The Dangers of Ibuprofen Usage

When Safe is Not That Safe After All......

In This Article –

  • The Role of Ibuprofen and Other NSAIDs
  • Uses of Ibuprofen
  • The Benefits of Taking Ibuprofen
  • The Dangers of Ibuprofen Usage

The Short Answer –

‘Ibuprofen could raise the risk of heart failure by up to 83%’ – fact or fiction?

Just another media scare story or something everyone should consider before taking? Here we take a balanced look at the benefits vs the dangers of Ibuprofen usage and ask is it worth the risk?

The Role of Ibuprofen And Other NSAIDs

Ibuprofen is the most popularly used product of a group of drugs known as NSAIDs. They are designed to block the production of prostaglandins and in doing so reduce inflammation around an injury or inflamed area, ultimately reducing your levels of pain.

*Strictly speaking, Aspirin is also an NSAID, but because it behaves very differently in the body to Ibuprofen and other common over-the-counter NSAIDs, we have dealt with it separately (The Dangers Of Taking Aspirin Every Day).*

The group of NSAIDs that Ibuprofen belongs to is commonly known as the non-selective NSAIDs meaning that they block both COX-1 and COX-2 enzymes. There is another class of NSAIDs that focus selectively on blocking just the COX-2 enzyme, but many of these have been selectively withdrawn from the market voluntarily by the companies that produced them due to a direct increase in heart attacks, with only Celebrex that we are aware of, still left on the market. We can deal with these separately as well since they carry their own controversy and are only available via doctors prescription anyway.

Of the ‘standard’ over-the-counter NSAIDs (ignoring Aspirin), Ibuprofen, Ketoprofen and Diclofenac are the most popular, with Ibuprofen by far the most used.

Uses Of Ibuprofen

Ibuprofen is used to target pain from a whole range of ailments most commonly including toothache, headache, muscle pain, menstrual pain and arthritis. It is probably most frequently used to combat pain from arthritis because it’s anti-inflammatory effect. It is also used sometimes to help with other minor aches and pains such as those associated with flu or even the common cold.

A cartoon of a man in bed with a cold towel over his head and ibuprofen by his bedside

The Benefits of Ibuprofen

Before covering the dangers of ibuprofen usage, it is important to understand the benefits –

  1. One of the biggest advantages with using Ibuprofen as your anti-inflammatory painkiller is that is it fundamentally more effective than its other very common brother, Aspirin. A 4000mg dose of Aspirin is approximately as effective as just 2400mg of Ibuprofen. This means you get the same therapeutic effect, but because of the lower dose, you see a reduced common side effect profile.
  2. Ibuprofen can provide some relief for rheumatoid arthritis. Although, it can not cure or even alter the course of the disease, the anti-inflammatory properties will help to relieve some of the pain and swelling.
  3. Ibuprofen is also not addictive, so will not cause problems for people prone to becoming dependent on it.
  4. Not only that, but numerous studies have shown that NSAIDs can actually slow down the onset of Alzheimer’s and even noticeably lower the chance of developing the disease in the first place. Without going in to the technical detail, it’s positive effect lies in Ibuprofen’s ability to reduce the levels of beta-amyloid that builds up in the brain.
  5. Finally, Ibuprofen has one other giant advantage – that being that people do not easily build up a tolerance to the drug leading to ever higher doses being needed to achieve the same anti-inflammatory outcome.
About Us

With every chemical drug you use to control pain, there will be risks and benefits. The job of a doctor is to balance those risks (with your likelihood of suffering from one of them) against the benefits. However, for over-the-counter medications such as Ibuprofen it is often YOU that have to be the assessor without necessarily really knowing the risks.

The Dangers of Ibuprofen Usage

However, with any drug there are also serious risks that need to be weighed against the benefits.

1.Increased Risk of Stroke or Heart Attack.

Unfortunately, one of the most serious and most prevalent side effects with all the NSAIDs (except Aspirin) but including Ibuprofen, is the increased risk of high blood pressure leading to heart failure.

