Aspirin vs. ibuprofen: Differences, Similarities, and Which One is Better For You

Aspirin and ibuprofen main differences | Conditions treated | Efficacy | Coverage and cost comparison | Side effects | Drug interactions | Warnings | When to avoid both aspirin and ibuprofen | FAQs

Aspirin (also known as acetylsalicylic acid) and ibuprofen are generic nonsteroidal anti-inflammatory drugs (NSAIDs). They are used for a variety of indications such as pain relief and inflammation. NSAIDs such as aspirin and ibuprofen work by blocking enzymes in the body called COX-1 and COX-2. COX stands for cyclooxygenase. These enzymes make substances called prostaglandins, which cause pain and inflammation. By blocking cyclooxygenase, the body makes fewer prostaglandins, which causes less pain and inflammation. Aspirin also blocks thromboxane A2, which helps prevent blood clots. 

Aspirin and ibuprofen can be found as single-ingredient products. You can find them over the counter in both brand and generic forms. Ibuprofen is also available in higher doses as a prescription-strength drug. Both aspirin and ibuprofen can also be found in combination products with other ingredients. This article will focus on the single-ingredient products aspirin and ibuprofen. Note that while many people mention Tylenol (acetaminophen) when talking about drugs for pain and fever, Tylenol is not an NSAID. Tylenol works in a different way than NSAIDs. It can help pain and fever, but not inflammation.

What are the main differences between aspirin and ibuprofen?

Aspirin and ibuprofen are both members of the drug class called nonsteroidal anti-inflammatory drugs, or NSAIDs. Both medicines are available in brand name and generic form. Common brand names of aspirin include Bayer and Ecotrin. Common brand names of ibuprofen include Advil and Motrin. Both are available in a variety of dosing forms to suit individual preferences.

While ibuprofen can be given to children as young as 6 months old, aspirin cannot be given to children. This is because aspirin use in children is associated with Reye Syndrome, a serious condition that can cause brain swelling, liver damage, and death. Aspirin—as well as any products that contain aspirin—should only be used in adults, unless otherwise instructed by your healthcare professional. 

Conditions treated by aspirin and ibuprofen

Aspirin and ibuprofen are commonly used to treat pain and fever from common colds, and other conditions such as headache, toothache, osteoarthritis, rheumatoid arthritis, muscle pain, and menstrual pain. Additionally, aspirin can be used for acute coronary syndrome—a sudden blockage of blood flow to the heart, for example, during a heart attack. In the case of acute coronary syndrome, the aspirin tablet is chewed. Aspirin can also be used in certain patients to prevent stroke and heart attack.  

Low-dose aspirin, generally 81 mg, is often used to prevent heart problems in people who have had a heart attack or stroke. Low-dose aspirin may be considered in certain adults with risk factors who are not at increased risk of bleeding. Low-dose aspirin is not routinely recommended to prevent heart disease in adults over 60 years without risk factors, or adults of any age who are at increased risk of bleeding. Aspirin may also help prevent certain cancers, especially colorectal cancer, after at least five years of use. 

Because everyone has a unique medical history and different risk factors, patients should consult their healthcare provider for questions about using aspirin to prevent heart attack and stroke. The decision about whether or not to use aspirin as preventive medicine should be made between the patient and the healthcare provider.

Is aspirin or ibuprofen more effective?

When deciding which medication to take, one must take into account the intended purpose of the medication. For example, your doctor may recommend that you take aspirin to prevent blood clots or other heart conditions. Ibuprofen is not recommended for this purpose. Another example is a child with a fever. Ibuprofen can be used in infants as young as 6 months old, while aspirin should not be used in children.  

If you are an adult looking for a medication to treat mild to moderate pain, you may wonder which drug is more effective. NSAIDs like aspirin and ibuprofen are similarly effective in relieving pain. However, Tylenol (acetaminophen—not an NSAID) may be a better first choice in certain cases, because it helps relieve pain, and with fewer side effects, it is generally well-tolerated. 

