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  2. Ibuprofen


  1. What is ibuprofen?
  2. What is ibuprofen used for?
  3. Types
  4. Who can take ibuprofen?
  5. Ibuprofen is not suitable for certain people
  6. How to take ibuprofen
  7. Side-effects
  8. Ibuprofen overdose
  9. FAQs

What is ibuprofen?

Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID), with antipyretic (fever reducing) properties.[1] It may be taken by both adults and children to manage many commonplace conditions associated with pain and inflammation, such as toothache, headache, joint pain and menstrual cramps.[2][3]

Ibuprofen is an everyday painkiller which is used to:

  • Relieve mild to moderate pain
  • Reduce fever
  • Reduce swelling

What is ibuprofen used for?

Ibuprofen functions by inhibiting the synthesis, i.e. slowing down or blocking the production, of prostaglandins,[4] hormones that cause pain within the body. Prostaglandins also cause fever, swelling and inflammation. Ibuprofen is a popular and effective way to lessen these types of discomfort, which are associated with a wide variety of conditions. Feeling unwell? Get a free symptom assessment with the [Ada app]((https://app.adjust.com/e8ex7r4?redirect_macos=https%3A%2F%2Fappstore.com%2Fadapersonalhealthcompanion).

Ibuprofen can be used to treat:

  • Mild to moderate localized pain, as is typical of conditions like menstrual cramps, toothache and headache
  • Fevers, when the body’s temperature rises beyond its normal rating of around 37 degrees Celcius to 38 or more degrees Celsius
  • Pain and swelling from injuries such as sprains and strains
  • Redness and inflammation stemming from ongoing conditions such as osteoarthritis, a condition characterized by pain and stiffening in the joints

Ibuprofen is not recommended for regular or long-term use without the supervision of a doctor, even in cases where pain is experienced on a long-term basis, as it has been linked to gastric discomfort and gastric conditions such as gastric or stomach ulcers and heart problems.

Anybody who is often or constantly taking ibuprofen should seek a medical opinion, as they may be suffering from an undiagnosed condition and/or may need to be prescribed alternative drugs that might be more suitable for long-term pain management.

Types of ibuprofen

Ibuprofen can be purchased from most pharmacies and supermarkets as a prescription free over-the-counter medication. However, some types and strengths of ibuprofen are only available on prescription. These are usually prescribed for treating specific conditions, such as rheumatoid arthritis.

Ibuprofen is available in various different forms, including:

  • Oral products, such as tablets, liquids and capsules
  • Other formulations for oral consumption; i.e. in form of granules that can be dissolved in a hot drink
  • Topical products, for application on the skin, such as creams, gels and sprays
  • In products where it is combined with other active ingredients, including other pain medications, such as paracetamol

Topical forms of ibuprofen tend to have fewer side-effects than oral ones. Therefore, in cases where ibuprofen is being used to treat an ongoing condition, e.g. pain related to a sporting injury, a locally applied topical form of ibuprofen ‒ such as a gel ‒ may be recommended.

Ibuprofen ingredients vary depending on the particular product used. In all ibuprofen products, the active ingredient, i.e. the element of the product which works as the painkiller, is ibuprofen itself, a white powder. Different products will contain different amounts of ibuprofen; oral products tend to come in dosage options of 200, 400, 600 or 800 mg.

In addition to the active ingredient ibuprofen and any other active ingredients that a given product may feature, such as paracetamol, painkilling products contain other ingredients, which do not treat pain or have any other medical use, but which give them their shape and/or consistency and taste, such as sucrose, lactose, glycerine, citric acid, and, in some cases, food colouring dyes. Always check the guidelines that come with the product for a complete list of ingredients, especially in the case of any known allergies or sensitivities.

