Can you take ibuprofen on an empty stomach?
Despite the common belief that you must take ibuprofen with food, you can safely take low-dose ibuprofen (up to 1200 mg daily in divided doses for 1 to 7 days) on an empty stomach, and this provides faster pain relief than taking ibuprofen with food. Food slows ibuprofen absorption time, although it doesn't affect the total amount absorbed.
There is actually no scientific evidence that taking ibuprofen with food prevents stomach irritation. Short-term, over-the-counter ibuprofen doses have a low incidence of gastric problems anyway.
This advice does not extend to high dose ibuprofen (more than 1200mg/day), including prescription dosages. High does ibuprofen is associated with a 2 to 3 times higher risk of stomach irritation. And the longer you take ibuprofen for, the more likely your stomach is to become irritated.
Ibuprofen stomach irritation risk factors
The risk of stomach irritation from ibuprofen depends more on individual risk factors than food intake, such as:
- Advanced age (over 65 years old)
- Taking other medications that increase stomach irritation risk, such as aspirin, SSRI antidepressants (like citalopram, fluoxetine), blood thinners (such as warfarin or dabigatran), or corticosteroids like prednisone
- Alcohol consumption
- Helicobacter pylori bacterial infection
- Smoking history
- Previous stomach ulcers, bleeding ulcers, or GERD (acid reflux disease)
- Recent surgical procedures
- Serious underlying medical conditions, including inflammatory bowel disease, liver disease, kidney disease, cancer, or diabetes.
Stomach protection with NSAIDs
The risk of gastrointestinal bleeding and stomach irritation can be reduced by using COX-2 selective NSAIDs, such as celecoxib, or by combining ibuprofen with a stomach protective agent such as misoprostol or omeprazole.
Related questions
- Can you take Ibuprofen if you have COVID-19 (coronavirus)?
- Naproxen vs ibuprofen: What's the difference?
- Can you take expired ibuprofen?
Why do different sources advise taking ibuprofen with food? Stomach protection & NSAID safety
This medical advice stems from a desire to protect patients from gastrointestinal side effects, such as indigestion (dyspepsia), or more serious complications, such as stomach bleeding.
Although research has demonstrated aspirin to be associated with high rates of adverse reactions and gastric irritation, there is no evidence that occasional, low-dose, over-the-counter NSAIDs, such as ibuprofen, cause gastrointestinal side effects. There is also no good quality study that taking NSAIDs with food prevents stomach side effects.
How NSAIDs cause stomach problems
The primary mechanism NSAIDs irritate the stomach lining is through inhibition of COX-1-dependent prostaglandins, which naturally protect the gastric mucosa from injury caused by stomach acid, although some medications also have a direct irritant effect on stomach tissue. Superficial stomach irritation is more common than peptic ulceration, and it is estimated that 1%–2% of people who take NSAIDs daily experience a significant gastrointestinal event annually.
How can I reduce the risk of GI side effects with ibuprofen or other NSAIDs?
You can reduce the risk of NSAID-induced GI complications by:
- Considering COX-2 selective inhibitors such as celecoxib (Celebrex). Celecoxib combined with omeprazole (Prilosec) offers the lowest risk for gastrointestinal events
- Using the lowest effective dosage for the shortest treatment duration possible
- Addressing modifiable risk factors (including alcohol consumption, tobacco use, concurrent GI-irritating medications)
- Adding gastro-protective medications like proton pump inhibitors
- Testing for (and treating if necessary) Helicobacter pylori bacterial infection.
Safer pain relief alternatives
Acetaminophen (Tylenol) carries the lowest risk for GI adverse events and should be considered for people at high risk for stomach problems. Other safer alternatives with reduced risk include topical NSAIDs (creams and gels), although they still carry some gastrointestinal risk. Healthcare providers encourage the use of non-drug treatments like heat therapy, massage therapy, physical exercise, or physiotherapy for pain management.
People with cardiovascular disease, kidney disease, hypertension, or other chronic health conditions, should consult their healthcare provider 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://www.dovepress.com/gastrointestinal-injury-associated-with-nsaid-use-a-case-study-and-rev-peer-reviewed-fulltext-article-DHPS
- 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://journals.lww.com/americantherapeutics/abstract/2000/07020/gastrointestinal_complications_of_prescription_and.8.aspx
- 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://www.acpjournals.org/doi/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://jamanetwork.com/journals/jama/fullarticle/193062
- 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://journals.sagepub.com/doi/10.1177/147323000203000311
- Nonsteroidal anti-inflammatory drugs (NSAIDs). Primary Health Tasmania. https://www.primaryhealthtas.com.au/wp-content/uploads/2023/03/A-guide-to-deprescribing-non-steroidal-anti-inflammatory-drugs.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://bpspubs.onlinelibrary.wiley.com/doi/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. https://pubmed.ncbi.nlm.nih.gov/26544675/
Read next
What's the difference between aspirin and ibuprofen?
Both aspirin and ibuprofen are popular NSAIDs (nonsteroidal anti-inflammatory drugs) that work by blocking prostaglandin production to reduce pain and inflammation. However, these over-the-counter pain relievers have important differences in safety, uses, and side effects.
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 readingSee also:
Related medical questions
- Meloxicam vs Ibuprofen: What's the difference?
- Can you drink alcohol with ibuprofen?
- Aleve vs Ibuprofen: What's the difference?
- What's the best medicine for sore throat?
- How do Celebrex and ibuprofen compare?
- Can you take Advil & Tylenol together? Safe Dosing Guide
- How much ibuprofen can I take and how often?
- Acetaminophen vs Ibuprofen: Which is better?
- Can I take ibuprofen with blood pressure medications?
- Is ibuprofen (Advil) a blood thinner?
- Is Ibuprofen bad for your kidneys and liver?
- What temperature is considered a fever?
- Can you take ibuprofen 800 mg with tramadol 50 mg?
- How long does ibuprofen take to work?
- Can ibuprofen cause constipation?
- What cold medicine can you take with diabetes?
- All Eyes on Ibuprofen: What are 10 Things You Need to Know?
- Is it safe to take ibuprofen right after taking prednisone?
- Can you take Ibuprofen after the COVID booster vaccine?
- Why is Ibuprofen dangerous for dogs? Here are safer alternatives
- What are the inactive ingredients in ibuprofen?
- I just took ibuprofen and prednisone, is that ok?
- Which painkiller should you use?
- Does Feverfew interact with any drugs?
Drug information
- Ibuprofen Information for Consumers
- Ibuprofen prescribing info & package insert (for Health Professionals)
- Side Effects of Ibuprofen (detailed)
- Ibuprofen user reviews (242)
Related support groups
- Ibuprofen (267 questions, 239 members)
- Pain (2,293 questions, 11,958 members)
- Back Pain (417 questions, 3,295 members)
- Rheumatoid Arthritis (337 questions, 1,334 members)
- Fever (106 questions, 176 members)
- Gout - Acute (29 questions, 29 members)
- Headache (421 questions, 1,469 members)
- Osteoarthritis (219 questions, 878 members)
- Muscle Pain (167 questions, 574 members)
- Sciatica (86 questions, 402 members)
- Toothache (79 questions, 161 members)