In terms of gastrointestinal side effects, aspirin tends to be more upsetting to the stomach than ibuprofen. Because of this, ibuprofen may be recommended over aspirin for conditions like back pain or dental pain. However, either drug (or any NSAID) may cause stomach trouble. If you are going to take aspirin or ibuprofen, you may want to ask your healthcare provider if you should also take medicine to help protect the stomach. For example, a proton pump inhibitor such as Nexium (esomeprazole) is sometimes used to lower the risk of developing a stomach ulcer from NSAID medication in adults who are at risk for developing a stomach ulcer (for example, adults who are 60 years and older and/or who have a history of stomach ulcers or other risk factors as determined by the healthcare provider). 

The most effective medication for you can only be determined by your healthcare provider, who can take into account your age, individual medical history, symptoms, and medications that you already take that may interact with aspirin or ibuprofen. Some people cannot take either aspirin or ibuprofen due to certain medical conditions or drug interactions. In this case, the healthcare provider may recommend Tylenol (acetaminophen) or another medication.

Coverage and cost comparison of aspirin vs. ibuprofen

As OTC drugs, aspirin and ibuprofen are typically not covered by commercial insurance plans or Medicare prescription plans, although there may be some exceptions, like state Medicaid plans. However, prescription-strength ibuprofen is generally covered by insurance and Medicare prescription plans. You can always use a SingleCare card to save on your prescription of ibuprofen. If, however, you want to save on the over-the-counter (OTC) version of aspirin or ibuprofen, you are welcome to use the free SingleCare card—accompanied by a prescription from your healthcare professional. 

With the SingleCare savings, you can reduce your cost of low-dose aspirin from about $7 out of pocket, to around just $3. Or, if you are getting prescription-strength ibuprofen, you can use a free SingleCare card to reduce the cost from about $32 to as low as $2. Your pharmacist can help you to compare prices and save the most money.

Side effects of aspirin vs. ibuprofen

Common side effects

Common side effects of both aspirin and ibuprofen include:

• Indigestion 
• Nausea 
• Vomiting 
• Stomach pain 
• Ringing in the ears 
• Dizziness 
• Increased levels of uric acid
• Bleeding and bruising
• Constipation or diarrhea
• Delayed ovulation (which may affect fertility in women trying to conceive)

Serious side effects

Some examples of serious side effects of both drugs may include*:

• Life-threatening allergic or skin reactions
• Swelling 
• Asthma attacks in people who have asthma
• Bleeding/stomach bleeding 
• Low platelet levels, which can increase the risk of bruising and bleeding
• Low red blood cells (anemia)
• Kidney problems/kidney failure
• Liver problems/liver failure

*see more information under Warnings section 

Certain symptoms can indicate severe or life-threatening side effects and require immediate medical attention, such as:

• Nausea 
• Vomiting blood/blood in the bowels
• Tiredness
• Weakness
• Itching 
• Yellowing of the skin or whites of the eyes
• Skin rash or blistering skin with fever
• Stomach pain 
• Unusual weight gain
• Flulike symptoms
• Swelling of the arms, legs, hands, and feet

This is not a full list of side effects, and others may occur. Consult your healthcare provider for a full list of side effects, and be sure to discuss what to do in the event of serious side effects.

Drug interactions of aspirin vs. ibuprofen

There are various drug interactions to consider with aspirin or ibuprofen, so before taking one of these medications, patients should tell their healthcare provider about all of the medications they take. This includes prescription and OTC drugs, vitamins, and supplements.

Alcohol should not be combined with aspirin or ibuprofen. The combination could increase the risk of stomach problems which could be life-threatening or cause death. 

Aspirin or ibuprofen should not be taken with a loop diuretic such as Lasix (furosemide) or a thiazide diuretic like hydrochlorothiazide, because the combination can increase the risk of kidney problems. 

When taking aspirin or ibuprofen, other NSAIDs should not be taken, unless under certain circumstances and under the direction and close monitoring of the healthcare professional. 