Good to know: Like all pharmaceutical drugs, ibuprofen products will have an expiration date on their packaging. Research from the Food and Drug Administration (FDA) suggests that, with some important exceptions like insulin and certain antibiotics, many pharmaceuticals retain most of their original potency after their expiration date.[5] However, in order to ensure that ibuprofen is safe and effective, medical guidelines recommend that any ibuprofen-containing products are taken within their expiry date.[6] Consuming expired meds also carries the risk that the shelf-life of the other ingredients in the product may be different to those of the active ingredients.

Ibuprofen vs aspirin

Ibuprofen and aspirin are both over-the-counter (OTC), non-steroidal anti-inflammatory drugs (NSAIDs). Both types of painkiller work by inhibiting the production of prostaglandins, thereby reducing pain and inflammation.The FDA considers both effective drugs to treat minor, i.e. mild to moderate aches and pains such as are associated with menstrual pain, toothache and headaches.

However, they can be used to treat a slightly different range of conditions and also differ somewhat in their side effects. Although both are linked to stomach upsets, aspirin is even more likely than ibuprofen to cause side effects related to the stomach, such as gastric ulcers.

Before taking any type of painkiller, always read the guidelines on the packet to ensure that it is suitable to treat the problem at hand. Seek medical advice on using the painkiller if in doubt, or if the pain or symptoms do not get better or go away as expected.

Ibuprofen vs paracetamol

Paracetamol is also known as acetaminophen, and by the brand name TylenolⓇ in the U.S.[7] It is an analgetic (pain relieving) and antipyretic (fever reducing) painkiller, rather than an NSAID like ibuprofen and aspirin. As such, it relieves or reduces pain and fever, but not swelling or inflammation. This means that it is not a suitable alternative for treating swelling, for example, due to arthritis, or an injury.

Unlike NSAIDs, paracetamol is suitable for pregnant people and people using blood thinning medication, because it does not have the same anticoagulant (anti-clotting) effects on the blood.

Good to know: Despite some controversy, paracetamol is now considered not to be damaging to the stomach lining and will not, therefore, lead to ulcers. However, it may lead to stomach upsets, heartburn or nausea, especially in higher concentrations.[8][9][10]

High and/or frequent doses of paracetamol should be avoided, as this kind of use carries a risk of liver damage.[11]

Who can take ibuprofen?

Ibuprofen is suitable for most adults, and children who are at least six months old. There are formulations and dosages available for babies older than 3 months and weighing more than 5 kgs, too, but they should not be given without consulting a doctor.

A doctor or pharmacist will be able to recommend the correct strength and formulation of ibuprofen for an individual’s needs, and the instructions on the packet will specify the correct dosage.

The appropriate dosage will depend on factors like:

  • The person’s age
  • The extent and type of pain they are experiencing
  • The recovery timeline of the condition that the ibuprofen is being used to treat
  • The strength and formulation of the product

Ibuprofen is not suitable for certain people

In rare cases, ibuprofen can cause heart attacks and strokes, particularly if it is used long-term or if a person takes high doses.[3] There are certain conditions and lifestyles which make this more likely, and which increase the risk of side-effects such as gastrointestinal damage.

It is not advisable for pregnant women to take ibuprofen, as it can affect the unborn child. In particular, it can compromise the development of the foetus and increases the risk that the newborn will develop asthma later on.[12]

Factors which increase the risk of complications arising from the use of ibuprofen include:[3]

  • Heart disease
  • High cholesterol
  • Diabetes
  • Asthma
  • High blood pressure
  • A history of gastric/stomach ulcers
  • Certain arthritis and musculoskeletal diseases such as Sjorgen’s syndrome
  • Liver disease
  • Kidney disease
  • Smoking

It is advisable to discuss one’s medical history with a doctor or pharmacist and establish whether it is safe to take ibuprofen.

Children affected by certain conditions should not be given ibuprofen, unless specified by a doctor. These include:[13]

  • Chicken pox (ibuprofen can cause a severe allergic skin reaction)
  • Asthma
  • Inflammatory bowel disease, such as Crohn’s disease or ulcerative colitis
  • Any conditions related to an increased risk of bleeding, such as haemophilia
  • Liver problems
  • Kidney problems

Ibuprofen may react with other drugs in a way which impedes their function and/or causes an adverse reaction within the body, and it is advisable to investigate this before using ibuprofen if one is currently or regularly taking any other medications.

