Who Should not take Ibuprofen

For years popping an ibuprofen for that pounding headache, low back pain, nagging knee pain or twisted ankle can provide quick relief from pain. But while this easily accessible, over-the-counter drug could temporarily mask discomfort and sometimes help a lot, experts and research has proved that ibuprofen does little to spur true healing. Furthermore, for certain groups of people, ibuprofen poses serious health risks that outweigh potential benefits. This group consists of but not limited to people with liver and kidney problems, people with asthma, people with hypertension and heart failure, pregnant women and people with a stroke history.

People with liver and kidney problems:

The liver and kidneys are two of our most important organs for filtering the toxins and waste from our blood. Your kidneys remove wastes and extra fluid from your body. Your kidneys also remove acid that is produced by the cells of your body and maintain a healthy balance of water, salts, and minerals such as sodium, calcium, phosphorus, and potassium in your blood. The liver is the largest solid organ in the body. It removes toxins from the body's blood supply, maintains healthy blood sugar levels, regulates blood clotting, and performs hundreds of other vital functions.

There are multiple peer reviewed articles suggesting that individuals with impaired liver and kidneys should avoid ibuprofen, as the drug can damage these vital organs. Despite being considered one of the safer nonsteroidal anti-inflammatory drugs (NSAIDs) for the liver, ibuprofen can cause hepatotoxicity, also known as liver damage and toxic hepatitis, a systematic review analyzing 22 studies found. This liver injury occurred within 12 days of starting treatment and was more common in women. As the body’s detoxifier, the liver breaks down and assesses compounds. Multiple doctors and researchers have found that ibuprofen is challenging for the liver to process efficiently. Also the liver is critical in removing wastes and degrading drugs. Ibuprofen can be toxic to these processes. The standard dosage of 200 to 400 milligrams three times daily is burdensome for the liver. Though ibuprofen overdose are rare, it can cause liver damage. A 2020 study from the University of California Davis found that even moderate doses of ibuprofen may have more significant adverse effects on liver health than doctors realize. The research in mice showed that ibuprofen treatment altered metabolic pathways, including those regulating amino acids, hormones, and vitamins.

Ibuprofen is also toxic to the kidneys, damaging blood vessels that filter waste. Overuse can lead to analgesic nephropathy, a kidney disease from excessive medications. This is more common in those over 45 and with kidney or liver problems. Individuals with kidney and liver problems should do their best to avoid ibuprofen.

People with asthma:

Asthma affects 1 in 13 Americans. It causes inflamed airways that produce excess mucus, leading to breathing issues. People with asthma should avoid NSAIDs like ibuprofen because it blocks inflammation pathways but can increase compounds called leukotrienes, causing bronchospasms, a tightening of the muscles that line the lung’s airways. A 2016 study linked short-term use of ibuprofen, aspirin, and diclofenac to asthma exacerbation in Taiwan. The study authors noted that the findings urge “physicians to reassess their treatment strategies for fever in children with asthma,” given that ibuprofen and other NSAIDs are sometimes prescribed or recommended to asthmatic children. Another 2019 study from Taiwan showed ibuprofen has higher asthma attack risks than acetaminophen in young children if they had an ER visit or hospitalization the prior year.

People with hypertension or heart failure:

Studies show ibuprofen and NSAIDs like naproxen can raise blood pressure. A two meta-analyses found NSAID use causes a significant 5 mmHg increase in mean blood pressure, especially in hypertensive patients, according to a review article published in Drug Safety. One report noted NSAID users had a 1.7 times higher risk of needing antihypertensives than nonusers. NSAID use was also linked to a 40 percent increased hypertension diagnosis risk. Ibuprofen can also decrease the effects of blood pressure medication. For the patients with conditions such as osteoarthritis who require treatment and also have hypertension, even mild elevations in blood pressure or inhibition of antihypertensive medication efficacy resulting from nonsteroidal anti-inflammatory drugs can be of significant clinical and public health importance,” according to a paper published in the Journal of Clinical Hypertension.

Given the link between high blood pressure and heart disease, Dr. Joseph Maroon, a professor of neurological surgery at the University of Pittsburgh Medical Center said people with heart conditions should avoid ibuprofen. A 2016 study published in the British Medical Journal associated NSAID use with higher heart failure risk due to increased blood pressure, platelet inhibition, and other properties.

Pregnant Women:

It is known in the medical world that pregnant women should avoid NSAIDs after 20 weeks, as the drugs can result in low amniotic fluid, according to the U.S. Food and Drug Administration (FDA). However, emerging research suggests that NSAIDs like ibuprofen can also harm the baby in early pregnancy. One study found ibuprofen reduced cell number, proliferation, and germ cell count regardless of gestational stage. The adverse effects were not fully reversed after stopping the drug for five days, indicating long-term impacts. A 2021 ex vivo study found NSAIDs altered fetal kidney development as early as seven developmental weeks in several ways, including cell death.

Additional research has linked ibuprofen during pregnancy to lower birth weight, more maternal bleeding, and higher asthma risk.

People with stroke history:

One of the most common symptoms after an individual has a stroke is nerve pain. However, taking NSAIDs like ibuprofen for relief is not recommended, according to Dr. Joseph Maroon. A systematic review of 15 studies found that NSAID use significantly raises the risk of hemorrhagic stroke. Researchers attribute the increased stroke risk to NSAIDs affecting vasoconstriction (the narrowing of blood vessels) and sodium excretion, worsening blood pressure. A 2021 study found that women with menstrual pain using NSAIDs have a higher stroke risk. NSAID use throughout periods is common.

 In short ibuprofen is not always the answer when searching for pain relief especially if the individual is currently 1 of the 5 types of individuals who were mentioned above. The ibuprofen can actually lead to more health complications. Safer alternatives for ibuprofen include but not limited to acetaminophen, nonacetylated salicylates (unless dealing with heart failure or hypertension), arnica, curcumin, bromelain, topical capsaicin, acupuncture, yoga and chiropractic

Author: Eric Mack, D.C.