Also, taking aspirin or ibuprofen with blood thinners or SSRI or SNRI antidepressants can increase the risk of bleeding, which can be life-threatening. 

This is not a full list of drug interactions and others may occur. Consult your healthcare professional for a full list of drug interactions.

Warnings of aspirin and ibuprofen

Ask your doctor before using aspirin or ibuprofen if you are at higher risk for stomach bleeding, if you have have a history of stomach problems including heartburn, if you have high blood pressure or problems with the heart, liver, or kidneys, if you take a diuretic medication, or if you have asthma.

Call your healthcare professional immediately if you have serious side effects. Call 911 if your symptoms feel life-threatening—or if you think you are having a medical emergency. Serious side effects and their symptoms can include the following:

• Allergic reaction: Aspirin or ibuprofen may cause a severe allergic reaction. Symptoms may include hives, trouble breathing, and swelling of the face, lips, tongue, or throat. Patients who are allergic to aspirin or any NSAID should not take aspirin or ibuprofen.
• Severe skin reactions: NSAIDs may cause severe skin reactions, which are life-threatening and can cause death if not treated. Symptoms may include fever, sore throat, burning eyes, red or purple rash, blistering or peeling skin. 
• Stomach bleeding: The risk of stomach bleeding is higher in people who are 60 years or older, people with a history of stomach ulcers or bleeds, people who take a blood thinner (anticoagulant), people who take other NSAIDs or certain other medications (see Drug interaction section), people who drink 3 or more alcoholic beverages daily, or people who take the medication for longer than directed. Symptoms of a stomach bleed may include vomiting blood, having black or bloody stools, and/or stomach pain that does not go away. 
• Liver problems: In rare cases, liver problems may occur, which can be serious or fatal. Symptoms may include nausea, tiredness, itching, stomach pain, dark urine, clay-colored stools, or yellowing of the skin and whites of the eyes.
• Monitor blood pressure during treatment.
• If you take an NSAID for a longer period of time, ask your healthcare provider about lab tests. Because of the risks associated with NSAIDs, you should take the lowest possible dose for the shortest period of time. If you are using an OTC NSAID, ask your doctor before using it for longer than ten days. Pain that is chronic may require a different medication. 

Women who are pregnant should consult their healthcare provider before using aspirin or ibuprofen. Starting at 20 weeks of pregnancy, these medications should be avoided because they can cause harm to the unborn baby as well as complications during delivery.

Aspirin has a warning about Reye syndrome. Children and teenagers should not take aspirin unless directed by their healthcare provider. Children and teenagers who have or are recovering from chickenpox or flulike symptoms should not take aspirin. Do not give aspirin to anyone under 19 years old unless directed by their doctor. 

Ibuprofen has a black box warning, which is the strongest warning required by the U.S. Food and Drug Administration. The warning states that:

• Ibuprofen can cause an increased risk of serious cardiovascular (heart) events such as blood clots, heart attack, or stroke, which can cause death. People who have heart disease—or risk factors for heart disease—are at higher risk. The risk also increases with the length of treatment. 
• Ibuprofen should not be used before or after coronary artery bypass graft (CABG) surgery.   
• Ibuprofen can cause an increased risk of serious stomach problems, including bleeding, ulcers, and perforation (holes) of the stomach or intestines, which can cause death. Older adults are at higher risk for these complications. 

Although aspirin does not have this black box warning, it is important to note that using aspirin with another NSAID can increase the risk of a serious stomach complication and the combination should not be used. For example, in most cases, if you take aspirin to prevent a heart attack, you should not take ibuprofen.

When to avoid both aspirin and ibuprofen

Not everyone can take aspirin or ibuprofen. People who are allergic to any drug in the NSAID drug class should not take aspirin or ibuprofen. Other people who should not take aspirin or ibuprofen include:

• People with aspirin- or NSAID-induced asthma or hives
• People with severe heart failure
• People with the aspirin triad (also called Samter’s triad—this means that the person has all three conditions: asthma, sensitivity to aspirin/NSAIDs, and sinus disease with nasal polyps)
• People with kidney problems
• People who consume a certain amount of alcohol
• People who are going to have, or have just had, CABG surgery
• People who have stomach bleeding or a history of stomach bleeding
• Pregnant women starting at 30 weeks (except those who take low-dose aspirin)

Any time you are going to have surgery or a medical procedure, tell your healthcare provider you take aspirin or ibuprofen. You may need to stop taking it for a few days before the procedure.