A person’s doctor will always be able to recommend a painkilling, and/or anti-inflammatory, alternative to ibuprofen, that is safe to use with other medications. It is never necessary, or advisable, to stop or miss a dose of one’s prescription medicine in order to use over-the-counter ibuprofen.

Some of the principal medications which are not recommended for use with ibuprofen without prior approval by your GP or healthcare provider include:[14]

  • Other non-steroidal anti-inflammatory drugs (NSAIDs) such as naproxen or high-dose aspirin
  • Selective serotonin reuptake inhibitors (SSRIs), a type of antidepressant drugs
  • Drugs used to prevent blood clots, such as warfarin or heparin
  • Diuretics - medicines used to treat high blood pressure - and other heart medications like certain beta-blockers or digoxin
  • Lithium, a medicine used to treat a range of mental health conditions including bipolar depression or major depression and
  • Cyclosporin, a medicine sometimes used to treat autoimmune conditions such as ulcerative colitis
  • Methotrexate, a medicine used to treat rheumatoid arthritis
  • Phenytoin, an anti-epileptic drug
  • Oral corticosteroids, a strong anti-inflammatory medication

Always consult a doctor before taking ibuprofen, if taking any prescription medication in order to avoid possible cross-reactivity.

Food and drink with ibuprofen

It is not necessary to avoid any particular foods or food groups whilst taking ibuprofen.

Good to know: It is safe to consume grapefruit and grapefruit-containing products, while taking ibuprofen. (For more information, see the FAQs.)

Drinking alcohol while taking ibuprofen

Drinking alcohol with ibuprofen excessively is not recommended, as it may make irritation irritation of the stomach even more likely and, over time, increases the chances of gastric side effects, like stomach ulcers. Ibuprofen can also cause liver damage in some cases, especially if taken in higher dosages over prolonged amounts of time; combining it with alcohol increases this risk. Most cases of liver toxicity due to ibuprofen are of mild to moderate severity and can be reversed by discontinuing the use of ibuprofen.[15]

How to take ibuprofen

Ibuprofen comes in many different oral and topical (to be applied on the skin) forms, so it is important to read the instructions that accompany the medication. The appropriate dosage depends on the strength and type of the ibuprofen and the age of the individual. The instructions will also explain how to store the ibuprofen. A cool, dry area is usually recommended,[16] but certain products may need to be refrigerated.

Ibuprofen should always be taken with or after food to avoid digestive discomfort.

The dosage guidelines vary between types of ibuprofen. Various OTC pain-relieving products may contain different strengths of ibuprofen. It is therefore vital to read the instructions associated with the particular type carefully before use and to note the maximum (max) dose suitable for the person taking the medicine.

It is important to ensure that there are appropriate intervals between doses. The amount of time that must pass before it is safe to take more ibuprofen depends on the strength of the product. For example, an adult may take one or two 200mg tablets every four to six hours, but should not take more than 1,200mg (six 200mg) tablets over a 24-hour period, if self-medicating.[2]

If prescribed and recommended by a doctor, adults can take up to a maximum of 2400 mg to 3200 mg within a 24 hour period. Different maximal doses are recommended in different countries. Children will usually need to take a lower, age-dependent amount.

Ibuprofen: children’s dosage

Different types of ibuprofen are recommended for children of different ages:[13]

  • Three months: Ibuprofen should only be given to infants of three months and older in syrup form and if approved by a doctor.
  • Six months and older: Ibuprofen in syrup form is most appropriate for children of six months and older. Until age six, children should not be given other forms of ibuprofen.
  • Six years and older: From the age of six, children can take ibuprofen in tablet or capsule form.
  • Seven years and older: From the age of seven, ibuprofen can be taken in form of chewable tablets.
  • Twelve years and older: Granules containing ibuprofen are suitable for children of age twelve and older.

