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Ibuprofen: 7 things you should know

Medically reviewed by Carmen Fookes, BPharm. Last updated on July 19, 2021.

1. How it works

  • Ibuprofen may be taken to relieve pain and inflammation.
  • Ibuprofen works by blocking the effects of cyclooxygenase (COX) enzymes. This prevents prostaglandin synthesis (prostaglandins elevate body temperature and make nerve endings more sensitive to pain transmission).
  • Ibuprofen belongs to a group of medicines known as NSAIDs (nonsteroidal anti-inflammatory drugs).

2. Upsides

  • Effective for the relief of minor to moderate aches and pains due to arthritis, backache, the common cold, headache and migraine, menstruation, muscular aches, and toothache in adults.
  • Relieves minor aches and pain in children aged 6 months or older.
  • Relieves inflammation and pain.
  • Temporarily relieves fever.
  • Does not cause dependence and is readily available at a low cost.
  • The incidence of stomach-related side effects is about half that seen with aspirin or indomethacin when ibuprofen is used at low dosages. However, this benefit is lost with higher dosages.
  • Available as tablets, capsules, chewable tablets, suspension, and in an injectable form.
  • Widely available over-the-counter.
  • May be used in combination with other medications for the relief of conditions such as rheumatoid arthritis in people without any contraindications.
  • Generic ibuprofen is available.

3. Downsides

If you are between the ages of 18 and 60, take no other medication or have no other medical conditions, side effects you are more likely to experience include:

  • Stomach-related side effects including indigestion, heartburn, and bleeding. People of older age, taking other medicines that affect the stomach, or who drink more than 3 glasses of alcohol per day may be more at risk.
  • All NSAIDs are associated with an increased risk of gastrointestinal events such as bleeding, ulceration, and perforation of the stomach and intestines, but ibuprofen has one of the lowest risks of stomach-related side effects compared with other NSAIDs.
  • Long-term administration of NSAIDs, including ibuprofen, has been associated with renal papillary necrosis and other kidney injuries. Renal toxicity has also been seen in people in whom renal prostaglandins play a compensatory role in the maintenance of renal perfusion.
  • Most NSAIDs have been associated with an increased risk of stroke or heart attack. The risk may be higher in patients with pre-existing cardiovascular conditions and with dosages of ibuprofen greater than 1200mg per day. May increase the risk for high blood pressure or cause a worsening of pre-existing high blood pressure.
  • May require three to four times daily dosing because of its short duration of action.
  • May not be suitable for some people including those with kidney disease, a history of stomach ulcers or other gastrointestinal disorders, or with pre-existing cardiovascular disease. Should not be given to people during or following coronary artery bypass graft surgery.
  • Avoid in people who have a hypersensitivity to aspirin, particularly those with the aspirin triad (asthma, aspirin sensitivity, and nasal polyps).
  • Can sometimes cause serious skin reactions such as exfoliative dermatitis, Stevens-Johnson Syndrome (SJS,) and toxic epidermal necrolysis (TEN), which can be fatal. Discontinue at the first sign of serious skin reactions.
  • May interact with some other medicines such as warfarin, SSRIs, ACE inhibitors, and diuretics.
  • NSAIDs, such as ibuprofen, should not be used during the last three months of pregnancy because they can cause premature closure of the fetal ductus arteriosus. In addition, the use of NSAIDs at around 20 weeks gestation or later in pregnancy may cause fetal kidney problems leading to oligohydramnios (low amniotic fluid volume) and in some cases kidney impairment. If NSAID treatment is deemed necessary between 20 and 30 weeks of pregnancy, use the lowest effective dose for the shortest possible time. Avoid NSAIDs after 30 weeks gestation.

Note: In general, seniors or children, people with certain medical conditions (such as liver or kidney problems, heart disease, diabetes, seizures) or people who take other medications are more at risk of developing a wider range of side effects. View complete list of side effects

4. Bottom Line

Ibuprofen is effective for the short-term relief of minor aches and pains and also reduces inflammation. The risk of stomach-related side effects is about half that seen with aspirin although the risk increases with higher dosages and a longer duration of use.

5. Tips

  • Take with food or milk if stomach disturbances (such as indigestion) occur with use. See a doctor if these persist.
  • Always use the lowest effective dose for the shortest duration consistent with the condition being treated.
  • If you are taking ibuprofen and find it is not working very well for you, you may like to try a different NSAID.
  • Response to different NSAIDs can vary so switching types (for example, from ibuprofen to naproxen) may improve response.
  • See a doctor immediately if you experience any difficulty with breathing, unexplained sickness or fatigue, loss of appetite, vision changes, fluid retention, or abnormal bleeding.
  • NSAIDs should not be used in the last 3 months of pregnancy; ask your doctor before using any medication during pregnancy.
  • Avoid ibuprofen if you have a history of asthma or hives due to aspirin use or other NSAIDs, like naproxen.
  • Do not use this medicine if you have just had heart bypass surgery (also called coronary artery bypass graft, or CABG).
  • NSAIDs, such as ibuprofen, should not be used in the last 3 months of pregnancy; always ask your doctor before using any medication during pregnancy. Do not use NSAIDs such as ibuprofen between 20 and 30 weeks gestation without your doctor's advice because this may cause kidney problems and low amniotic fluid volumes in the newborn. Acetaminophen may be considered to treat pain and inflammation during pregnancy.

6. Response and effectiveness

  • Peak levels of ibuprofen are reached 1-2 hours after administration.
  • Equally affects COX-1 and COX-2 enzymes.

7. Interactions

Medicines that interact with ibuprofen may either decrease its effect, affect how long it works for, increase side effects, or have less of an effect when taken with ibuprofen. An interaction between two medications does not always mean that you must stop taking one of the medications; however, sometimes it does. Speak to your doctor about how drug interactions should be managed.

Common medications that may interact with ibuprofen include:

  • ACE inhibitors or ARBs, such as captopril, enalapril, or losartan
  • antibiotics, such as ciprofloxacin or vancomycin
  • anticoagulants (blood thinners) such as apixaban, dabigatran, fondaparinux, heparin, or warfarin
  • antidepressants, such as citalopram, escitalopram, fluoxetine, or paroxetine
  • antifungals, such as voriconazole
  • antiplatelets, such as clopidogrel or ticagrelor
  • beta-blockers, such as acebutolol, atenolol, bisoprolol, or carvedilol
  • bisphosphonates, such as alendronate
  • corticosteroids, such as dexamethasone or prednisone
  • digoxin
  • diuretics (water pills), such as chlorthalidone, chlorothiazide, hydrochlorothiazide (HCTZ), or furosemide
  • glucagon
  • haloperidol
  • HIV medications (eg, Stribild, tenofovir)
  • metformin
  • other nonsteroidal anti-inflammatories (NSAIDs), such as celecoxib, diclofenac, etodolac, ketorolac, meloxicam, nabumetone, or naproxen
  • sulfonylureas (a type of diabetes medication), such as glimepiride, glyburide, or glipizide
  • supplements, such as glucosamine, omega-3 fatty acids, vitamin E
  • others, such as cyclosporine, lithium, methotrexate, pemetrexed, pirfenidone, or tacrolimus.

Drinking alcohol while taking ibuprofen may increase the risk of gastrointestinal-related side effects or kidney damage.

Note that this list is not all-inclusive and includes only common medications that may interact with ibuprofen. You should refer to the prescribing information for ibuprofen for a complete list of interactions.

References

Further information

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use ibuprofen only for the indication prescribed.

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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