact rules see can I take Nurofen and Panadol together and how far apart to take them. For prescription combinations, read Endone or codeine with Nurofen. Interactions with other medicines (blood pressure tablets, antidepressants, blood thinners) are covered in our guide to combining medicines safely.
Who should avoid ibuprofen and other NSAIDs?
Ask a doctor or pharmacist before taking ibuprofen, or choose paracetamol instead, if any of these apply:
- Stomach: a stomach ulcer or bleed now or in the past, or indigestion that keeps coming back.
- Kidneys and heart: kidney disease, heart failure, a previous heart attack or stroke, or high blood pressure that isn’t controlled.
- Asthma: asthma that gets worse with aspirin or NSAIDs. Many people with asthma tolerate ibuprofen, but this group must not.
- Other medicines: blood thinners (warfarin, apixaban, rivaroxaban, clopidogrel), SSRI antidepressants, steroids such as prednisolone, lithium, methotrexate, or blood pressure tablets combined with a diuretic. See ibuprofen and blood pressure medicines.
- Pregnancy: avoid NSAIDs unless a doctor advises them, especially from 20 weeks, when they can affect the baby’s kidneys and circulation. Paracetamol is the usual choice.
- Older age: people over 65 are more likely to have bleeding and kidney side effects. Use the lowest dose for the shortest time, or a gel.
- Dehydration: vomiting, diarrhoea or gastro. NSAIDs plus dehydration can injure the kidneys.
Children can have paracetamol from birth (ask a doctor for babies under one month) and ibuprofen from 3 months, with doses calculated from weight. Our article on Panadol and Nurofen for children explains when using both makes sense.
When pain needs a doctor rather than a painkiller
Get medical advice promptly if pain is severe or sudden (“worst headache of my life”), follows a head injury, comes with chest pain, breathlessness, weakness, confusion, a stiff neck and rash, or high fever. Also see a doctor if you need painkillers for more than about 3 days for fever or 10 days for pain, if pain wakes you at night, or if you notice black stools or vomit that looks like coffee grounds while taking NSAIDs.
Frequent use of painkillers for headaches, on more than about 10–15 days a month, can itself cause daily “medication-overuse” headaches. A doctor can help you break that cycle and look at preventive treatment.
Articles in this guide
Each article answers one specific question in depth.
- Can I Take Nurofen and Panadol Together?Yes, most adults can take Nurofen (ibuprofen) and Panadol (paracetamol) together or alternate them. Doses, spacing, daily limits and who should not.
- How Far Apart Should You Take Nurofen and Panadol?No gap is needed between Nurofen and Panadol, but each has its own interval. Sample alternating schedule, daily maximums and a dose log you can copy.
- Panadol vs Nurofen: What Is the Difference?Panadol is paracetamol, Nurofen is ibuprofen. How they work, which suits headache, fever, period pain or injuries, and who should avoid each.
- Which Ibuprofen Is Easiest on the Stomach?Coated, liquid-capsule or lysine forms do not protect the stomach lining. What actually lowers the risk, and pain relief options for a sensitive stomach.
- Can You Take Nurofen and Voltaren Together?Voltaren tablets and Nurofen are both NSAIDs, so don't combine them. Why the gel is different, and safer combinations for pain.
- Low-Dose vs Regular-Dose Aspirin: What Is the Difference?75–100 mg aspirin thins the blood; 300–900 mg doses treat pain and fever. Who takes low-dose aspirin, why you shouldn't start it yourself, and bleeding risks.
- Can a Child Have Panadol and Nurofen Together?Paracetamol and ibuprofen for children: weight-based doses, why alternating is rarely needed, and when a feverish child needs a doctor.
- How Ibuprofen Is Made – and Who Makes ItFrom the Boots discovery in the 1960s to the three-step BHC synthesis: how ibuprofen is manufactured, who makes it today and why brands cost more.
- Can You Take Endone or Codeine with Nurofen?Oxycodone (Endone) or codeine combinations with ibuprofen are often prescribed. Doses to watch, hidden paracetamol, and side effects.
Frequently asked questions about pain relief
Does Nurofen contain paracetamol?
No. Standard Nurofen tablets and capsules contain only ibuprofen. Some combination products do contain both, such as Nuromol, and Nurofen Plus contains ibuprofen with codeine. Always check the active ingredients on the pack.
Is Nurofen an aspirin?
No. Both are NSAIDs, but ibuprofen and aspirin are different medicines. People allergic to aspirin often react to ibuprofen too, so don’t swap one for the other without advice.
How often can you take Nurofen?
For adults, every 4–6 hours as needed, up to 1,200 mg in 24 hours without medical supervision. That is three doses of 400 mg or six 200 mg tablets. Children have weight-based doses no more than three times a day.
Which is stronger, Panadol or Nurofen?
Neither is simply stronger. For headaches and fever they perform similarly. Ibuprofen tends to work better where inflammation drives the pain, such as period pain, toothache and sprains. Paracetamol has fewer side effects.
Why does ibuprofen make me sleepy?
Drowsiness is an uncommon side effect of ibuprofen itself. More often the pain or illness is making you tired, or the product also contains a sedating antihistamine or codeine, as many “night” and cold products do. If it happens regularly, ask your pharmacist about an alternative.
Can I take Nurofen with prednisolone?
Steroids such as prednisolone and NSAIDs both raise the risk of stomach ulcers and bleeding. The combination is sometimes prescribed with stomach protection, but don’t add over-the-counter ibuprofen to a steroid course without asking your doctor or pharmacist. Paracetamol is the safer choice.
Sources and further reading
Combining medicinesWhich medicines clash and why: duplicate ingredients, NSAID combinations, sedatives, alcohol and blood pressure…
Stomach & gutGaviscon, famotidine, omeprazole, sucralfate, loperamide and lactulose: how they work, how to take them together,…
Surgery & proceduresWhich medicines to stop before surgery, what is usually fine, fasting rules, and pain relief, laxatives and…