Are NSAIDs Like Ibuprofen Bad for My Liver and Kidneys?

two prescription bottles with pills next to them
Dr. Sharon Orrange
Dr. Orrange is an Associate Professor of Clinical Medicine in the Division of Geriatric, Hospitalist and General Internal Medicine at the Keck School of Medicine of USC.
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It’s logical to wonder if a medication you often take for pain is safe. There are some concerns about the popular over-the-counter pain relievers known as NSAIDs (non-steroidal anti-inflammatory drugs), which include ibuprofen (a.k.a. Motrin or Advil). Every week, I’m asked: How much can I take, and is it bad for my liver or kidneys?

How much ibuprofen can I take?

To treat mild to moderate pain, minor fever, and acute or chronic inflammation, 200 mg to 400 mg of ibuprofen will work. That amount is comparable to 650 mg of acetaminophen (Tylenol) or aspirin.

Generally, the maximum amount of NSAIDs you should take per day is 2400 mg or 12 over-the-counter tablets. That means if you take a dose every six hours, you can take 600 mg each time (or 300 mg each time if you take it every eight hours).

Can ibuprofen cause liver damage?

Ibuprofen and other NSAIDS rarely affect the liver. Unlike acetaminophen (Tylenol), most NSAIDs are absorbed completely and undergo negligible liver metabolism.

In other words, the way NSAIDs are metabolized makes liver toxicity (aka. hepatotoxicity) very rare. Estimates are that one in 100,000 NSAID prescriptions result in acute liver injury. Generally, NSAIDs are very liver-safe.

Is ibuprofen bad for my kidneys?

While NSAIDs rarely affect the liver, they have important adverse effects on the kidney that you should know about. Here is the science behind the problem. Ibuprofen and other NSAIDs block prostaglandins, natural body chemicals that normally dilate blood vessels leading to the kidneys. Blocking prostaglandins may lead to decreased blood flow to the kidneys, which means a lack of oxygen to keep the kidneys alive. That can cause acute kidney injury.

A simple blood test may show a rise in creatinine if your kidneys are being affected, usually seen within the first three to seven days of NSAID therapy. Acute kidney injury can occur with any NSAID, though naproxen seems to be a bigger culprit. In one study, folks who took NSAIDs had twice the risk of acute kidney injury within 30 days of starting to take the NSAIDs. Good news is it’s reversible if you stop taking them.

Who is at risk? In people with high blood pressure, taking NSAIDs long-term may worsen underlying high blood pressure. Also, people with existing kidney problems more often get in trouble with NSAIDs. Regardless, if you are taking ibuprofen for long periods of time, it’s not a bad idea to have a check of your kidney function with a quick blood test. Remember, acute kidney injury from NSAIDs doesn’t cause any symptoms.

To sum it up

NSAIDs are safe for the liver, but can cause a problem with kidney function that is reversible if you stop taking them. Generally safe, but worth paying attention to.

Dr O.

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