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Stockholders' equity - Reclassifications out of AOCI (Details) - USD ($)
$ in Millions
 3 Months Ended 9 Months Ended
Sep. 30, 2023
Jun. 30, 2023
Mar. 31, 2023
Sep. 30, 2022
Jun. 30, 2022
Mar. 31, 2022
Sep. 30, 2023
Sep. 30, 2022
Reclassification out of Accumulated Other Comprehensive Income [Line Items]                
Total revenues $ 6,903     $ 6,652     $ 19,994 $ 19,484
Other income (expense), net 685     100     2,431 (747)
Income before income taxes 1,947     2,392     7,003 5,598
Provision for income taxes (217)     (249)     (1,053) (662)
Net income 1,730 $ 1,379 $ 2,841 2,143 $ 1,317 $ 1,476 5,950 4,936
Product sales                
Reclassification out of Accumulated Other Comprehensive Income [Line Items]                
Total revenues 6,548     6,237     19,077 18,249
Reclassification out of Accumulated Other Comprehensive Income | Cash flow hedges                
Reclassification out of Accumulated Other Comprehensive Income [Line Items]                
Income before income taxes (53)     (129)     64 (312)
Provision for income taxes 11     28     (14) 67
Net income (42)     (101)     50 (245)
Reclassification out of Accumulated Other Comprehensive Income | Foreign currency contract gains | Cash flow hedges | Product sales                
Reclassification out of Accumulated Other Comprehensive Income [Line Items]                
Total revenues 33     69     121 149
Reclassification out of Accumulated Other Comprehensive Income | Cross-currency swap contract losses | Cash flow hedges                
Reclassification out of Accumulated Other Comprehensive Income [Line Items]                
Other income (expense), net (86)     (198)     (57) (461)
Reclassification out of Accumulated Other Comprehensive Income | Cash flow hedges | Foreign currency contract gains | Cash flow hedges | Product sales                
Reclassification out of Accumulated Other Comprehensive Income [Line Items]                
Total revenues 33     69     121 149
Reclassification out of Accumulated Other Comprehensive Income | Cash flow hedges | Cross-currency swap contract losses | Cash flow hedges                
Reclassification out of Accumulated Other Comprehensive Income [Line Items]                
Other income (expense), net $ (86)     $ (198)     $ (57) $ (461)