Ibuprofen: Uses, Dosage & Side Effects

What Is Ibuprofen and What Is It Used For?

Ibuprofen is a non-steroidal anti-inflammatory drug (NSAID) used to treat mild to moderate pain, reduce fever, and decrease inflammation. It works by inhibiting cyclooxygenase (COX) enzymes, thereby reducing prostaglandin production in the body. Ibuprofen is one of the most widely used medicines worldwide and is listed on the WHO Model List of Essential Medicines.

Ibuprofen belongs to the propionic acid derivative subclass of NSAIDs and is one of the oldest and best-studied drugs in this class. First developed in the 1960s by researchers at Boots Group in the United Kingdom, ibuprofen was initially available only by prescription but became the first NSAID approved for over-the-counter sale in the 1980s. Today, it remains one of the most commonly purchased non-prescription medicines globally, used by millions of people for everyday pain relief.

The drug exerts its effects through non-selective inhibition of both COX-1 and COX-2 enzymes, which are responsible for producing prostaglandins. Prostaglandins play key roles in mediating inflammation, pain signaling, and temperature regulation. By reducing prostaglandin synthesis, ibuprofen provides a triple therapeutic benefit: analgesic (pain-relieving), antipyretic (fever-reducing), and anti-inflammatory effects.

Ibuprofen is commonly used for the following indications in adults and adolescents over 12 years:

• Headache and migraine – effective for both tension headache and mild to moderate migraine
• Toothache – a first-line over-the-counter option for dental pain
• Menstrual cramps (dysmenorrhea) – particularly effective when taken early at the onset of menstruation
• Muscle and joint pain – including sprains, strains, and exercise-related soreness
• Back pain – short-term relief for acute low back pain
• Fever associated with colds and flu – effective at reducing body temperature within 30–60 minutes
• Mild to moderate arthritis – including osteoarthritis and rheumatoid arthritis (often at higher, prescribed doses)

When used at prescribed doses under medical supervision, ibuprofen is also effective for managing chronic inflammatory conditions such as rheumatoid arthritis, juvenile idiopathic arthritis, and ankylosing spondylitis. Intravenous ibuprofen formulations are used in hospital settings for treatment of patent ductus arteriosus (PDA) in premature neonates and for post-operative pain and fever management.

What Should You Know Before Taking Ibuprofen?

Before taking ibuprofen, be aware of important contraindications including active peptic ulcers, severe heart failure, the last trimester of pregnancy, and allergy to aspirin or other NSAIDs. People with cardiovascular disease, kidney or liver impairment, or a history of GI bleeding should consult a doctor before use.

While ibuprofen is widely available over the counter and considered safe for short-term use at recommended doses, it is not suitable for everyone. Understanding the contraindications and precautions before taking ibuprofen is essential for safe use. As with all NSAIDs, the general principle is to use the lowest effective dose for the shortest possible duration to minimize the risk of adverse effects.

Contraindications

You must not take ibuprofen if any of the following apply to you:

• Allergy to ibuprofen or any other ingredient in the product
• History of allergic reactions to aspirin or other NSAIDs – symptoms such as asthma, hives, nasal congestion, or facial swelling after taking these medicines
• Active or history of recurrent peptic ulcer or gastrointestinal bleeding – two or more episodes of proven ulceration or bleeding
• History of GI bleeding or perforation related to previous NSAID use
• Severe liver or kidney disease
• Severe heart failure (NYHA Class IV)
• Last three months of pregnancy (third trimester)
• Any condition with increased bleeding tendency
• Shortly before or after coronary artery bypass graft (CABG) surgery

Warnings and Precautions

Speak to your doctor or pharmacist before taking ibuprofen if you have or have had any of the following conditions. These situations do not necessarily prevent you from using ibuprofen but may require closer monitoring or dose adjustment:

Cardiovascular risk: NSAIDs, including ibuprofen, may be associated with a small increased risk of heart attack or stroke, particularly when used at high doses and for prolonged periods. This risk is most relevant for patients who already have cardiovascular disease or significant risk factors such as high blood pressure, high cholesterol, diabetes, or smoking. The European Medicines Agency (EMA) and the U.S. FDA recommend using the lowest effective dose for the shortest necessary duration to minimize this risk.

Gastrointestinal risk: NSAIDs can cause ulceration, bleeding, or perforation of the stomach or intestines, which can be fatal. These events can occur at any time during treatment, with or without warning symptoms, and are more common in elderly patients. The risk increases with higher doses, longer duration of use, concurrent use of oral corticosteroids or anticoagulants, a history of peptic ulcer disease, and alcohol consumption. Patients at increased GI risk may benefit from concomitant use of a proton pump inhibitor (PPI) as protective therapy.

