Ibuprofen is one of the world's most widely used pain-relieving medicines.
It can help relieve headaches, dental pain, muscle and joint pain, period pain, pain after injuries and other painful inflammatory conditions. It can also reduce fever.
Because ibuprofen is available without a prescription in many countries, it can be easy to assume that it is harmless.
It isn't.
For most people, occasional ibuprofen use at the recommended dose is generally well tolerated, but like every medicine, ibuprofen can cause side effects. The risks become particularly important when it is taken at higher doses, used frequently or for long periods, or taken by people with certain medical conditions.
If you regularly take ibuprofen, understanding these risks can help you use pain medicines more safely.
What Is Ibuprofen?
Ibuprofen belongs to a group of medicines called non-steroidal anti-inflammatory drugs (NSAIDs).
Other NSAIDs include medicines such as:
- naproxen
- diclofenac
- celecoxib
- indomethacin.
Aspirin also has NSAID properties, although its uses and dosing can differ substantially from those of ibuprofen.
NSAIDs reduce the production of chemicals called prostaglandins.
Prostaglandins contribute to pain, inflammation and fever, so reducing their production can make ibuprofen effective for pain and inflammation.
However, prostaglandins also perform useful functions elsewhere in the body, including helping protect the stomach lining and supporting blood flow through the kidneys.
That helps explain why NSAIDs can sometimes cause problems involving the stomach and kidneys.
What Is Ibuprofen Used For?
Depending on the formulation and local medical guidance, ibuprofen may be used for conditions including:
- headache
- migraine
- toothache
- period pain
- muscle pain
- joint pain
- sprains and strains
- pain after minor injuries
- inflammatory conditions
- fever.
It is available in several forms, including tablets, capsules, liquids and topical gels.
Different formulations and strengths require different instructions.
Always follow the directions supplied with the specific product you are using or instructions from your healthcare professional.
Is Ibuprofen Safe?
For many adults, short-term ibuprofen use according to the product directions is generally considered safe.
But over-the-counter does not mean risk-free.
Ibuprofen can cause mild side effects such as:
- indigestion
- stomach discomfort
- nausea
- vomiting
- diarrhoea
- constipation
- dizziness
- headache
- skin rash.
More serious complications are less common but can occur.
These include gastrointestinal bleeding, stomach ulcers, kidney problems, severe allergic reactions and cardiovascular complications.
Risk generally increases with factors such as higher doses, longer treatment and certain underlying medical conditions.
1. Ibuprofen Can Irritate the Stomach
One of the best-known problems associated with NSAIDs is irritation of the gastrointestinal tract.
Ibuprofen can contribute to:
- indigestion
- stomach pain
- gastritis
- stomach or intestinal ulcers
- gastrointestinal bleeding.
Serious gastrointestinal bleeding can sometimes occur without much warning.
Risk is generally higher in older adults and people with a previous history of stomach ulcers or gastrointestinal bleeding.
Certain medicines can increase the risk further.
Warning Signs of Gastrointestinal Bleeding
Seek urgent medical care if you develop symptoms such as:
- vomiting blood
- vomit that resembles coffee grounds
- black, sticky or tar-like stools
- blood in the stool
- severe or persistent abdominal pain
- unexplained weakness, dizziness or fainting.
These symptoms can indicate gastrointestinal bleeding and should not simply be treated with more pain medicine.
2. Ibuprofen Can Affect the Kidneys
This is an especially important risk that regular users should understand.
NSAIDs can reduce blood flow through the kidneys.
In some circumstances, this can contribute to acute kidney injury or worsen existing chronic kidney disease.
The risk is greater when someone:
- already has reduced kidney function
- is dehydrated
- has heart failure
- has certain liver conditions
- is older
- takes high doses
- uses NSAIDs frequently or for long periods
- takes certain other medicines affecting kidney function or blood pressure.
People with chronic kidney disease should not routinely self-treat with oral NSAIDs without discussing their individual circumstances with a healthcare professional.
The National Kidney Foundation specifically advises people with CKD to avoid NSAIDs, particularly when eGFR is below 60, unless their healthcare professional determines that their use is appropriate.
Dehydration Can Increase Kidney Risk
Your kidneys depend on adequate blood flow.
NSAIDs can interfere with mechanisms that help maintain that blood flow.
If you are significantly dehydrated because of vomiting, diarrhoea, fever, heavy sweating or inadequate fluid intake, the kidneys may already be under additional stress.
Using NSAIDs in this situation can further increase the risk of kidney injury in susceptible people.
If you are ill and dehydrated, particularly if you have kidney disease or take medicines affecting kidney function, seek professional advice about which medicines are appropriate.
Possible Signs of Kidney Problems
Seek medical advice if you develop concerning symptoms such as:
- significantly reduced urination
- swelling of the ankles, feet or hands
- unexplained shortness of breath
- blood in the urine
- unusual or severe weakness.
Kidney problems do not always cause obvious early symptoms, however.
People who regularly require NSAIDs and have risk factors for kidney disease may need appropriate medical monitoring.
3. Ibuprofen Can Affect Blood Pressure
NSAIDs can sometimes raise blood pressure or make existing hypertension more difficult to control.