The dosage instructions for ibuprofen depend on a child’s age and the strength of the syrup or tablets used.

For ibuprofen syrup containing 100mg per 5ml, the following dosages are appropriate for children:[13]

  • 3-5 months old: 2.5ml, 3 times in 24 hours
  • 6-11 months old: 2.5ml, 3-4 times in 24 hours
  • 1-3 years old: 5ml, 3 times in 24 hours
  • 4-6 years old: 7.5ml, 3 times in 24 hours
  • 7-9 years old: 10ml, 3 times in 24 hours
  • 10-11 years old: 15ml, 3 times in 24 hours
  • 12-17 years old: 15-20 ml, 3-4 times in 24 hours

For ibuprofen tablets, the following dosages are appropriate:[13]

  • 7-9 years old: 200mg, 3 times in 24 hours
  • 10-11 years old: 300mg, 3 times in 24 hours
  • 12-17 years old: 300-400 mg, 3-4 times in 24 hours, up to a maximum of 600 mg, 4 times in 24 hours. If treating a child oneself, administer no more than 1200 mg of ibuprofen in 24 hours. If higher dosages are needed to relieve symptoms, please consult a doctor.

Ibuprofen side-effects

NSAIDs like ibuprofen can increase the likelihood of internal bleeding and can irritate the stomach and the gut. This is because the prostaglandins play several key roles within the body. In addition to the negative properties that the NSAIDs inhibit, i.e. causing pain and inflammation, prostaglandins perform positive functions such as protecting the lining of the gut and helping facilitate coagulation (clotting of the blood).[17]

Common ibuprofen side-effects include:

  • Nausea and/or vomiting
  • Abdominal pain
  • Indigestion
  • Constipation
  • Bloating
  • Diarrhea

Ibuprofen is also associated with some more serious, but less common, side-effects.

Less common ibuprofen side-effects include:

  • Dizziness
  • Drowsiness
  • Headaches
  • Allergic reactions, such as skin itching or a rash, up to severe allergic reactions that are an emergency
  • Gastric/stomach ulcers
  • Worsening of asthma symptoms
  • Kidney failure
  • Problems with the liver
  • Problems with the heart and circulation, for example, strokes and heart attacks
  • Internal bleeding, indicated by black stools and the presence of blood in one’s vomit

The likelihood of experiencing side-effects from ibuprofen is increased by:

  • Taking more than the recommended dose
  • Taking ibuprofen at high doses for long periods of time
  • Taking ibuprofen with some of the drugs mentioned above, like corticosteroids
  • Being in poor general health
  • Being elderly
  • Having severe pre-existing kidney and/or liver diseases

Anyone who experiences side-effects as a result of taking ibuprofen should seek a medical opinion in a timely manner, as both internal bleeding and complications arising from stomach and/or gut irritation can become life-threatening if left unchecked/untreated.

Ibuprofen overdose

Most people can take up to 800mg of ibuprofen four times in a 24-hour period without the risk of overdosing.[3] However, overdoses of ibuprofen can be fatal, and symptoms of an overdose are not always seen immediately. For this reason, it is important and generally recommended to seek medical attention if a person has taken more than the maximum dose of ibuprofen recommended for their age and condition, especially when experiencing any of the symptoms below.