Renal risk: Ibuprofen can reduce kidney blood flow by inhibiting prostaglandins that help maintain renal perfusion. This is especially relevant for patients who are dehydrated, have pre-existing kidney disease, heart failure, or liver cirrhosis, and those taking diuretics, ACE inhibitors, or angiotensin receptor blockers (ARBs). Adequate hydration is important when taking ibuprofen. Children and adolescents who are dehydrated are at particular risk of impaired kidney function.

Masking of infection: Ibuprofen can mask signs of infection such as fever and pain. This may lead to delayed diagnosis and treatment of the underlying infection, potentially increasing the risk of complications. This has been observed with bacterial pneumonia and bacterial skin infections associated with chickenpox (varicella). Do not use ibuprofen during chickenpox (varicella). If you have an infection and symptoms persist or worsen while taking ibuprofen, contact your doctor promptly.

Medication overuse headache: Regular, prolonged use of pain-relieving medications, including ibuprofen, can paradoxically cause or worsen headache. If you suspect this applies to you, consult your doctor before taking further pain medication.

Pregnancy and Breastfeeding

Ibuprofen use during pregnancy requires careful consideration depending on the trimester:

• First trimester (weeks 1–12): Use only if clearly necessary and on medical advice. Some studies suggest a slightly increased risk of miscarriage and certain birth defects, though evidence is not conclusive.
• Second trimester (weeks 13–27): Should be avoided unless benefits clearly outweigh risks. From week 20 onwards, prolonged use can cause kidney problems in the fetus, leading to low amniotic fluid (oligohydramnios) or premature closure of the ductus arteriosus. Your doctor may recommend additional monitoring if treatment beyond a few days is necessary.
• Third trimester (weeks 28–40): Ibuprofen must not be used. It can cause serious harm to the unborn child, including heart and kidney problems, and can affect both the mother's and baby's bleeding tendency. It may also delay and prolong labor.

Breastfeeding: Ibuprofen passes into breast milk in very small amounts and is unlikely to affect the nursing infant at recommended doses. It is generally considered compatible with breastfeeding for short-term use. Consult your doctor if you need ibuprofen for more than occasional use while breastfeeding.

Fertility: Ibuprofen may temporarily impair female fertility by affecting ovulation. This effect is reversible upon stopping the medication. Ibuprofen is not recommended for women who are trying to conceive or undergoing fertility investigations.

Special Populations

Children: Ibuprofen tablets (200 mg) are suitable for children aged 6–12 years weighing over 20 kg. For younger children, oral suspensions with age- and weight-based dosing are available. Always follow the specific dosing instructions for your child's age and weight. There is a risk of kidney impairment in dehydrated children and adolescents.

Elderly patients: Older adults are at increased risk of NSAID-related adverse effects, particularly gastrointestinal bleeding, cardiovascular events, and renal impairment. Lower doses and shorter treatment courses are advisable. Elderly patients should be especially vigilant for any abdominal symptoms, particularly during the early stages of treatment.

Driving and operating machinery: Ibuprofen may cause dizziness, drowsiness, or visual disturbances in some individuals. If you experience these effects, do not drive or operate heavy machinery until they resolve.

How Does Ibuprofen Interact with Other Drugs?

Ibuprofen can interact with numerous medicines, including anticoagulants (blood thinners), other NSAIDs, aspirin, lithium, methotrexate, ACE inhibitors, SSRIs, corticosteroids, and diuretics. Do not combine different pain-relieving medicines without medical advice. Always tell your doctor or pharmacist about all medicines you are taking.

Drug interactions with ibuprofen can increase the risk of adverse effects or reduce the effectiveness of either ibuprofen or the other medication. Understanding these interactions is crucial for safe use. The following table summarizes the most important drug interactions, though this list is not exhaustive – always consult your doctor or pharmacist before combining ibuprofen with other medicines.

Major Interactions

These interactions carry significant clinical risk and require particular attention:

Other Important Interactions

The following interactions are also clinically relevant and may require dose adjustment or monitoring:

What Is the Correct Dosage of Ibuprofen?

For adults, the recommended OTC dose is 200–400 mg every 4–6 hours as needed, with a maximum of 1,200 mg per day. Children aged 6–12 years take 200 mg up to three times daily. Always use the lowest effective dose for the shortest time needed. Do not exceed the recommended dose without medical supervision.

The correct dosage of ibuprofen depends on the condition being treated, the patient's age and weight, and whether the medicine is being used for self-treatment or under medical prescription. The following dosing information applies to over-the-counter use for temporary, mild to moderate pain and fever. Prescription doses for chronic conditions such as arthritis may be higher and should be determined by your doctor.

