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Stockholders' equity - Schedule of Reclassifications Out of AOCI (Details) - USD ($)
$ in Millions
 3 Months Ended 9 Months Ended
Sep. 30, 2025
Sep. 30, 2024
Sep. 30, 2025
Sep. 30, 2024
Reclassification out of Accumulated Other Comprehensive Income [Line Items]        
Product sales $ 9,557 $ 8,503 $ 26,885 $ 24,338
Other income, net 2,080 1,830 3,204 1,288
Income before income taxes 3,921 3,101 7,462 3,827
Provision for income taxes (705) (271) (1,084) (364)
Net income 3,216 2,830 6,378 3,463
Reclassification out of AOCI | Cash flow hedges        
Reclassification out of Accumulated Other Comprehensive Income [Line Items]        
Income before income taxes (67) 166 256 238
Provision for income taxes 14 (36) (56) (51)
Net income (53) 130 200 187
Cross-currency swap contract (losses) gains | Reclassification out of AOCI | Cash flow hedges        
Reclassification out of Accumulated Other Comprehensive Income [Line Items]        
Other income, net (39) 121 216 87
Cross-currency swap contract (losses) gains | Cash flow hedges | Reclassification out of AOCI | Cash flow hedges        
Reclassification out of Accumulated Other Comprehensive Income [Line Items]        
Other income, net (39) 121 216 87
Product        
Reclassification out of Accumulated Other Comprehensive Income [Line Items]        
Product sales 9,137 8,151 25,781 23,310
Product | Foreign currency forward contract (losses) gains | Reclassification out of AOCI | Cash flow hedges        
Reclassification out of Accumulated Other Comprehensive Income [Line Items]        
Product sales (28) 45 40 151
Product | Foreign currency forward contract (losses) gains | Cash flow hedges | Reclassification out of AOCI | Cash flow hedges        
Reclassification out of Accumulated Other Comprehensive Income [Line Items]        
Product sales $ (28) $ 45 $ 40 $ 151