Head-to-head clinical analysis & difference comparison: details on mechanism of action, dosing, half-life, interactions, and maternal-fetal safety.
ADVIL ALLERGY AND CONGESTION RELIEF vs ACULAR LS
Clinician-reviewed, head-to-head comparison of mechanism, dosing, pharmacokinetics, and safety profiles.
Last clinically reviewed: July 2026 · OpiCalc Medical Review Team
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that inhibits cyclooxygenase (COX-1 and COX-2), reducing prostaglandin synthesis, which mediates inflammation, pain, and fever. Pseudoephedrine is a sympathomimetic amine that acts as a decongestant by stimulating alpha-adrenergic receptors in the nasal mucosa, causing vasoconstriction.
Selective COX-2 inhibitor; inhibits prostaglandin synthesis, reducing ocular inflammation and pain.
Temporary relief of symptoms due to hay fever or other upper respiratory allergies: nasal congestion, sinus pressure, sneezing, runny nose, itching of nose or throat, and itchy, watery eyes due to allergies.,Temporary reduction of fever.,Relief of minor aches and pains associated with the common cold, headache, toothache, muscular aches, backache, menstrual cramps, and arthritis pain.
FDA: Treatment of postoperative inflammation in patients who have undergone cataract surgery,Off-label: Relief of ocular pain, photophobia, and inflammation associated with corneal abrasion or refractive surgery
Ibuprofen 200 mg and pseudoephedrine HCl 30 mg per tablet. Usual adult dose: 1-2 tablets orally every 4-6 hours as needed, not to exceed 6 tablets in 24 hours.
1 drop in the affected eye(s) four times daily
Ibuprofen: 2-4 hours; pseudoephedrine: 5-8 hours. Shorter half-life requires frequent dosing for sustained relief.
The terminal elimination half-life is approximately 1.8 hours (range 1.2–2.5 hours) following topical ocular administration. This short half-life is consistent with rapid clearance from the systemic circulation.
Ibuprofen is primarily metabolized by cytochrome P450 (CYP) enzymes, mainly CYP2C9, to inactive metabolites (hydroxyibuprofen and carboxyibuprofen). Pseudoephedrine is partially metabolized in the liver by N-demethylation to an inactive metabolite.
Primarily hepatic via CYP2C9; undergoes glucuronidation and oxidation to inactive metabolites.
Renal excretion of unchanged drug and metabolites; approximately 1% excreted unchanged (pseudoephedrine) and 15% (ibuprofen). Biliary/fecal elimination accounts for <5%.
Renal excretion of metabolites and unchanged drug accounts for approximately 26% of the dose. Fecal excretion accounts for approximately 74% of the dose, primarily as metabolites.
Ibuprofen: 99% bound to albumin; pseudoephedrine: negligible protein binding.
Ketorolac is highly protein bound, approximately 99% bound to plasma proteins, primarily albumin.
Ibuprofen: 0.1-0.2 L/kg; pseudoephedrine: 2.5-3 L/kg.
The volume of distribution is approximately 0.12 L/kg, indicating distribution primarily into extracellular fluid with limited tissue penetration.
Oral: ibuprofen 80-100%; pseudoephedrine 100%.
Ophthalmic bioavailability is approximately 2% of the administered dose due to extensive nasolacrimal drainage and systemic absorption. Oral bioavailability of ketorolac is approximately 80-100%, but this route is not used for ophthalmic formulations.
For pseudoephedrine: Cr Cl <30 m L/min, reduce dose by 50% or administer every 12 hours. For ibuprofen: avoid use if Cr Cl <30 m L/min; if Cr Cl 30-59 m L/min, use lowest effective dose and monitor renal function.
No dosage adjustment required for renal impairment
For ibuprofen: Child-Pugh class A and B: no adjustment necessary; Child-Pugh class C: avoid use. For pseudoephedrine: use with caution in severe hepatic impairment; no specific dose adjustment recommended, but monitor for adverse effects.
No dosage adjustment required for hepatic impairment but use with caution in severe hepatic disease due to potential for increased systemic exposure
Not indicated for children under 12 years of age. For children 12 years and older: same as adult dose (1-2 tablets every 4-6 hours, max 6 tablets per day). Weight-based: not routinely used; safety and efficacy not established for <25 kg.
Safety and efficacy in pediatric patients below 2 years of age have not been established; for children 2 years and older, same as adult dosing
For ibuprofen: use lowest effective dose for shortest duration; monitor renal function and GI bleeding risk. For pseudoephedrine: initiate at lower doses (e.g., one tablet every 6 hours) due to increased sensitivity and risk of hypertension, urinary retention, and CNS effects.