Adults and Adolescents Over 12 Years (Over 40 kg)

Children Aged 6–12 Years (Over 20 kg)

Elderly Patients

Elderly patients should use the lowest effective dose for the shortest possible time due to the increased risk of gastrointestinal bleeding, cardiovascular events, and kidney impairment. No specific dose reduction is routinely required, but careful monitoring is advised, particularly at the start of treatment and in patients with risk factors.

Missed Dose

Since ibuprofen is typically taken as needed for pain or fever, a missed dose is not usually a concern. If you are taking ibuprofen on a regular schedule, take the missed dose as soon as you remember – unless it is nearly time for your next dose. Do not take a double dose to make up for a missed one.

Overdose

If you or someone else has taken too much ibuprofen, contact a poison control center or emergency department immediately for assessment and advice. Overdose symptoms may include:

• Nausea, vomiting (possibly with blood), and abdominal pain
• Headache and ringing in the ears (tinnitus)
• Confusion and involuntary eye movements (nystagmus)
• Drowsiness and loss of consciousness
• Seizures (particularly in children)
• Low blood pressure, rapid heartbeat, and difficulty breathing

Symptoms typically appear within 4 hours of ingestion. Management is primarily supportive, as there is no specific antidote for ibuprofen overdose.

What Are the Side Effects of Ibuprofen?

Common side effects of ibuprofen include gastrointestinal symptoms (heartburn, nausea, abdominal pain, diarrhea), headache, dizziness, and drowsiness. Serious but rare side effects include gastrointestinal bleeding, cardiovascular events, severe allergic reactions, and serious skin reactions. Using the lowest effective dose for the shortest time minimizes risk.

Like all medicines, ibuprofen can cause side effects, although not everyone experiences them. The likelihood of side effects increases with higher doses and longer duration of use. The following classification uses standard frequency categories based on clinical trial data and post-marketing surveillance.

Stop taking ibuprofen and seek emergency medical care immediately if you experience any of the following serious symptoms:

• Swelling of the face, tongue, or throat; difficulty swallowing; hives and breathing difficulties (angioedema)
• Reddish, target-like or circular patches on the body, often with central blisters; skin peeling; mouth, throat, nose, or genital sores (signs of Stevens-Johnson syndrome or toxic epidermal necrolysis)
• Widespread rash, high temperature, and enlarged lymph nodes (DRESS syndrome)
• Red, scaly, widespread rash with bumps under the skin and blisters, accompanied by fever (acute generalized exanthematous pustulosis)

Additional side effects that have been reported with unknown frequency include fixed drug eruption (recurrent skin reaction in the same location), photosensitivity (increased sensitivity to sunlight), and chest pain that may indicate Kounis syndrome (a potentially serious allergic cardiovascular reaction).

How Should You Store Ibuprofen?

Store ibuprofen at room temperature, away from moisture and direct sunlight. Keep all medicines out of sight and reach of children. Do not use ibuprofen after the expiration date printed on the packaging. Dispose of unused or expired medicines safely through your local pharmacy take-back program.

Proper storage ensures that ibuprofen remains effective and safe throughout its shelf life. Following these simple guidelines will help maintain the quality of your medicine:

• Temperature: Store at room temperature, typically below 25°C (77°F). Do not refrigerate or freeze unless specifically instructed on the label.
• Moisture: Keep in the original packaging to protect from moisture. Do not store in bathrooms or other humid environments.
• Light: Protect from direct sunlight and excessive heat.
• Children: Store out of the sight and reach of children. Consider using child-resistant packaging.
• Expiration: Do not use after the expiration date (month/year) printed on the carton and blister. The expiration date refers to the last day of that month.

Disposal: Do not dispose of medicines via wastewater or household waste. Return unused or expired medicines to your local pharmacy for safe disposal. These measures help protect the environment.

What Does Ibuprofen Contain?

The active substance is ibuprofen. Standard tablets contain 200 mg or 400 mg of ibuprofen per tablet. Inactive ingredients vary by manufacturer but commonly include microcrystalline cellulose, croscarmellose sodium, magnesium stearate, and hypromellose (tablet coating).

Ibuprofen is available in multiple formulations to suit different patient needs and preferences:

Common inactive ingredients (excipients) in ibuprofen tablets typically include: colloidal anhydrous silica, magnesium stearate, croscarmellose sodium, microcrystalline cellulose, hypromellose, polydextrose (E1200), and polyethylene glycol (macrogol) 4000. The tablets are generally white, round, and slightly convex. Specific excipients may vary between manufacturers and brands.

Most ibuprofen tablet formulations contain less than 1 mmol (23 mg) sodium per tablet, meaning they are essentially sodium-free. This is relevant for patients on sodium-restricted diets.