All Eyes on Ibuprofen: What are 10 Things You Need to Know?

1. Cheap, Effective, and Overused?

Ibuprofen (Advil, Motrin IB, and generic equivalents) belongs to a group of drugs known as NSAIDs. NSAID stands for nonsteroidal anti-inflammatory drug.

NSAIDs work by blocking a specific group of enzymes called cyclo-oxygenase enzymes (COX enzymes). These enzymes are involved in the production of prostaglandins which control many different processes such as inflammation, blood flow, and the formation of blood clots.

You've probably used ibuprofen yourself to reduce fever or relieve various aches and pains. Maybe you've used it when you've had a toothache, period pain, back pain, or if you suffer from arthritis.

Ibuprofen is so commonly used it's known as vitamin "I" in some circles. But is it genuinely harmless?

2. High Doses of Ibuprofen Can Cause Stomach Erosions

NSAIDs block prostaglandin, a substance released by our body in response to pain that also helps protect the lining of our stomach.

Without this protective barrier, stomach acids, and other irritating substances can irritate the lining of the stomach, causing inflammation and symptoms such as reflux, heartburn, or indigestion. Sometimes a gastric ulcer may occur - this is a hole in the lining of the stomach that can be reasonably painful.

Research has shown ibuprofen is unlikely to cause stomach irritation if it is used in dosages totaling less than 1200 mg/day (in split doses), and for short periods only (1 to 7 days). But high dosages (over 1200 mg/day) can increase your risk of stomach irritation. You are more likely to experience gastric irritation from ibuprofen if you have other risk factors, such as:

• Being older (>65 years)
• Using 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
• Prescription dosages of ibuprofen (this increases the risk 2 to 3-fold)
• Taking ibuprofen for long periods
• A helicobacter pylori infection
• A history of smoking
• A 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.

3. Ibuprofen Thins the Blood

All NSAIDs affect the blood, ibuprofen included. While not as strong as some medicines (for example, aspirin), ibuprofen still slows down blood clotting time. This means that if you cut yourself, or have an injury, it may take longer to stop bleeding.

The risk of bleeding and stomach ulceration is also increased in people who:

• Have had stomach ulcers or bleeding problems in the past
• Take prednisone or other steroids
• Smoke or drink alcohol regularly
• Take other medicines that thin the blood such as warfarin, clopidogrel (Plavix), or ticagrelor (Brilinta).

4. If You Have Asthma or Rhinitis Be Careful Taking Ibuprofen

NSAIDs can exacerbate symptoms of asthma or allergic rhinitis (symptoms include a stuffy, runny nose) in about 10% of people with these conditions. Within 30 to 120 minutes of taking an NSAID such as ibuprofen, nasal congestion, a runny nose, or shortness of breath may occur. Some people may experience a serious asthma attack, especially if they have aspirin-sensitive asthma.

If you have asthma, hay fever, or rhinitis, you should talk with your doctor before taking ibuprofen or other NSAIDs such as diclofenac (Cataflam), celecoxib (Celebrex), naproxen (Aleve), or aspirin.

5. Reduced Kidney Blood Flow A Danger To Some

Ibuprofen, like other NSAIDs, reduces blood flow to the kidneys. This is not usually a problem if you are healthy and take ibuprofen at the recommended dosages for short periods only (like a maximum of 3 days for fever or 10 days for pain).

However, NSAID use can be a problem for people with pre-existing kidney disease or those who are dehydrated. People with heart disease, high blood pressure, or liver disease, who are over the age of 65, or who take diuretics like hydrochlorothiazide (Aquazide H) or furosemide (Lasix) should talk with their doctor before taking NSAIDs.

The risk of kidney injury is also increased in people with a virus, such as the cold, flu, or COVID-19, who also become dehydrated. In some situations, acetaminophen is the preferred pain reliever to use.

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6. Water Retention is Not Good For Blood Pressure

NSAIDs can cause water retention and edema in some people. You may notice your ankles look puffy or your weight rapidly increases within a few hours of taking ibuprofen.

Having all that extra water on board can exacerbate pre-existing conditions such as high blood pressure or heart failure. It can also prevent your normal medications from working properly.

If you suffer from any medical conditions, talk with your doctor before taking ibuprofen or any NSAID. Alternative pain relievers such as acetaminophen (Tylenol) may be a better option for you.

7. Long-Term Use and High-Doses Are Risky to Heart Health

No drug is risk-free and over-the-counter pain relievers such as ibuprofen are no exception. Many people do not realize that taking NSAIDs increases your risk of having a heart attack or stroke.

An analysis of over 200 studies published in the Lancet that involved more than 300,000 people revealed that taking ibuprofen at dosages of more than 2400 mg/day increased the risk of heart attack and possibly stroke.

The risk is even higher in people who have recently suffered a heart attack and who take ibuprofen in addition to other blood thinners such as Plavix.

8. Ibuprofen Has No Positive Effect on Sports Performance and May Cause Harm

If you compete in challenging sporting events, then chances are you've popped a few ibuprofen in your time. Seven out of ten runners in the 100-mile Western States Endurance Run took them, as did 60% of Ironman competitors in Brazil. Taking NSAIDs before and during a race now seems commonplace.

But there is no proof that ibuprofen enhances athletic performance. No difference in feelings of exertion or race times was found between athletes who did or didn't take the drug. Ibuprofen users were also more likely to injure themselves, become dehydrated, or develop hyponatremia (low sodium blood levels).

9. Ibuprofen May Be Associated With Sexual Dysfunction and Infertility

Men who have trouble achieving or maintaining an erection or women who have difficulty conceiving should take a look at their NSAID use and speak to their doctor.

Studies have shown men who take high doses of ibuprofen for several months are more at risk of infertility, erectile dysfunction, fatigue, and muscle wastage. Prolonged ibuprofen usage disrupts testosterone hormones.

Erection problems were twice as common in men who took NSAIDs regularly compared with men who took the drugs less frequently or not at all in a Journal of Urology study. Several studies have reported an increase in rates of conception once NSAIDs were stopped.

10. Do Not Take Ibuprofen During Pregnancy, Especially In the Last Trimester

Babies inside the womb get all the nutrients, blood, and oxygen they need from their mothers. This means that anything the mother eats or takes, whether it be food or medicine, can potentially cross the placenta into her unborn child.

This is why NSAIDs, including ibuprofen, should not be taken by pregnant women, and the last trimester is the most critical period of all for avoiding these drugs.

NSAIDs taken during this period can cause an early closing of the blood vessel that shunts blood away from the lungs in the fetus, leading to lung and heart problems in the newborn.