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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