No specific dose adjustment recommended; use with caution due to increased incidence of age-related ocular conditions
Cardiovascular risk: NSAIDs may increase the risk of serious cardiovascular thrombotic events, myocardial infarction, and stroke, which can be fatal. Risk increases with duration of use and in patients with cardiovascular risk factors. Contraindicated for perioperative pain in coronary artery bypass graft (CABG) surgery. Gastrointestinal risk: NSAIDs increase the risk of serious gastrointestinal adverse events including bleeding, ulceration, and perforation of the stomach or intestines, which can be fatal. Elderly patients and those with prior peptic ulcer disease and/or GI bleeding are at greater risk.
None
Cardiovascular effects: may increase risk of heart attack or stroke; use lowest effective dose for shortest duration. Gastrointestinal effects: may cause GI ulceration, bleeding, perforation. Renal effects: avoid in advanced renal disease; monitor renal function. Hepatic effects: may cause liver enzyme elevation; discontinue if liver disease develops. Anaphylactic reactions: may occur in patients with or without prior NSAID sensitivity. Asthma: may cause bronchospasm. Hypertension: may worsen hypertension. Avoid in late pregnancy due to risk of premature closure of ductus arteriosus. Pseudoephedrine: may cause nervousness, dizziness, insomnia, hypertension, arrhythmias; use with caution in patients with cardiovascular disease, diabetes, glaucoma, prostatic hypertrophy, hyperthyroidism. Avoid in severe hypertension or coronary artery disease.
Increased risk of bleeding and bleeding-related adverse events due to platelet inhibition,May prolong bleeding time,Cross-sensitivity with aspirin and other NSAIDs,Caution in patients with prior history of corneal epithelial defects or ocular surgery,Not for intraocular injection
Hypersensitivity to ibuprofen, pseudoephedrine, or any component of the formulation. History of asthma, urticaria, or allergic-type reaction after taking aspirin or other NSAIDs. In the setting of coronary artery bypass graft (CABG) surgery. Severe hypertension. Coronary artery disease. Concurrent use with or within 14 days of monoamine oxidase inhibitors (MAOIs) due to risk of hypertensive crisis. Pregnancy (third trimester).
Hypersensitivity to ketorolac tromethamine or any component of the formulation,Patients with active peptic ulcer disease, recent GI bleeding, or perforation,Patients with advanced renal disease or at risk for renal failure,Patients with known history of asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs
Take with food or milk to minimize GI upset. Avoid alcohol as it may increase risk of GI bleeding. No specific food-drug interactions.
No known food interactions for ophthalmic ketorolac. However, maintain good hydration and nutrition to support corneal healing.
First trimester: Possible increased risk of cardiovascular malformations and gastroschisis with NSAID use. Second trimester: No specific malformation risk reported, but avoid prolonged use due to potential oligohydramnios. Third trimester: NSAIDs (including ibuprofen) are contraindicated due to risk of premature ductus arteriosus closure and oligohydramnios. Pseudoephedrine: Limited data; possible association with gastroschisis if used in first trimester; avoid due to vasoconstrictive effects.
Ketorolac tromethamine, the active ingredient in ACULAR LS, is a nonsteroidal anti-inflammatory drug (NSAID). In animal reproduction studies, administration of ketorolac during organogenesis resulted in increased embryofetal mortality, delayed ossification, and increased incidence of skeletal abnormalities at doses less than the maximum recommended human ophthalmic dose. However, systemic exposure following ocular administration is very low. NSAIDs are generally avoided during pregnancy, especially in the third trimester, due to the risk of premature closure of the ductus arteriosus and oligohydramnios. The risk is considered low for ophthalmic use but should be used only if clearly needed.
Ibuprofen: Excreted in low levels (M/P ratio ~0.006); considered compatible with breastfeeding. Pseudoephedrine: Excreted in breast milk (M/P ratio ~2.5-3.5); may reduce milk production and cause irritability in infants; use with caution.
It is not known whether ketorolac is excreted in human milk after ophthalmic administration. Systemic levels are low, and following oral administration, ketorolac is excreted in breast milk at low concentrations (M/P ratio approximately 0.37). Due to the potential for adverse effects on the nursing infant, caution should be exercised. The low systemic absorption likely poses minimal risk.
