Is ibuprofen riskier than other pain relievers?

April 17, 2018 Elizabeth Meade, MD



Over-the-counter (OTC) pain medications are the most common treatment method for everyday ailments like muscle sprains, headaches, and fever.

But like all medicines, ibuprofen and other pain relievers can have side effects.

Ibuprofen pros and cons

Whether prescribed by a doctor, or purchased over the counter, ibuprofen is widely used to relieve mild to moderate pain from swelling, stiffness, and joint pain—everything from arthritis to fever to menstrual cramps and other inflammatory conditions.

Moreover, given the current public health crisis of overuse (and overdosing) of opioids — an epidemic which extends to children — ibuprofen can be a reliable, safer alternative for short-term acute pain or intermittent chronic pain.

Ibuprofen is available in children’s formulas, and is safe to give to children when used correctly. The dosage depends on the child’s age and weight. And, as with other pain relievers, children who take too much ibuprofen can become very sick and develop stomach or intestinal problems. The American Academy of Pediatrics has a useful ibuprofen dosage table for fever and pain, but it is not a substitute for the advice of a pediatrician.

That said, ibuprofen carries its own potential risks, some of which are only just beginning to emerge. 

Common side effects include nausea, dizziness, headache, allergic rashes, gastrointestinal distress (vomiting, diarrhea, constipation, even stomach bleeding), and high blood pressure. 

Risk factors increase, the longer you take the medication, with age and poor health, and if you consume more than three alcoholic drinks per day.  

There are two black box warnings on ibuprofen—the strictest warning applied by the FDA when there is credible evidence of serious risk:

  1. Cardiovascular risk—elevated risk of heart attack which may increase with prolonged use of the medication.
  2. Gastrointestinal risk—elevated risk of serious and potentially fatal bleeding, ulcer, and stomach or intestine perforation.

More recently, some small studies have shown a possible link between ibuprofen use and male infertility. Building on an earlier study showing the effect of several common painkillers on male reproductive development, one new study appears to show that ibuprofen disrupts reproductive hormones in otherwise healthy young men. Although the effect appears to derive from high daily doses of the drug, such doses are not uncommon among athletes, who often take painkillers prophylactically before a big game. 

What should you do?

Whether you’re a patient or the parent of a pediatric patient, it’s your responsibility to be a wise health consumer, understand possible side effects of pain medication and discuss any symptoms or concerns with your doctor as soon as you notice them. 

Like all medicines, ibuprofen has both positive and potentially negative side effects. However, the side effects can be managed if your doctor knows about them. Consult with your doctor or pediatrician. She can change the dose, change the type of medicine, or help you find other forms of non-pharmaceutical pain relief that work better for you or your child. If you have had a recent surgery or other medical procedure, take blood-thinning medications, have a bleeding disorder, or have a history of stroke, heart disease or other medical problems, make sure you check with your health care provider before taking ibuprofen or other non-steroidal anti-inflammatory medications.

Find a skilled Swedish doctor in our provider directory or call 1-800-SWEDISH (793-3474).

Elizabeth Meade, MD, is chief of pediatrics at Swedish.

This information is not intended as a substitute for professional medical care. Always follow your health care professional's instructions.


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