They can also interact with some medicines used to treat high blood pressure.
This does not mean everyone with hypertension can never use ibuprofen.
But if you have high blood pressure—particularly if it is difficult to control or you take regular medication—ask a doctor or pharmacist whether an NSAID is appropriate for you.
4. NSAIDs Can Increase Cardiovascular Risk
Non-aspirin NSAIDs can increase the risk of serious cardiovascular events such as heart attack and stroke.
The degree of risk depends on factors including the particular medicine, dose, duration of use and the person's underlying cardiovascular risk.
People with established cardiovascular disease or significant cardiovascular risk factors require particular caution.
The principle remains important:
Use the lowest effective dose for the shortest period necessary.
Do not take more because the recommended amount has not relieved your pain.
If pain repeatedly requires high doses or prolonged treatment, the underlying problem should be assessed.
5. Ibuprofen Can Cause Fluid Retention
NSAIDs can cause the body to retain sodium and fluid.
For some people, particularly those with heart failure, this can worsen symptoms.
Someone with heart failure should obtain medical advice before using NSAIDs rather than assuming an over-the-counter product is safe.
New or worsening swelling, sudden unexplained weight gain or increasing breathlessness deserves medical attention.
6. Ibuprofen Can Cause Allergic Reactions
Some people are allergic or hypersensitive to ibuprofen and other NSAIDs.
A serious allergic reaction can cause:
- swelling of the lips, mouth, tongue or throat
- difficulty breathing
- wheezing
- widespread hives or rash
- dizziness or collapse.
This can be a medical emergency.
Contact your local emergency medical service immediately if someone develops signs of a severe allergic reaction.
People who have previously experienced a serious reaction to aspirin, ibuprofen or another NSAID should obtain professional advice before taking related medicines.
7. Some People With Asthma Need Extra Caution
Most people with asthma can take appropriate pain medicines, but NSAIDs can trigger worsening respiratory symptoms in some individuals.
This is sometimes associated with NSAID-exacerbated respiratory disease.
If ibuprofen or aspirin has previously caused wheezing, breathing difficulty or another significant reaction, do not simply try the medicine again without professional medical advice.
8. Ibuprofen Can Interact With Other Medicines
One of the most important aspects of safe over-the-counter medicine use is checking for interactions.
Ibuprofen may interact with medicines including certain:
- anticoagulants or blood thinners
- antiplatelet medicines
- corticosteroids
- antidepressants
- blood-pressure medicines
- diuretics
- other NSAIDs.
The exact significance depends on the medicines, doses and person's medical circumstances.
If you regularly take prescription medicines, particularly medicines for blood pressure, heart disease, kidney disease or blood clotting, ask a pharmacist or doctor before regularly taking ibuprofen.
Do Not Routinely Combine Different NSAIDs
Taking more than one NSAID at the same time can increase the risk of adverse effects.
For example, you generally should not take ibuprofen and naproxen together unless specifically instructed by a healthcare professional.
Be particularly careful with combination cold, flu and pain products.
The same or related pain-relieving ingredient may appear in more than one product, creating a risk of accidental excessive dosing.
Read the active-ingredient section of the label rather than relying only on brand names.
9. Pregnancy Requires Special Consideration
Ibuprofen use during pregnancy requires caution.
Recommendations vary somewhat by country, so pregnant people should obtain advice from an appropriate healthcare professional before taking it.
NSAIDs are particularly problematic later in pregnancy.
For example, the U.S. Food and Drug Administration warns that NSAID use at around 20 weeks of pregnancy or later can, in rare cases, cause fetal kidney problems that may lead to low levels of amniotic fluid.
Use later in pregnancy can present additional risks.
Do not assume that because ibuprofen can be bought without a prescription it is automatically suitable during pregnancy.
10. What About Ibuprofen and Hearing Loss?
The original 2016 version of this KandyWandy article focused heavily on a study examining pain-reliever use and hearing loss in women.
Researchers analysing participants in the Nurses' Health Study II found an association between long-term regular use of some pain relievers and a modestly increased risk of self-reported hearing loss.
This research was valuable, but there is an important distinction:
An observational association does not prove that ibuprofen directly caused hearing loss.
Many factors can affect hearing, and people who regularly use pain medicines may differ from non-users in other ways.
Therefore, the study should not be interpreted as evidence that occasional ibuprofen use will make someone lose their hearing.
The established gastrointestinal, kidney and cardiovascular risks are more important considerations when discussing routine NSAID safety.
If you develop persistent hearing loss, ringing in the ears or other hearing changes, seek appropriate medical assessment rather than assuming ibuprofen is the cause.
11. Frequent Pain May Be the Bigger Issue
If you find yourself reaching for ibuprofen every day or most days, it is worth asking:
Why am I needing pain relief so frequently?
Pain is a symptom.
Repeatedly suppressing the symptom without understanding its cause can sometimes delay diagnosis or appropriate treatment.
Frequent headaches, for example, may require assessment rather than indefinite self-treatment.
Excessive use of some acute headache medicines can itself contribute to medication-overuse headache.
