Ibuprofen

Boxed warning

Ibuprofen has a US Food and Drug Administration issued boxed warning for cardiovascular and gastrointestinal risks. Cardiovascular events can include heart attacks and strokes that can result in death.¹

Do not use ibuprofen as a pain treatment around the time of, or after a coronary artery bypass graft procedure.

Taking ibuprofen, like all nonsteroidal anti-inflammatory drugs, carries a risk of gastrointestinal side effects, such as sores (ulcers), bleeding, or holes in the stomach and intestines, which can be fatal.

These risks are present at any time when using ibuprofen and may not present warning signs. Older adults are at a greater risk of adverse effects.

What is ibuprofen?

Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID). This class of medication has anti-inflammatory, pain-relieving, and fever-reducing properties.

Ibuprofen inhibits the activity of enzymes called COX-1 and COX-2, which reduce prostaglandins (substances in the body that are responsible for mediating pain, inflammation, swelling, and fever).

What is ibuprofen used to treat?

Ibuprofen can be used to help relieve inflammation, minor or moderate pain, or fever associated with a number of conditions including:

• Rheumatoid arthritis and osteoarthritis

• Cold and flu

• Menstrual cramps

• Headaches, including migraines

• Toothaches

• Back pain

• Musculoskeletal injuries

Dosage forms and strengths

Ibuprofen is widely available over-the-counter (OTC) in:

• 200mg tablets or capsules

• 400mg “extra-strength” tablets or capsules

• 100mg chewable tablets

• 5mg/100mg oral suspension

Prescription ibuprofen comes in the form of oral tablets or caplets in the following strengths:

• 400mg

• 600mg

• 800mg

Prescription ibuprofen intravenous injectable solution is available in:

• 100mg/mL single-dose vials (which must be diluted) 

• 4mg/mL ready-to-use bags

How do you take ibuprofen?

Take the lowest dose of ibuprofen possible in order to treat symptoms successfully, and for the shortest duration possible.

Higher doses are associated with an elevated risk of side effects.²

The following doses are general guidelines. For the best and safest results, it is important to follow the package instructions if using over-the-counter ibuprofen, or adhere to your prescribing doctor or pharmacist’s recommendations if you are taking prescription-strength ibuprofen.

Pain relief

A standard dose of ibuprofen for mild to moderate pain is one 200mg tablet taken every 4 to 6 hours as needed.

Dysmenorrhea

A standard dose of ibuprofen for painful menstrual cramps is one 200mg or 400mg tablet every 4 to 6 hours as needed.

Rheumatoid arthritis and osteoarthritis

What You Need To Know About Osteoarthritis

Dosage for rheumatoid arthritis and osteoarthritis flare-ups varies depending on whether you are taking over-the-counter or prescription ibuprofen.

Your doctor may suggest 200mg, 400mg, 600mg, or 800mg tablets every 4 to 6 hours daily.

Take ibuprofen with food

You should take ibuprofen with food or milk to reduce adverse gastrointestinal effects.

Never chew, break, crush, or suck ibuprofen tablets or capsules.

Liquid ibuprofen formulas and powder that you can mix with water and drink are also available.

Seeing results

Most people experience pain relief within about 20 to 30 minutes of taking ibuprofen.

However, if you start at a low dose and do not get results, or the effects last for less than 4 to 6 hours, talk with your doctor about whether or not to increase the strength or frequency of taking ibuprofen.

For certain types of chronic pain associated with inflammatory conditions (such as rheumatoid arthritis and osteoarthritis), it may take up to three weeks for full anti-inflammatory effects to take place.³

Who should not take ibuprofen?

Taking ibuprofen is not recommended if you:

• Have recently had coronary artery bypass graft (CABG) surgery

• Have recently had a heart attack or a history of heart failure

• Have a history of gastrointestinal issues, including heartburn, gastritis (inflammation), ulcers, or bleeding

• Have experienced past allergic reactions from taking NSAIDs

• Have ever experienced aggravated asthma symptoms after taking any type of NSAIDs, including aspirin or ibuprofen

• Have chronic kidney disease (CKD) 

• Are taking diuretics, other NSAIDs, or anticoagulants (blood thinners)

• Are in the second half of pregnancy. Taking ibuprofen in this period may lead to low amniotic fluid levels around the baby, or may cause premature closure of the ductus arteriosus (a vessel that connects the aorta to the pulmonary artery) in the fetus. It is important to keep this vessel open in the womb as it allows the blood to bypass the fetus’s lungs since no oxygen is available there before birth.

