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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, 2024 | Dec. 31, 2022
Business Acquisition [Line Items] |  |  |  |
Goodwill |  | $ 18,629 | $ 18,637 | $ 15,529
Horizon Therapeutics |  |  |  |
Business Acquisition [Line Items] |  |  |  |
Acquisition price per share (in usd per share) | $ 116.50 |  |  |
Consideration transferred | $ 27,800 |  |  |
Goodwill increase |  |  | $ 25 |
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 | $ 5,014 |  |  |
Business combination, turnover period of inventory acquired (in months) | 27 months |  |  |
Deferred tax liability | $ 2,488 |  |  |
Deferred tax asset | 795 |  |  |
Goodwill | 3,136 |  |  |
Acquisition related costs |  | 487 |  |
Share-based compensation acceleration expense |  | 167 |  |
Acquisition related transaction costs |  | $ 320 |  |
Horizon Therapeutics | Developed-product-technology rights |  |  |  |
Business Acquisition [Line Items] |  |  |  |
Estimated fair value | $ 20,700 |  |  |
Weighted average period of amortization (in years) | 10 years |  |  |

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