Ibuprofen: No specific dose adjustment recommended for pregnancy; however, avoid use in third trimester. Pseudoephedrine: No dose adjustment studied; use lowest effective dose for shortest duration. Neither drug is recommended for regular use during pregnancy.
No dosing adjustments are necessary for ophthalmic use during pregnancy due to negligible systemic absorption. Standard dosing (1 drop in the affected eye(s) four times daily) is recommended. Systemic NSAIDs may require dose adjustment due to increased volume of distribution and renal changes, but this does not apply to topical ocular ketorolac.
Combination of ibuprofen (NSAID) and pseudoephedrine (decongestant). Ibuprofen may increase blood pressure, counteracting pseudoephedrine's vasoconstriction; monitor in hypertensive patients. Avoid in patients with severe CAD, uncontrolled HTN, or within 2 weeks of MAOI use.
ACULAR LS (ketorolac tromethamine ophthalmic solution 0.4%) is a nonsteroidal anti-inflammatory drug (NSAID) indicated for the reduction of ocular pain and photophobia following corneal refractive surgery. Use with caution in patients with known bleeding tendencies or those on anticoagulants due to increased risk of ocular bleeding. Avoid concurrent use with other NSAIDs or steroids to minimize corneal adverse effects. Monitor for corneal epithelial breakdown or delayed healing.
Do not take with other NSAIDs or cold/flu products to avoid overdose.,Pseudoephedrine may cause insomnia; take last dose at least 4-6 hours before bedtime.,Ibuprofen can cause GI bleeding; take with food or milk to reduce risk.,Stop use and consult doctor if symptoms persist >7 days or if fever lasts >3 days.,Avoid alcohol while taking this medication.
Do not touch the dropper tip to any surface to avoid contamination.,Remove contact lenses before instillation and wait at least 10 minutes before reinserting.,Use only in the affected eye(s) as prescribed; do not use for longer than directed.,Temporary stinging or burning may occur upon instillation.,Report any persistent pain, redness, or visual changes to your doctor immediately.,Avoid driving or operating machinery if vision is blurred after use.
No interactions on record
No interactions on record
Explore head-to-head clinical comparisons of other medications in the same therapeutic classes.
Common clinical questions about ADVIL ALLERGY AND CONGESTION RELIEF vs ACULAR LS, answered by our medical review team.
ADVIL ALLERGY AND CONGESTION RELIEF is a NSAID/Decongestant Combination that works by Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that inhibits cyclooxygenase (COX-1 and COX-2), reducing prostaglandin synthesis, which mediates inflammation, pain, and fever. Pseudoephedrine is a sympathomimetic amine that acts as a decongestant by stimulating alpha-adrenergic receptors in the nasal mucosa, causing vasoconstriction.. ACULAR LS is a NSAID Ophthalmic that works by Selective COX-2 inhibitor; inhibits prostaglandin synthesis, reducing ocular inflammation and pain.. They differ in pharmacokinetic profiles, FDA-approved indications, and side effect profiles.
Potency comparisons between ADVIL ALLERGY AND CONGESTION RELIEF and ACULAR LS depend on the specific clinical indication. These are agents from distinct pharmacological classes and are not directly interchangeable by dose. A physician or clinical pharmacist should guide any therapeutic switching decisions.
The standard adult dose of ADVIL ALLERGY AND CONGESTION RELIEF is: Ibuprofen 200 mg and pseudoephedrine HCl 30 mg per tablet. Usual adult dose: 1-2 tablets orally every 4-6 hours as needed, not to exceed 6 tablets in 24 hours.. The standard adult dose of ACULAR LS is: 1 drop in the affected eye(s) four times daily. Dosing should always be individualized based on indication, renal and hepatic function, age, and other patient factors.
No direct drug-drug interaction has been formally documented between ADVIL ALLERGY AND CONGESTION RELIEF and ACULAR LS in current clinical databases. However, individual patient risk factors including other medications, organ function, and comorbidities should always be evaluated by a qualified healthcare provider.
The maternal-fetal safety profiles differ. ADVIL ALLERGY AND CONGESTION RELIEF is classified as Category C. First trimester: Possible increased risk of cardiovascular malformations and gastroschisis with NSAID use. Second trimester: No specific malformation risk reported, but avoid prolo. ACULAR LS is classified as Category C. Ketorolac tromethamine, the active ingredient in ACULAR LS, is a nonsteroidal anti-inflammatory drug (NSAID). In animal reproduction studies, administration of ketorolac during org. Always consult a maternal-fetal medicine specialist before taking either drug during pregnancy or lactation.