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Acquisitions and divestitures - Acquisition of Horizon Therapeutics plc (Details) - USD ($) $ / shares in Units, shares in Millions, $ in Millions |  | 3 Months Ended | 12 Months Ended |  |
--- | --- | --- | --- | --- | ---
Oct. 06, 2023 | Dec. 31, 2023 | Dec. 31, 2023 | Dec. 31, 2023 | Dec. 31, 2022 | Dec. 31, 2021
Business Acquisition [Line Items] |  |  |  |  |  |
Goodwill |  | $ 18,629 | $ 18,629 | $ 18,629 | $ 15,529 | $ 14,890
Horizon Therapeutics |  |  |  |  |  |
Business Acquisition [Line Items] |  |  |  |  |  |
Acquisition price per share (in usd per share) | $ 116.50 |  |  |  |  |
Consideration transferred | $ 27,800 |  |  |  |  |
Acquisition related costs |  |  | 487 |  |  |
Integration related costs |  |  | 167 |  |  |
Acquisition related transaction costs |  |  | 320 |  |  |
Cash purchase price | 26,700 |  |  |  |  |
Consideration transferred for vested and outstanding awards | 523 |  |  |  |  |
Consideration transferred for replacement awards | 180 |  |  |  |  |
Liabilities incurred | $ 382 |  |  |  |  |
Replacement equity awards issued (in shares) | 1.7 |  |  |  |  |
Inventories | $ 5,025 | 5,000 | $ 5,000 | $ 5,000 |  |
Business combination, turnover period of inventory acquired |  |  |  | 27 months |  |
Deferred tax liabilities | 2,492 |  |  |  |  |
Deferred tax asset | 834 |  |  |  |  |
Goodwill | 3,111 |  |  |  |  |
Revenue of acquiree |  | 955 |  |  |  |
Net losses of acquiree |  | $ 1,200 |  |  |  |
Horizon Therapeutics | Fair Value Adjustment to Inventory |  |  |  |  |  |
Business Acquisition [Line Items] |  |  |  |  |  |
Net losses of acquiree |  |  |  | $ 633 |  |
Horizon Therapeutics | Amortization Of Intangibles Assets |  |  |  |  |  |
Business Acquisition [Line Items] |  |  |  |  |  |
Net losses of acquiree |  |  |  | $ 479 |  |
Horizon Therapeutics | Developed-product-technology rights |  |  |  |  |  |
Business Acquisition [Line Items] |  |  |  |  |  |
Estimated fair value | $ 20,700 |  |  |  |  |
Weighted average period of amortization | 10 years |  |  |  |  |

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