Potential side effects of ibuprofen

Ibuprofen is generally well-tolerated, especially when taken as directed. However, as with any medication, it is best to be aware of possible side effects so that you can monitor your reaction and seek medical advice or attention if needed.

The following is not an exhaustive list of all possible side effects. Please make sure to consult with a qualified medical professional if the symptoms you are taking ibuprofen for do not improve, or if you develop any new symptoms.

Common side effects

Common ibuprofen side effects may include:

• Elevated blood pressure (monitor your blood pressure levels while using this medication)

• Headaches

• Nausea

• Vomiting

• Indigestion

• Flatulence

• Diarrhea or constipation

• Stomach discomfort or pain

• Dizziness

If these common side effects do not improve or persist, make sure to consult with your doctor.

Severe side effects

Gastrointestinal problems such as bleeding or intestinal perforation (holes in the digestive tract) can occur at any time while taking ibuprofen.

Symptoms of gastrointestinal issues may include:

• Bloody or black stool

• Vomiting blood

• Pain or discomfort in the chest, throat, stomach, or abdomen that doesn’t go away

Taking NSAIDs also increases the risk of cardiovascular issues, such as heart attack and stroke. Symptoms may include:

• Easily bruising or bleeding

• Chest pain

• Difficulty breathing

• Weakness in one side of the body

• Pain or stiffness in the shoulder or neck

• Severe fatigue

• Slurred speech

• Blurry vision

Other severe side effects can include kidney impairment. Symptoms may include:

• Difficulty urinating

• Decreased urine output

• Cloudy or bloody urine

• Swollen ankles

Another side effect, although rare, can include severe liver dysfunction, symptoms may include:

• Persistent nausea or vomiting

• Yellowing of the skin or eyes (jaundice)

• Dark urine

• Loss of appetite

If you experience any of these severe side effects stop taking ibuprofen, and seek medical help immediately from the nearest emergency service, or call 911.

The risk of developing serious side effects while taking ibuprofen increases if you:

• Are 60 years or older

• Have a history of cardiovascular disease

• Have a history of gastrointestinal issues such as stomach ulcers or bleeding problems

• Take ibuprofen regularly or for long periods of time

• Exceed health guidelines for moderate alcohol consumption (one drink or less per day for women, two drinks a day or less for men, on days that alcohol is consumed)⁴

• Take a blood thinning (anticoagulant) or steroid medication

• Take another NSAID drug such as aspirin, or naproxen (Aleve)

Overdose

Patients taking ibuprofen should not exceed 3200mg per day.

If you take more than 3200mg in a few hours, you may experience dizziness, nausea, and vomiting, stomach pain, sleepiness, ringing in the ears, difficulty breathing, or the slowing or speeding up of your heart rate.

You may also observe coughing up blood, black stool, or blood in vomit if stomach bleeding occurs. Ibuprofen overdose can also lead to fainting, coma, or even death.

If you suspect you or someone else may be experiencing overdose symptoms, seek immediate medical attention or call the Poison Help line from anywhere in the US at 1-800-222-1222.

Allergy information

Anaphylactic reactions can occur in patients with allergies to NSAIDs and are especially dangerous for asthmatic patients.

Symptoms of an anaphylactic reaction may include

• Difficulty breathing

• Lightheadedness or faintness

• Wheezing

• Fast heartbeat

• Confusion and anxiety

• Loss of consciousness

Asthma and NSAID hypersensitivity

What You Need To Know About Asthma

In addition, some children and adults living with respiratory conditions such as asthma or rhinosinusitis may experience aggravated symptoms when taking ibuprofen or other non-steroidal anti-inflammatory medications (NSAIDs), such as aspirin. However, taking NSAIDs may also precipitate the first asthma attack in some healthy individuals who have never experienced asthma before.

Hypersensitivity can present similar to anaphylaxis, but the main symptoms are respiratory (coughing, chest tightness, and wheezing) and appear within approximately 30 minutes to three hours of taking ibuprofen.

A hypersensitive reaction to this class of medications may also involve a runny nose, watery or red eyes, and nasal congestion (the presence of existing nasal polyps or chronic sinus inflammation can predispose you to these symptoms).

Additional symptoms may include flushing of the neck and abdomen, hives or rash, swelling of the face or lips, or stomach-related symptoms.⁵

If you have asthma but have never had an adverse reaction to NSAIDs, it is important to only take ibuprofen while under medical supervision.

