How Much Ibuprofen is Too Much?

If you pull a muscle while running, are experiencing menstrual cramps or have a killer headache, you’re likely to reach for an ibuprofen pill, such as Advil or Motrin, to reduce the inflammation and quash the pain. When taken correctly, ibuprofen is a safe and effective choice.

Available both over-the-counter and by prescription, ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that inhibits cyclooxygenase enzymes to prevent or reduce pain and inflammation.

While ibuprofen works well when you take it as directed, taking more of the medicine or taking it too often is not helpful and can actually hurt you, says gastroenterologist Gerard Isenberg, MD.

“People who take it chronically are at risk of developing problems," he says. "A recent study showed that incorrect use of NSAIDs is estimated to account for 107,000 hospitalizations and 15,600 deaths annually in the United States.”

Risks of Incorrect Ibuprofen Use

Among the risks of chronic or incorrect ibuprofen use are:

• Ulcers, with an annual incidence of 2 to 4 percent
• Worsening kidney function
• Cardiovascular issues, such as heart attack, heart failure, stroke and increased blood pressure
• Gastrointestinal bleeding
• Stomach upset and - rarely - a condition called microscopic colitis, which can cause diarrhea
• Nausea
• Complications with childbirth and in the newborn, when the mother takes ibuprofen during the third trimester (but ibuprofen use is fine when breastfeeding)

Ibuprofen is an appropriate option for most people, but Dr. Isenberg says it can cause these complications when:

• Used by someone who has liver disease
• Taken with another NSAID, such as aspirin
• Taken with a blood thinner, such as Coumadin
• Taken with other medications, such as clopidogrel, phenytoin or cyclosporine
• Dosing instructions are ignored (i.e., taking too many at a time or taking subsequent doses too soon)
• Used during the third trimester of pregnancy

If you choose to take ibuprofen to help you through an injury or other painful condition, Dr. Isenberg says you can mitigate your risk of developing side effects by following these five guidelines:

1. Take the lowest dose that is effective for your symptoms.
2. Consult your doctor before taking ibuprofen if you have a history of stomach, kidney or heart issues, or if you are pregnant.
3. Ask your doctor about using a topical NSAID gel, such as Diclofenac, instead of oral ibuprofen for musculoskeletal pain. This gel, available in a patch, is a good choice for athletes.
4. Consider taking something to reduce acid when taking ibuprofen. Check with your doctor and/or pharmacist to make sure you're not on other medications that can increase your chance for side effects.
5. Ask your physician whether ibuprofen or another NSAID best treats your symptoms and has the fewest potential side effects.

“Ibuprofen is one of the most commonly used meds in the United States,” Dr. Isenberg says. “It has many therapeutic benefits and, despite some of the risks, a very strong safety profile. You just need to be cognizant of how much you use, for how long and whether you have any issues that could cause an increased risk of side effects.”

Gerard Isenberg, MD is a gastroenterologist and associate chief and director, Clinical Operations, Division of Gastroenterology and Liver Disease, and chief medical quality officer, University Hospitals Digestive Health Institute, at University Hospitals Cleveland Medical Center. You can request an appointment with Dr. Isenberg or any other medical provider online.