According to The Lancet, as many as 140,000 heart attacks were caused by the Cox-2 inhibitors, leading to the withdrawal from the market of Vioxx (Read About It Here In The Lancet). These heart attacks were actually nothing to do with the non-selective NSAIDs such as Ibuprofen, but it did spark the desire to research the impact of all NSAIDs on blood pressure and heart attacks as well.

Wider Implications…

This further research then showed that the increased risk was not limited to Cox-2 inhibitors but in fact a potential side effect of all the NSAIDs. Indeed, so strong was the evidence linking NSAIDs such as Ibuprofen, Diclofenec, Naproxen etc to heart failure that the FDA ( The American Food and Drugs Authority) took an unusual step in strengthening it’s warning against NSAIDs stating on record the following –

  • Both heart attack and the risk of stroke is increased with the use of NSAIDs, even with just short-term use and the risk starts to increase within just a few weeks of starting to take an NSAID (Ibuprofen)
  • The risk of heart attack or stroke increases as the dose increases and is also much greater the longer the period of time they are taken for.
  • The risk is strongest for anyone that has already got heart disease, but people without heart disease are still at considerable risk.

There have been some studies suggesting that Naproxen may be safer than Ibuprofen and other NSAIDs, but the FDA were also clear in pointing out that the ‘evidence’ after review by their expert panel, was not solid enough to support this belief and so Naproxen should be considered just as risky as the other NSAIDs (with the aforementioned exception of Aspirin).

A Picture of a packet of Ibuprofen

2.Relative Increase In Risk of Heart Failure

At the time, newspapers took this to the maximum with headlines such as the Daily Mirror (in England) reporting that

“Ibuprofen could raise the risk of heart failure by up to 83%”.

Analysis of the data shows this however to be substantially wide of the wide, as clarified by the UK’s own NHS website. In fact, the increased risk with Ibuprofen was nearer to 20%, but the fact remains that the connection between use of NSAIDs and heart failure or stroke are very real. How much increased risk there is depends on many factors – each NSAID had slightly different scores, but it also depends on other factors such as lifestyle, weight and your reason for taking them in the first place.

If you are taking them long-term for back pain or arthritis, then your chances of developing other complications is clearly much higher than two days treatment for tooth ache.

3.Increased Risk of GI/ Stomach Problems

All NSAIDs can cause stomach issues such as ulcers or heartburn. In some cases, PPIs (proton pump inhibitors) can be prescribed to neutralise some of the acid, but prolonged use can lead to a whole range of gastric problems.

The Final Word –

Although Ibuprofen is available over the counter, it still carries a risk. However, taking any NSAID (remember Aspirin is treated separately) for a few days is highly unlikely to lead to a heart attack or stroke, unless there are other very substantial risk factors at play – such as a history of heart disease or blood clotting issues. If you fall in to one of these categories then alternatives to NSAIDs should be sought, and certainly NEVER take them without the express consent of your doctor first.

If you don’t have any history of heart disease, then taking Ibuprofen in low doses is as safe as taking any over-the-counter medicine – the risks being considered very low. Always keep to the lowest dose where possible though, as with all drugs, to minimise any possible side effects.

If you do have to take Ibuprofen as a long-term therapy, considering taking ‘holidays’ and using an alternative to an NSAID such as ‘Acetaminophen’ (paracetamol). This drug doesn’t appear to increase the chances of heart failure, but equally has it’s own risk factors around liver damage – so again speak to your doctor before making any decision, just be aware that there are options out there.

Finally, as with everything we offer for the information of our community – please understand that Ibuprofen has many benefits in the short-term and some in the long-term, but these have to be weighed against the risks and always try to consult a doctor before using it. And if you do start to experience any form of chest pain, weakness or shortness of breath, make sure you get to a doctor immediately and tell them exactly what you are taking so they can make informed decisions on your behalf.

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References –

1. Dr David J Graham MD, David Campen MD, Rita Hui, PharmD, Michele Spence, PhD, Craig Cheetham, PharmD, Gerald Levy, MD et al. (Feb 2005). Risk of acute myocardial infarction and sudden cardiac death in patients treated with cyclo-oxygenase 2 selective and non-selective non-steroidal anti-inflammatory drugs: nested case-control study. The Lancet.
2. NHS Website (2016)

Ibuprofen-like painkillers linked to an increased risk of heart failure

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