However, if you have asthma and any history of hypersensitivity to any type of NSAIDs (no matter how mild), you must not take ibuprofen.

If you have asthma and experience worsening symptoms or attacks while using ibuprofen, use your rescue inhaler then seek immediate medical care.

If you are without your asthma medication or experiencing your first-ever asthma attack, call 911 immediately or proceed to the nearest emergency room.

NSAID hypersensitivity is a risk factor for potentially life-threatening or fatal asthma outcomes, so it’s vital to take even a mild reaction seriously.⁶

Severe adverse skin reactions

Skin reactions can also result from taking ibuprofen if you are allergic to NSAIDs, including:

• Severe inflammation of the skin surface

• Flu-like symptoms and a fast-spreading, life-threatening rash (Stevens-Johnson syndrome) that requires immediate medical attention⁷

If you experience skin irritation, rashes, or respiratory symptoms, stop taking ibuprofen and seek immediate medical attention.

Long-term use of ibuprofen

Short-term or long-term use of ibuprofen has the risk of developing severe side effects. However, those who use ibuprofen chronically or in high doses are much more likely to experience side effects.

So, suppose you have a condition that requires long-term use of ibuprofen. In that case, it is crucial to discuss the risks with your doctor and carefully monitor for any gastrointestinal, cardiovascular, kidney, or liver issues, and inform your physician as soon as you notice any new symptoms while taking ibuprofen.

Pregnancy category

Ibuprofen is a Category C drug, meaning that risks to pregnant women cannot be ruled out. Human research studies are not yet adequate, but animal studies do not indicate developmental abnormalities.

Ibuprofen and pregnancy

Ibuprofen should be used in pregnancy only if your physician decides that the potential benefits outweigh the potential risks to the fetus.

Not recommended during the second half of a pregnancy

Avoid using ibuprofen after 20 weeks of pregnancy, as it may cause rare but serious kidney problems in an unborn baby.⁸ This can lead to low levels of amniotic fluid surrounding the baby and possible complications.

Additionally, the use of ibuprofen during late pregnancy should be avoided due to the known effects of NSAIDs on the fetal cardiovascular system (closure of ductus arteriosus).

The effects of ibuprofen on labor and delivery in pregnant women are unknown, but animal studies have reported the occurrence of some complications or reduction in survival rate.

Using ibuprofen while breastfeeding

Ibuprofen can be used safely during breastfeeding due to its extremely low levels in breast milk and short half-life.⁹

Ibuprofen is usually a first-line treatment as an analgesic or anti-inflammatory for nursing mothers.

Missed doses

Over-the-counter ibuprofen is to be taken only as needed, therefore, there won’t be a set dose schedule or potentially missed doses like there would be with prescription medication.

You can evaluate the necessity of taking another ibuprofen dose only after four hours from the previous dose, provided you are not exceeding the maximum recommended daily use for your age and weight.

If you are taking prescription-strength ibuprofen, follow your doctor or pharmacist’s guidance on what to do if a missed dose occurs.

Do not take two doses at the same time or close in time to each other to make up for the missed dose, as this could increase your chance of experiencing side effects.

Drug interactions

The following drugs and supplements are known to interact with ibuprofen. Please note that this is not an exhaustive list. Discuss all possible interactions between over-the-counter, prescription, and illicit drugs, vitamins, and herbal supplements with your doctor.

Blood pressure medications

ACE-inhibitors help lower your blood pressure. Taking ibuprofen while taking ACE inhibitors can reduce the ACE inhibitor's effect which could result in dangerously elevated blood pressure. Beta-blockers, another anti-hypertensive medication can also interact with ibuprofen.

Antidepressants

Taking ibuprofen while on lithium elevates the risk of lithium toxicity. In addition, using ibuprofen while on selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs) can interfere with the effectiveness of the antidepressant, as well as contribute to an increased risk of bleeding.¹⁰

Using NSAIDs with second-generation antidepressants has also been found to increase the risk of intracranial hemorrhage (bleeding in the brain).¹¹ ¹² Check with your doctor about suitable pain management options while on antidepressants.

Aspirin

Taking aspirin and ibuprofen together is not recommended due to the increased risk of adverse effects. These two drugs are both nonsteroidal anti-inflammatories (NSAIDs). Combining them is not beneficial and can be dangerous.

Diuretics

Ibuprofen taken with diuretics can reduce the effect of some diuretics such as furosemide and thiazide, increasing the risk of renal (kidney) issues. Diuretics reduce the amount of excess water in your body.