For people that cannot take an NSAID such as aspirin or ibuprofen, Tylenol (acetaminophen) may be a better option. If you cannot take or tolerate an NSAID, discuss alternatives with your healthcare provider. 

Depending on your condition, you can also discuss home remedies with your healthcare provider, that you can do in combination with your medication, such as:

• Ice or heat
• Physical therapy/exercise
• Massage
• Rest 
• Yoga or meditation
• Acupuncture 
• Vitamins or supplements

Frequently asked questions about aspirin vs. ibuprofen

What is aspirin?

Aspirin is a nonsteroidal anti-inflammatory drug (NSAID) that can be used for a variety of conditions, such as pain, fever, and prevention of heart attack or stroke, among others. 

What is ibuprofen?

Like aspirin, ibuprofen is an NSAID. It is commonly used for pain and fever. Ibuprofen does not protect against heart attack or stroke.

Are aspirin and ibuprofen the same?

No. In some ways, they are similar. They are both NSAIDs and they can be used for some of the same conditions. They have similar side effects and drug interactions. However, they do have differences as outlined above. For example, aspirin can be used to prevent a heart attack or stroke while ibuprofen cannot. And ibuprofen can be used in children while aspirin should not be used in children. 

Is aspirin or ibuprofen better?

In terms of pain management, aspirin and ibuprofen are similarly effective, but aspirin may cause more gastrointestinal side effects. However, which medication is appropriate depends on the reason for its use. For example, aspirin can be used in certain patients with risk factors to prevent heart attacks and strokes, while ibuprofen is not indicated for this use. And ibuprofen can be used in children, while aspirin is not used in children. You can consult your healthcare provider for more information about which medication is appropriate for you. 

Can I use aspirin or ibuprofen while pregnant?

You can use low-dose aspirin while pregnant, if instructed by your healthcare provider. However, starting at 20 weeks through the remainder of pregnancy, you should avoid full-dose aspirin or ibuprofen because they can cause harm to the baby and/or complications during delivery. 

Women who are trying to become pregnant should consult their healthcare provider, because NSAIDs may delay ovulation, which could make it difficult to conceive.

Can I use aspirin or ibuprofen with alcohol?

You should consult your healthcare provider about alcohol use. Aspirin or ibuprofen can cause stomach bleeds which can be life-threatening. Having 3 or more alcoholic drinks per day can increase the risk of bleeding. When drinking alcohol, you should also be mindful of serving sizes, because it can be easy to overestimate a serving. One serving of alcohol is 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of distilled spirits.

Is aspirin a weaker painkiller than Tylenol or ibuprofen?

Because each drug is different, it’s difficult to compare these three drugs in terms of which is strongest. It’s better to look at what the drug would be used for, side effects, individual needs, the person’s medical conditions and other medications they take, etc. Aspirin can help pain and fever, but can cause stomach problems and cannot be used in children. Tylenol provides pain relief, but does not help inflammation. It is more gentle on the stomach and can be used in children. Ibuprofen can help with pain, fever, and inflammation and can be used in children. It can cause stomach problems, but is not as hard on the stomach as aspirin. You can ask your healthcare provider which medication would be best for you.

Can ibuprofen be taken with aspirin?

Generally, the two drugs are not taken together. However, in some cases a healthcare professional may recommend ibuprofen to a patient who is taking low-dose aspirin. In these cases, the patient would be carefully monitored for bleeding and kidney function. The combination of ibuprofen and aspirin could increase the risk of stomach ulcers, perforation, and bleeding, which could be life-threatening—as well as kidney problems. Ibuprofen may also decrease aspirin’s protective effect on the heart.