Key takeaways:
Ibuprofen (Advil, Motrin) is a nonsteroidal anti-inflammatory drug (NSAID). It's available over-the-counter (OTC) and by prescription, and can be helpful for mild to moderate aches and pains.
Taking ibuprofen can cause stomach problems, like bleeding or ulcers, especially if taken at higher doses or for a long time.
You should take the lowest dose of ibuprofen needed for the shortest time possible to lower your risk of stomach side effects.
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You may have heard that ibuprofen (Advil, Motrin) can cause stomach problems. But, have you ever wondered exactly what those problems are? Well, it’s more than just a little indigestion for some people.
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID). It’s used to treat a variety of health conditions, such as arthritis, muscle pain, and headaches. It’s available over-the-counter (OTC) and by prescription at higher doses. Some people may think that since ibuprofen is available as an OTC medication, it’s always safe to take.
But there are some serious side effects linked to ibuprofen use. For instance, ibuprofen can cause gastrointestinal (GI) side effects, like stomach ulcers or stomach bleeding. The risk for these side effects is higher if you take ibuprofen at higher doses or for long periods of time. And, it’s a risk for all NSAID medications.
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In this article, we’ll review what you need to know about the risks of stomach ulcers and stomach bleeding while using ibuprofen.
What is ibuprofen used for?
Ibuprofen is used to help relieve fever, pain, and inflammation (swelling). Depending on the dose, it can be helpful for mild to moderate symptoms.
The labeling for OTC ibuprofen states that it can be used to temporarily relieve:
Backaches
Minor arthritis pain
Muscle aches
Headaches
Toothaches
Menstrual cramps
Aches and pains due to the common cold
Fever
Prescription-strength ibuprofen is FDA-approved to treat:
Symptoms of rheumatoid arthritis (RA)
Symptoms of osteoarthritis (OA)
Painful menstrual periods
Mild to moderate pain
The biggest difference between OTC and prescription-strength ibuprofen is the tablet strength. OTC ibuprofen comes as 200 mg tablets and capsules. Prescription ibuprofen comes in 400 mg, 600 mg, and 800 mg tablets.
Both OTC and prescription ibuprofen work by blocking the production of prostaglandins. Prostaglandins are substances in your body that help create pain and inflammation to help with healing. But they also help protect the lining of the stomach and intestines (also called the GI tract).
When ibuprofen stops prostaglandins from being made, those substances aren’t there to help protect the GI tract. And that’s why ibuprofen can cause GI side effects.
What are the gastrointestinal side effects of ibuprofen?
Ibuprofen is generally considered safe for most people when taken as directed. But, it can cause stomach problems, including some that are serious.
Examples of possible GI side effects with ibuprofen include:
Heartburn
Diarrhea
Constipation
Gas
Stomach pain
GI bleeding
GI ulcers
Tears of the stomach, intestines, or esophagus (the tube connecting the mouth and stomach)
Serious GI problems, with or without symptoms, can happen at any time when taking NSAIDs, including ibuprofen. Thankfully, they’re pretty uncommon. Stomach ulcers, bleeding, and tears happen to around 1% of people regularly taking NSAIDs for 3 to 6 months, and 2% to 4% of those using them for 1 year.
Your risk of these serious side effects is 10 times higher if you have a history of GI bleeding or ulcers (e.g., peptic ulcers). The risk of serious GI side effects is also higher for older adults and those taking oral corticosteroids or blood thinners (anticoagulants).
The longer you take ibuprofen, the greater your risk is of developing serious GI side effects. But even if you take ibuprofen for a short period of time, these side effects can still happen. However, one study found that people taking the maximum recommended dose of OTC ibuprofen (1,200 mg per day for up to 10 days) had a similar risk of stomach side effects to those who took a placebo (a pill with no medication).
How much ibuprofen (Advil or Motrin) does it take to cause stomach pain?
The amount of ibuprofen needed to cause stomach pain varies from person to person. Some people may be more sensitive to the stomach side effects of ibuprofen than others. There’s not a specific dose where the side effects will definitely happen. But in general, the higher the dose of ibuprofen, the greater the risk of developing stomach pain.
Are stomach ulcers serious?
Stomach ulcers (gastric ulcers) can be serious. They can lead to bleeding, tears, or blockages in the stomach.