Ginkgo biloba

This is a popular supplement with mixed evidence to support its efficacy in treating a number of health conditions such as promoting blood flow (or slowing blood clotting) and improving cognition.

Ginkgo biloba can be dangerous when taken along with ibuprofen or other NSAIDs. The combination reportedly increases the risk of bleeding and other complications, which has been fatal in some cases.¹³

Methotrexate

Ibuprofen may reduce the clearance of methotrexate, increasing the risk of methotrexate toxicity.

Warfarin-type anticoagulants

Simultaneously taking both ibuprofen and anticoagulants can increase the risk of bleeding.

Can I drink alcohol while taking ibuprofen?

Drinking alcohol while taking any NSAIDs greatly increases the risk of gastrointestinal adverse effects.

What to discuss with your doctor before starting ibuprofen

Speaking with your doctor before starting ibuprofen is essential to determine whether it is the best treatment for your symptoms. Before you start using ibuprofen, be sure to tell your doctor:

• About the symptoms you are currently experiencing

• Your full medical history, including conditions you have had or currently have, as well as any diseases or conditions that run in your family

• Any history of substance use disorders, including alcoholism, prescription drug misuse, or illicit drug use

• If you are pregnant, planning a pregnancy, or breastfeeding

• If you have any allergies, particularly any history of allergy from taking any other NSAIDs or pain medications

• Previous medications you may have tried for your symptoms and whether they caused any side effects 

• About your use of other medications, such as OTC or prescription drugs, as well as any herbal or nutritional supplements

• About any upcoming medical or dental procedures

• Whether or not you consume alcohol, and if so, how much

Stopping ibuprofen

Stop taking ibuprofen immediately if you experience any serious side effects and inform your doctor or seek urgent medical care.

Ideally, you should only be taking an NSAID like ibuprofen short-term. Therefore, after your symptoms improve, you should be able to stop using ibuprofen without medical supervision or withdrawal symptoms.

Drug approval history

The US FDA has approved ibuprofen to treat the following symptoms and conditions:

• Inflammatory diseases

• Rheumatoid disorders

• Mild to moderate pain

• Fever reduction in adults and children

• Menstrual cramps 

• Osteoarthritis

Prescription use of ibuprofen was first approved by the FDA in 1974.¹⁴

In 1984, ibuprofen became available over the counter.

The oral suspension became available over the counter in 1989.

In 1994, the first chewable ibuprofen tablets were released, followed by pediatric ibuprofen drops in 1998.

In 2009, IV ibuprofen received regulatory approval for use in healthcare settings.

The FDA has also given approval to the use of the brand NeoProfen injections, in the treatment required to close patent ductus arteriosus, in babies who have been born prematurely. This blood vessel is supposed to close naturally when the baby is born within a couple of days, but in premature babies, they may not close and require assistance.¹⁵

Tips for taking ibuprofen

• Take ibuprofen as directed by your doctor

• If the recommended or prescribed dosage and frequency you take ibuprofen is not helping with your symptoms, ask your doctor for advice 

• Take ibuprofen with meals or milk to reduce the risk of digestive issues

• If you experience stomach discomfort that doesn’t improve, ask your doctor about other medication options

Frequently asked questions

What is the downside of taking ibuprofen?

There are numerous side effects that could result from taking ibuprofen, some could be mild or temporary and others could be serious. Your risk of experiencing serious side effects increases if you take ibuprofen in high doses or for a long duration. In that case, there is a higher risk of gastrointestinal ulcer or bleeding, in addition to a number of cardiovascular issues.

Can children take ibuprofen?

Speak with your child’s doctor before giving them ibuprofen. If appropriate, the dosage and frequency will be determined according to age and body weight. Ibuprofen also comes in special “junior strength” or children’s chewable tablets. Do not give infants under six months of age ibuprofen unless their doctor tells you to.¹⁶

Why would a doctor tell you not to take ibuprofen?

If you have pre-existing or current conditions that impact your heart and circulatory health, ibuprofen can increase the risk of strokes and heart attacks. Your doctor may tell you not to take ibuprofen if you have stomach problems or if you have had them recently or in the past. A doctor may also recommend not taking ibuprofen if you have had a history of adverse reactions to aspirin or other NSAIDs.

What happens if you take ibuprofen daily?

Because there are risks involved in taking ibuprofen daily, such as stroke, heart attacks, ulcers, and gastrointestinal bleeding, you should only take a daily dose of ibuprofen only under a doctor's supervision.