Stockholders' equity - Schedule of Reclassifications Out of AOCI (Details) - USD ($) $ in Millions	3 Months Ended		6 Months Ended
	Jun. 30, 2025	Jun. 30, 2024	Jun. 30, 2025	Jun. 30, 2024
Reclassification out of Accumulated Other Comprehensive Income [Line Items]
Product sales	$ 9,179	$ 8,388	$ 17,328	$ 15,835
Other (expense) income, net	(394)	(307)	1,124	(542)
Income before income taxes	1,568	794	3,541	726
Provision for income taxes	(136)	(48)	(379)	(93)
Net income	1,432	746	3,162	633
Reclassification out of AOCI | Cash flow hedges
Reclassification out of Accumulated Other Comprehensive Income [Line Items]
Income before income taxes	184	52	323	72
Provision for income taxes	(40)	(11)	(70)	(15)
Net income	144	41	253	57
Cross-currency swap contract gains (losses) | Reclassification out of AOCI | Cash flow hedges
Reclassification out of Accumulated Other Comprehensive Income [Line Items]
Other (expense) income, net	172	(3)	255	(34)
Cross-currency swap contract gains (losses) | Cash flow hedges | Reclassification out of AOCI | Cash flow hedges
Reclassification out of Accumulated Other Comprehensive Income [Line Items]
Other (expense) income, net	172	(3)	255	(34)
Product
Reclassification out of Accumulated Other Comprehensive Income [Line Items]
Product sales	8,771	8,041	16,644	15,159
Product | Foreign currency forward contract gains | Reclassification out of AOCI | Cash flow hedges
Reclassification out of Accumulated Other Comprehensive Income [Line Items]
Product sales	12	55	68	106
Product | Foreign currency forward contract gains | Cash flow hedges | Reclassification out of AOCI | Cash flow hedges
Reclassification out of Accumulated Other Comprehensive Income [Line Items]
Product sales	$ 12	$ 55	$ 68	$ 106