If you have any of these symptoms, you should seek medical attention immediately:
Dark or black stools
Rectal bleeding
Vomiting blood
Coffee ground appearance in vomit
Stomach pain that gets worse after eating
Keep in mind that only 1 in 5 people who develop serious stomach side effects, like ulcers, from ibuprofen experience symptoms. Be sure to regularly follow up with your healthcare provider if you’re taking ibuprofen most days or every day. This will help them keep an eye out for these side effects.
Can children’s ibuprofen cause stomach ulcers in kids?
Yes, children’s ibuprofen can cause stomach ulcers in kids. The same GI side effects that are seen in adults can also happen to children. If your child is taking ibuprofen, it’s important to watch for any signs of stomach pain, bleeding, or ulcers. You should also discuss how long your child should take ibuprofen with their healthcare provider.
How can I protect my stomach from ibuprofen?
There are a few things you can do to protect your stomach from ibuprofen. If you develop signs of stomach bleeding or ulcers, the first thing you should do is stop taking ibuprofen and any other NSAIDs. You should also contact your healthcare provider right away.
These suggestions can help lower the risk of stomach problems while taking ibuprofen or other NSAIDs:
Take the lowest dose of ibuprofen for the shortest amount of time possible.
Avoid drinking alcohol and smoking while taking ibuprofen.
If suggested by your healthcare provider, use a medication that lowers stomach acid. Examples include histamine-2 blockers, like famotidine (Pepcid), and proton pump inhibitors (PPIs), like omeprazole (Prilosec).
Can you take ibuprofen (Advil or Motrin) on an empty stomach?
The current recommendation is that you shouldn’t take ibuprofen on an empty stomach. The thought is that doing so may raise your risk of developing stomach-related side effects. This can include stomach upset, ulcers, and bleeding. But, this link between an empty stomach and a higher risk of side effects hasn’t been confirmed.
Although it’s recommended to take ibuprofen with food or milk, some experts say this may not be necessary. You may have better and faster pain relief if you take ibuprofen on an empty stomach. More research is needed to clarify this issue. But if you find you tolerate ibuprofen better when you take it with food, feel free to continue taking it that way.
What can I take instead of ibuprofen for pain or inflammation?
There aren't other OTC non-NSAID options for treating body-wide inflammation. Medications like naproxen (Aleve) and aspirin are also NSAIDs and have similar GI risks as ibuprofen. You should avoid them if you’re looking to avoid medications like ibuprofen.
But acetaminophen (Tylenol) may be an option for aches and pains. It’s an OTC pain reliever that doesn't have the same stomach-related side effects as ibuprofen and other NSAIDs. However, it doesn’t treat inflammation.
The topical NSAID diclofenac gel (Voltaren Arthritis Pain) is available OTC. It has a lower risk of stomach side effects because you apply it to the skin. Your body absorbs less of the medication from this topical gel than when you take it as a pill. You could also try OTC lidocaine patches, creams, or lotions. These topical products could be good options if you have pain in a specific area, like your joints.
If you feel that you need a different medication to help with pain or inflammation, talk with your healthcare provider about your options to see what might be the best for you.
The bottom line
Ibuprofen is a medication that can be used to help relieve pain and inflammation. However, it also comes with the risk of serious GI side effects, such as stomach ulcers and bleeding. The risk is higher with longer periods of use and higher doses of ibuprofen.
To help protect your stomach, avoid drinking alcohol while taking it and use an OTC antacid or acid reducer (with your healthcare provider’s OK). It’s also recommended to take the lowest dose needed for the shortest time possible.
If you have concerns about taking ibuprofen or other NSAIDs, talk to your healthcare provider about other options for pain relief.
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References
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Doyle, G., et al. (1999). Gastrointestinal safety and tolerance of ibuprofen at maximum over-the-counter dose. Alimentary Pharmacology & Therapeutics.
Food and Drug Administration. (2016). Medication guide for nonsteroidal anti-inflammatory drugs (NSAIDs).
Lanza, F. L., et al. (2009). Guidelines for prevention of NSAID-related ulcer complications. The American Journal of Gastroenterology.
MedlinePlus. (2022). Ibuprofen.
Moore, R. A., et al. (2015). Effects of food on pharmacokinetics of immediate release oral formulations of aspirin, dipyrone, paracetamol and NSAIDs – A systematic review. British Journal of Clinical Pharmacology.
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