Persistent joint, abdominal, dental, menstrual, back or other pain may also have underlying causes that deserve investigation.
How Long Should You Take Ibuprofen?
There is no single duration appropriate for every person or every condition.
For non-prescription use, follow the product label applicable in your country.
Do not exceed the stated dose or duration.
As a general medication-safety principle, NSAIDs should be taken at the lowest effective dose for the shortest necessary period.
If the pain persists, repeatedly returns or requires ongoing treatment, consult a healthcare professional instead of continually extending self-treatment.
Does Taking Ibuprofen With Food Make It Completely Safe for the Stomach?
No.
Taking ibuprofen with or after food may help reduce stomach discomfort for some people.
However, food does not eliminate the possibility of stomach ulcers or gastrointestinal bleeding.
People at higher risk may require a different treatment strategy or, in certain circumstances, additional stomach-protecting medication prescribed by a healthcare professional.
Are Ibuprofen Gels Safer Than Tablets?
Topical NSAIDs such as gels are applied to a specific painful area rather than swallowed.
They generally produce lower systemic exposure than oral NSAIDs.
For some localised muscle or joint problems, a topical NSAID may therefore be an option worth discussing with a pharmacist or healthcare professional.
This does not mean topical products are completely risk-free.
Always follow their directions and precautions.
Is Paracetamol/Acetaminophen a Safer Alternative?
Paracetamol, known as acetaminophen in countries including the United States, is not an NSAID.
It does not carry exactly the same gastrointestinal and kidney effects as oral NSAIDs when used appropriately.
However, it has its own risks.
Taking too much acetaminophen can cause severe liver injury.
It is also contained in many combination cold, flu and pain medicines, making accidental overdose possible if people do not check ingredient labels.
There is therefore no painkiller that should be treated casually.
The best option depends on:
- the type of pain
- other medical conditions
- other medicines being taken
- age
- pregnancy status
- individual risk factors.
A pharmacist or doctor can help determine an appropriate option.
Who Should Speak to a Healthcare Professional Before Using Ibuprofen?
Ask for professional advice before using ibuprofen if you have or have previously had conditions such as:
- chronic kidney disease
- stomach or intestinal ulcers
- gastrointestinal bleeding
- significant heart disease
- heart failure
- high blood pressure
- liver disease
- blood-clotting problems
- stroke
- certain forms of asthma or previous NSAID reactions.
You should also seek advice if you are pregnant, trying to become pregnant, take several prescription medicines, or expect to use ibuprofen frequently.
When Should You Seek Urgent Medical Help?
Seek urgent medical attention for symptoms such as:
- vomiting blood
- black or tar-like stools
- severe breathing difficulty
- swelling of the face, tongue or throat
- collapse or loss of consciousness
- severe chest pain
- sudden weakness or numbness
- difficulty speaking
- severe reduction in urine output
- serious symptoms after taking more ibuprofen than recommended.
Contact your local emergency medical service for potentially life-threatening symptoms.
If you accidentally take more than the recommended amount, contact an appropriate poison-information service or healthcare professional promptly, even if you initially feel well.
Five Rules for Safer Ibuprofen Use
For most people who can safely take ibuprofen, remember these basic principles:
- Use the lowest effective dose.
- Use it for the shortest necessary time.
- Never exceed the instructions on your product or prescription.
- Check other medicines to avoid duplicate NSAID ingredients or harmful interactions.
- Get medical advice if you need painkillers frequently or for persistent pain.
These simple precautions are much more useful than assuming that an over-the-counter medicine is harmless.
The Bottom Line
Ibuprofen is an effective and useful medicine.
Millions of people use it safely for short-term pain, inflammation and fever.
The message is therefore not that everyone should stop taking ibuprofen.
The important message is that ibuprofen is a real medicine with real potential side effects.
Regular or high-dose use deserves particular attention because NSAIDs can contribute to gastrointestinal bleeding, kidney injury, increased blood pressure and cardiovascular complications in susceptible people.
Risk can also increase when ibuprofen interacts with certain medicines or is used by people with particular medical conditions.
If you only occasionally use ibuprofen and can safely take NSAIDs, following the package directions is generally appropriate.
If you use it frequently, have kidney or cardiovascular disease, take several medications, are pregnant or have persistent pain, speak with an appropriately qualified healthcare professional about whether ibuprofen is suitable for you.
Medical Disclaimer
This article provides general educational information and is not a substitute for personalised medical advice, diagnosis or treatment. Do not start, stop or change prescribed medication solely because of information in this article. Medicine recommendations and available formulations vary internationally. Follow the instructions supplied with your medicine and consult a qualified healthcare professional or pharmacist if you have questions about your individual circumstances.
Sources and Further Reading
U.S. Food and Drug Administration — NSAIDs: Drug Safety Communication
https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/non-steroidal-anti-inflammatory-drugs-nsaids
National Kidney Foundation — Pain Medicines and Kidney Disease
https://www.kidney.org/kidney-topics/pain-medicines-and-kidney-disease
NHS — Ibuprofen for Adults
https://www.nhs.uk/medicines/ibuprofen-for-adults/
NHS — Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
https://www.nhs.uk/medicines/nsaids/
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