Symptoms of an overdose can include:

  • Vomiting
  • Nausea
  • Abdominal pain
  • Breathing difficulties
  • Reduced motor skills
  • Tinnitus (ringing in the ears)

Ibuprofen FAQs

Q: Can ibuprofen cause miscarriage?
A: Ibuprofen is not suitable for use at any point during a pregnancy, but the risks posed to the developing fetus are different, depending on how many weeks pregnant a person is. Before week 30 of pregnancy, ibuprofen may increase the risk of miscarriage. Research indicates that taking any type of NSAID, including ibuprofen, during pregnancy can more than double the risk of miscarriage, compared to avoiding this type of painkiller. A possible explanation for the link between NSAIDs and miscarriage is that they may compromise the mechanism by which prostaglandins are naturally blocked in the body during pregnancy, thus causing miscarriage.[18]

After week 30 of pregnancy, ibuprofen may cause the baby to develop a heart problem and may reduce the amount of amniotic fluid in the womb.[19]

Q: What medications can be used safely by pregnant people, instead of ibuprofen?
A: Paracetamol is the most suitable medication for pregnant people to use instead of ibuprofen. There is no evidence that paracetamol poses risks to a developing baby, and this medication can provide pain relief and/or reduce the symptoms of a fever, similar to the effects of ibuprofen. Pregnant people are recommended to take the lowest possible dose of paracetamol, for the shortest possible time.[20]

Good to know: Many OTC brands of paracetamol also contain caffeine. Excess caffeine intake should be avoided during pregnancy, so it is important to ensure that any paracetamol intended for use by a pregnant person is caffeine-free.[20]

Q: Is ibuprofen suitable to use when breastfeeding?
A: In general, ibuprofen is safe to use when breastfeeding, unless a person has asthma or a stomach ulcer which gets worse when they take ibuprofen. Only small amounts of ibuprofen are usually present in breast milk and these are not believed to cause harm to the baby. However, if a baby has a low birth weight, was born prematurely or has a medical condition, it is advisable to consult a doctor before using ibuprofen, as the traces in breast milk may be harmful in these cases.[21]

Q: Is it safe to drink alcohol at the same time as using ibuprofen?
A: Drinking alcohol excessively when taking any NSAID is likely to irritate the stomach. Drinking a moderate amount of alcohol is not thought to have an impact on the safety or effectiveness of taking ibuprofen, provided a person is over 21 years of age, is not pregnant and is not affected by any long-term health conditions. The Centres for Disease Control and Prevention (CDC) recommend that women drink no more than one drink per day and that men drink no more than two drinks per day.[22]

Q: Does ibuprofen reduce swelling?
A: Yes. Ibuprofen works by blocking the production of prostaglandins, which the body produces in response to illness and/or injury, and which cause pain, inflammation, fever and swelling. Although ibuprofen can temporarily reduce swelling, the root cause of the illness or injury may need to be addressed before the body stops producing the swelling. For example, ibuprofen may temporarily relieve the pain and swelling associated with dental abscess, but, in almost all dental abscess cases, a visit to the dentist may be required in order to treat the problem fully and prevent further pain and swelling developing at the site of the problem.[23]

Q: Is ibuprofen a blood thinner?
A: Ibuprofen is not designed to be used as a blood thinning medication. However, like other NSAIDs, it interferes with the way that platelets work, and thus can make the body’s blood clotting abilities less efficient than normal. For this reason, ibuprofen is often described as a blood thinner. Ibuprofen is not recommended for use with actual blood thinners, i.e. antiplatelet drugs or anticoagulants, because of this property. It is recommended that people who are using prescription blood thinners and who need to use painkillers opt for paracetamol, rather than ibuprofen or aspirin, to avoid interactions related to blood thinning. However, anybody who is on a course of blood thinning medication should only use painkillers according to their doctors recommendations, with caution, and in the lowest possible dose.[24]

Q: Is it bad to take ibuprofen every day?
A: Yes. Ibuprofen is only recommended for short-term use; as long-term or regular use, it is linked to an increased likelihood of experiencing harmful side effects, such as stomach ulcers and heart problems. Seek a medical opinion if you need to use a painkiller for long-term pain management, so a doctor can find the best way to help you, and, if necessary, prescribe a safe alternative. Feeling unwell? Get a free symptom assessment with the [Ada app]((https://app.adjust.com/e8ex7r4?redirect_macos=https%3A%2F%2Fappstore.com%2Fadapersonalhealthcompanion).

