Can you take ibuprofen on an empty stomach?
Despite popular belief that you have to take ibuprofen with food, you can take low-dosages of ibuprofen (up to 1200mg/day in split doses for 1 to 7 days) on an empty stomach and this will give you faster pain relief than taking it with food. Food increases the time it takes for ibuprofen to be absorbed, although it won't affect how much is absorbed. There is actually no evidence that taking ibuprofen with food prevents gastric irritation – ibuprofen at OTC doses has a low incidence of gastric irritation anyway. The risk of gastric irritation has more to do with other risk factors that may be present, such as:
- Older age (>65 years)
- Use of other medications that also increase gastric irritation, such as aspirin, SSRI antidepressants (eg, citalopram, fluoxetine), anticoagulants (such as warfarin or dabigatran), or prednisone
- Alcohol use
- Higher dosages of ibuprofen (more than 1200mg/day), including prescription dosages (this increases the risk 2 to 3 fold)
- Duration of ibuprofen use
- Helicobacter pylori infection
- History of smoking
- Previous history of gastric ulcers, bleeding ulcers, or GERD
- Recent surgery
- Serious other medical conditions, such as chronic inflammatory bowel disease, liver or kidney disease, cancer, or diabetes.
The risk of gastrointestinal bleeding and irritation is reduced by using a COX-2 selective NSAID, such as celecoxib, or by taking ibuprofen with a mucosal protective agent such as misoprostol or omeprazole.
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Why do different sources advise taking ibuprofen with food?
This advice stems from a desire to protect people from gastrointestinal adverse events, such as dyspepsia, or more serious events such as gastrointestinal bleeding. Although research has shown aspirin to be associated with higher rates of adverse events and gastric irritation there is no evidence that taking occasional, intermittent doses of OTC NSAIDs, such as ibuprofen, produce higher event rates. In addition, there is no convincing evidence that taking NSAIDs with food prevents side effects.
The primary way NSAIDs irritate the gastric mucosa is via inhibition of COX-1-dependent prostaglandins, which protect the stomach lining from injury from stomach acid, although some also have a direct irritant effect. Superficial irritation to the gastric lining is more common than ulceration and it is estimated that 1%–2% of people who take NSAIDs daily experience a significant gastrointestinal event per year.
How can I reduce the risk of GI adverse events with ibuprofen or other NSAIDs?
For older patients requiring NSAID pain who have no contraindications for NSAID use, reducing the risk of NSAID-induced GI complications can be achieved by:
- Considering COX-2 inhibitors such as celecoxib. Celecoxib with omeprazole offers the lowest risk for GI events
- Using the lowest effective dose for the shortest possible time
- Targeting modifiable risk factors (such as alcohol use, smoking, concurrent GI irritating medications)
- Adding gastro-protective agents
- Testing for (and treating if necessary) Helicobacter pylori infection.
Acetaminophen carries the lowest risk for GI adverse events so should be considered for people at high risk. Other alternatives with less risk are topical NSAIDs, although they still carry some risk. Encourage the use of other non-pharmacological treatments like heat packs, massage, exercise, or physiotherapy.
People with heart disease, kidney problems, high blood pressure, or other chronic medical conditions, should ask their doctor about using ibuprofen before taking it.
References
- Goldstein, J. L., & Cryer, B. (2015). Gastrointestinal injury associated with NSAID use: a case study and review of risk factors and preventative strategies. Drug, healthcare and patient safety, 7, 31–41. https://doi.org/10.2147/DHPS.S71976
- Singh G. (2000). Gastrointestinal complications of prescription and over-the-counter nonsteroidal anti-inflammatory drugs: a view from the ARAMIS database. Arthritis, Rheumatism, and Aging Medical Information System. American journal of therapeutics, 7(2), 115–121. https://doi.org/10.1097/00045391-200007020-00008
- Silverstein, F. E., Graham, D. Y., Senior, J. R., Davies, H. W., Struthers, B. J., Bittman, R. M., & Geis, G. S. (1995). Misoprostol reduces serious gastrointestinal complications in patients with rheumatoid arthritis receiving nonsteroidal anti-inflammatory drugs. A randomized, double-blind, placebo-controlled trial. Annals of internal medicine, 123(4), 241–249. https://doi.org/10.7326/0003-4819-123-4-199508150-00001
- Silverstein, F. E., Faich, G., Goldstein, J. L., Simon, L. S., Pincus, T., Whelton, A., Makuch, R., Eisen, G., Agrawal, N. M., Stenson, W. F., Burr, A. M., Zhao, W. W., Kent, J. D., Lefkowith, J. B., Verburg, K. M., & Geis, G. S. (2000). Gastrointestinal toxicity with celecoxib vs nonsteroidal anti-inflammatory drugs for osteoarthritis and rheumatoid arthritis: the CLASS study: A randomized controlled trial. Celecoxib Long-term Arthritis Safety Study. JAMA, 284(10), 1247–1255. https://doi.org/10.1001/jama.284.10.1247
- Rampal, P., Moore, N., Van Ganse, E., Le Parc, J. M., Wall, R., Schneid, H., & Verrière, F. (2002). Gastrointestinal tolerability of ibuprofen compared with paracetamol and aspirin at over-the-counter doses. The Journal of international medical research, 30(3), 301–308. https://doi.org/10.1177/147323000203000311
- Nonsteroidal anti-inflammatory drugs (NSAIDs) Primary Health Tasmania. https://www.primaryhealthtas.com.au/wp-content/uploads/2018/09/A-Guide-to-Deprescribing-NSAIDS-2019.pdf
- Moore, R. A., Derry, S., Wiffen, P. J., & Straube, S. (2015). Effects of food on the pharmacokinetics of immediate release oral formulations of aspirin, dipyrone, paracetamol, and NSAIDs - a systematic review. British journal of clinical pharmacology, 80(3), 381–388. https://doi.org/10.1111/bcp.12628
- Moore RA, Wiffen PJ, Derry S, Maguire T, Roy YM, Tyrrell L. Non‐prescription (OTC) oral analgesics for acute pain ‐ an overview of Cochrane reviews. Cochrane Database of Systematic Reviews 2015, Issue 11. Art. No.: CD010794. DOI: 10.1002/14651858.CD010794.pub2. Accessed 30 April 2023.
Read next
What's the difference between aspirin and ibuprofen?
Even though aspirin and Ibuprofen are both NSAIDs (nonsteroidal anti-inflammatory drugs) and work similarly, there are several differences between the two drugs and they are not considered interchangeable. Continue reading
Can you overdose on ibuprofen?
Despite ibuprofen having a wide safety margin, it is possible to overdose on it, but death from ibuprofen overdose is rare. Children are more susceptible to the effects of ibuprofen and likely to experience an overdosage of ibuprofen if dosages of more than 400mg/kg (in the range of 8000mg for a 20kg child [the equivalent of 40 x 200mg ibuprofen tablets]) are ingested. Studies have reported patients ingesting less than 99 mg/kg are unlikely to have symptoms. Continue reading
Can you take tramadol with acetaminophen, ibuprofen, or aspirin?
Yes, it is safe for most people to take tramadol with acetaminophen, ibuprofen, or aspirin if they are old enough (aspirin is not recommended for children less than 16 years and tramadol should not be taken by children under the age of 12). Continue reading
See also:
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Drug information
- Ibuprofen Information for Consumers
- Ibuprofen prescribing info & package insert (for Health Professionals)
- Side Effects of Ibuprofen (detailed)
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