Q: I take Advil fairly regularly for pain, but how do I know if I’m taking more than is safe?
Headaches. Fevers. Period cramps. Pain on the back.
These are all symptoms that can be treated with ibuprofen, a drug better known by one of its brand names, Advil.
Given the drug’s broad pain-relieving effects, excellent safety profile, and over-the-counter availability, it’s no surprise that some people pop the little red-brown pills whenever they feel the slightest discomfort.
“It’s my passion when I’m in pain,” says Candy Tsourouni, a professor of clinical pharmacy at the University of California, San Francisco.
However, ibuprofen – which is also sold under brand names such as Motrin and Nuprin – can carry some health risks, especially for those with kidney or stomach problems.
Here’s how to feel good and stay safe.
How to know if you’re overdoing it
Scan the label on over-the-counter ibuprofen and you’ll see that adults and children 12 and older are recommended to take one (or two, if needed) 200-milligram tablets, capsules, or gel capsules every four to six hours while symptoms persist. And those taking the drug should not exceed 1,200 milligrams (or six pills) in 24 hours.
But because doctors sometimes prescribe ibuprofen in much higher doses, up to 3,200 milligrams a day, it can be hard to tell how much is too much.
This discrepancy is rooted in security concerns. The Food and Drug Administration sets strict dosage limits for over-the-counter drugs because they can be taken by people with various risk factors, Dr. Tsourounis said. If you are unlikely to have an adverse reaction, your doctor may prescribe a higher dose.
Even with over-the-counter ibuprofen, doctors sometimes advise patients to take up to 3,200 milligrams a day for a short time — up to a week or two — because the anti-inflammatory effects are better at higher doses, Lauren Haggerty said. . clinical pharmacist at Johns Hopkins Medicine. This can happen after an injury or surgery, he said.
If you haven’t consulted a doctor about how much is safe or if you’re not sure about your risk factors, it’s best not to exceed the recommended limit of 1,200 milligrams per day, Dr. Tsourounis said.
Since ibuprofen can cause stomach upset, consider taking it with at least a few bites of food — dairy or non-dairy alternatives are especially helpful, Dr. Tsourounis said.
Be careful not to accidentally take more than prescribed. “I have patients who don’t know that Advil and generic ibuprofen are the same, so they might take both,” said Dr. Sarah Ruff, a physician at UNC Family Medicine in Durham, NC.
Also keep in mind that ibuprofen is sometimes added to some cold medicines, such as Sudafed PE Head Congestion and Pain Relief, so always read the ingredients list on medicines before using them.
When to be extra careful
Ibuprofen belongs to a class of drugs known as nonsteroidal anti-inflammatory drugs, or NSAIDs, which reduce pain and inflammation by inhibiting the activity of certain enzymes, Dr. Tsourounis said. That’s why squeezing them often makes you feel better.
But these enzymes also help maintain kidney and liver function and regulate the fluid and electrolyte balance in your body, Dr. Tsourounis said. Therefore, taking ibuprofen can be dangerous for patients with kidney disease or failure. people with liver damage or cirrhosis. and people with conditions that strain their kidneys, such as high blood pressure or heart failure.
Those at high risk for these conditions — as well as stomach ulcers, heart attacks, stroke or bleeding problems — should talk to their doctors before taking ibuprofen, Dr. Haggerty said. The same applies if you are pregnant. Ibuprofen is not recommended at or after 20 weeks, according to the FDA, because it can in rare cases harm a fetus’s kidneys.
People taking medications such as diuretics, anticoagulants, ACE inhibitors or ARBs (angiotensin receptor blockers) to manage cardiovascular problems should also be careful, Dr. Tsourounis said, because ibuprofen puts strain on the kidneys and heart.
To reduce these health risks, don’t take the maximum recommended dose for more than a week or two at a time, Dr. Ruff cautioned. “If you need it for more than two weeks, that’s a good sign you should go see your doctor.”
When taken for long periods of time, ibuprofen can also increase the risk of stomach ulcers, Dr. Ruff said. The drug inhibits enzymes that, among other things, help produce mucus that lines and protects the lining of the stomach — so without these enzymes, the stomach becomes vulnerable to irritation and damage.
And ironically, regular use of ibuprofen in people with headache disorders (such as migraines) can cause rebound headaches, for reasons doctors don’t fully understand.
“It’s really frustrating for patients – because if they get into this situation, the only way to make it go away is to wean them off all the painkillers,” Dr Ruff said. “And that’s a painstaking process.”