Q: Is it safe to consume grapefruit-containing products at the same time as using ibuprofen?
A: Yes, it is safe to consume grapefruit when taking ibuprofen. However, it is always advisable to check whether any medication, including other pain-relief and anti-inflammatory medication, will perform differently in the body when grapefruit is consumed. Grapefruit, especially grapefruit juice, contains particular chemicals which can alter the way the body metabolizes (breaks down) some medications, resulting in more, or, in some cases, less, than the required quantity of a given drug entering a person’s bloodstream. All OTC medications come with a “Drug Facts” label which will mention whether there is any cross-reactivity with grapefruit.[25]

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  3. Ibuprofen for adults: including nurofen.” NHS Beta. Accessed: 19 February 2018.

  4. The effects of a prostaglandin synthetase inhibitor, ibuprofen, on the cardiopulmonary response to endotoxin in sheep.” Circulatory Shock. 1982. Accessed: 19 February 2018.

  5. Drug expiration dates: do they mean anything?.” 13 August 2018. Accessed: 18 September 2018.

  6. Why do medicines have expiry dates?” NHS. 20 January 2017. Accessed: 18 September 2018.

  7. TylenolⓇ is not affiliated with Ada. It is mentioned in this guide in order to provide the most relevant and current information on the differences between popular OTC painkillers.

  8. Endoscopic comparison of gastroduodenal injury with over-the-counter doses of new fast-dissolving ibuprofen and paracetamol formulations: a randomized, placebo-controlled, 4-way crossover clinical trial.” Clinical and Experimental Gastroenterology. 16 April 2018. Accessed: 20 September 2018.

  9. acetaminophen (OCT)." Medscape. 2018. 13 December 2018.

  10. Gastrointestinal safety of paracetamol: is there any cause for concern?.” Expert Opinion on Drug Safety. 2004. Accessed: 20 September 2018.

  11. Know the difference between your pain relievers.” University of Tennessee Medical Center. 19 June 2012. Accessed: 18 September 2018.

  12. Effects of ibuprofen, diclofenac, naproxen, and piroxicam on the course of pregnancy and pregnancy outcome: a prospective cohort study.” BJOG: An International Journal of Obstetrics and Gynaecology. July, 2013. Accessed: 19 February 2018.

  13. Ibuprofen for children.” NHS Beta. Accessed: 19 February 2018.

  14. NSAIDs.” NHS Choices. 22 March 2016. Accessed: 19 February 2018.

  15. Drug record: Ibuprofen.” National Institutes of Health. 05 July 2018. Accessed: 18 September 2018.

  16. Why you should keep medicines out of summer heat.” Health News from NPR. 11 July 2012. Accessed: 19 February 2018.

  17. Non-steroidal anti-inflammatory drugs and gastrointestinal damage—problems and solutions.” British Medical Journal: Postgraduate Journal. 26 October 1999. Accessed: 19 February 2018.

  18. Ibuprofen may ‘raise miscarriage risk’.” NHS. 07 September 2011. Accessed: 18 September 2018.

  19. Can I take ibuprofen when I’m pregnant?.” NHS Choices. 04 April 2016. Accessed: 19 February 2018.

  20. Can I take paracetamol when I’m pregnant?.” NHS Choices. 27 May 2015. Accessed: 19 February 2018.

  21. Can I take ibuprofen while I’m breastfeeding?.” NHS Choices. 19 March 2015. Accessed: 19 February 2018.

  22. "Fact-sheets: moderate drinking." CDC. `18 October 2016. Accessed: 13 December 2018.

  23. Ibuprofen Mechanism.” Medical Life Sciences News. 02 December 2014. Accessed: 19 February 2018.

  24. Bad mix: blood thinners and NSAIDs.” Harvard Medical School. October 2013. Accessed: 18 September 2018.

  25. Grapefruit juice and some drugs don’t mix.” FDA US Food and Drug Administration. 18 July 2017. Accessed: 19 February 2018.