Ibuprofen

Is ibuprofen safe?

For short-term use at the dose on the packet, yes, for most adults. Ibuprofen, sold as Advil and Motrin in the US and Nurofen in Britain, is one of the most studied painkillers in the world and an overdose is far less dangerous than with acetaminophen.

The problems come with regular use, higher doses and certain people. Like all NSAIDs except aspirin, it raises the risk of heart attack and stroke, and it can cause ulcers and bleeding in the stomach without warning signs. That is why every US prescription ibuprofen label carries a boxed warningBoxed warningThe strongest safety warning the US FDA puts on a medicine's label, printed inside a black border at the top.More in the glossary, and why we score it 74 rather than in the 80s.

Stomach bleeding: the main risk

Ibuprofen blocks prostaglandins, the chemicals behind pain and swelling. Some of them also protect the stomach lining. The FDA label puts serious stomach events from NSAIDs (ulcers, bleeding or perforation) at about 1% of people treated for 3 to 6 months and 2% to 4% after a year. Only about one in five people who develop such a problem has warning symptoms beforehand.

The over-the-counterOver-the-counterA medicine you can buy without a prescription, in a pharmacy or shop, with directions on the pack for safe use without a doctor.More in the glossary label lists who is most at risk:

• people aged 60 or over
• anyone who has had an ulcer or bleeding problem
• people taking a blood thinner such as warfarin, or a steroid
• people taking more than one NSAID, including aspirin or naproxen
• people who have three or more alcoholic drinks a day

If one of these applies, talk to a pharmacist before buying it. Black or tarry stools, vomiting blood or stomach pain that does not go away need urgent medical attention.

Heart attack, stroke and kidneys

In 2015 the FDA strengthened its warning that NSAIDs other than aspirin increase the risk of heart attack and stroke, and that the risk can start in the first weeks of use. The added risk is larger at higher doses and in people who already have heart disease. Prescription ibuprofen must not be used around heart bypass surgery.

Kidneys are the other weak spot. Ibuprofen reduces blood flow to the kidneys, which matters little in a healthy person but can tip someone into kidney injury when combined with dehydration, a diuretic and an ACE inhibitor or ARB blood pressure drug. Pharmacists sometimes call that combination the "triple whammy".

Doses: shop shelf versus prescription

Use	Typical adult dose	Maximum in 24 hours
Over the counterOver-the-counterA medicine you can buy without a prescription, in a pharmacy or shop, with directions on the pack for safe use without a doctor.More in the glossary (US and UK)	200 to 400 mg, at least 4 hours apart	1,200 mg
Prescription (US label)	Set by the doctor	3,200 mg

The NHS advises taking ibuprofen with or after food. The US over-the-counter label says not to use it for more than 10 days for pain or 3 days for fever without asking a doctor.

Ibuprofen or acetaminophen?

They suit different situations. Ibuprofen works better for pain with inflammation, such as a sprain, period pain or dental pain. Acetaminophen is gentler on the stomach, kidneys and heart, but has a much smaller overdose marginOverdose marginHow far a normal dose is from a harmful one. A wide margin means an accidental extra dose is unlikely to cause serious harm.More in the glossary. Many people can use both for a short time, because they do not interact.

	Ibuprofen	Acetaminophen
Reduces inflammation	Yes	No
Stomach bleeding risk	Yes, rises with dose and time	Very low
Heart and kidney risk	Rises with dose and time	Very low at label doses
Danger in overdose	Usually mild	Liver failure possible

Who should be careful

Pregnancy is the clearest case. In 2020 the FDA warned against NSAIDs from about 20 weeks of pregnancy because they can affect the baby's kidneys and lower amniotic fluid. People with asthma who react to aspirin can have the same reaction to ibuprofen. Others who should get advice first include those with heart failure, kidney or liver disease, past stroke, high blood pressure, or anyone on lithium or methotrexate, whose levels ibuprofen can raise.

Overdose is rarely life-threatening in adults, but a child who swallows tablets or more than one dose of liquid should still be checked: call Poison Control (1-800-222-1222) in the US or NHS 111 in the UK.

How we scored it

Dependence (97) and track record (95) are excellent, and the overdose marginOverdose marginHow far a normal dose is from a harmful one. A wide margin means an accidental extra dose is unlikely to cause serious harm.More in the glossary (85) is much wider than for acetaminophen. Serious side effects (65) and regulatory warnings (45) pull it down because of the boxed warningBoxed warningThe strongest safety warning the US FDA puts on a medicine's label, printed inside a black border at the top.More in the glossary on stomach bleeding and heart risk, which grow with dose and duration.