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Ibuprofen: Dangers of a “mild” medication…

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Ibuprofen is one of the most common medications for headache in the world, part of a class known as NSAIDs – nonsteroidal anti-inflammatory drugs.  It’s one of those things (along with paracetamol / acetaminophen and aspirin) that many of us take without thinking – before seeing a doctor or taking something more “serious”.

But the problem is that these drugs, although safer than many, are still not “harmless”.

For most people, taken an Advil for a headache really is no big deal.  But if they do it again – and again – over time . . . it can do a lot more harm than most people think.

Of course every medication has a long list of possible side effects.  Thankfully, despite the amount of ibuprofen taken around the world each day, there are comparatively few problems.

However, ibuprofen can have a cumulative effect if taken many times a month, for example.  Problems with the digestive system are most common, but these can cause a chain-reaction of issues that can be quite serious.

Symptoms may include:

  • Blood in the stools / dark stool
  • Burning or sharp pain in the abdomen
  • vomiting
  • nausea
  • heart burn
  • weakness

These symptoms may come from conditions such as ulcers, gastrointestinal bleeding, and even kidney failure.

A study in 1999 (Anti-inflammatory and immunosuppressant drugs. Rang, Dale, Ritter) suggested that many patients with gastric damage have no symptoms (yet).

Ibuprofen stands as another reminder that headache patients need to talk to their doctors, unless their headaches are very rare.  If you have new headache conditions, or a headache every month or more, you need to see a doctor right away.  If the headaches continue, are disabling, or are more frequent, a visit to a specialist would be wise.

Even “safe” medications like ibuprofen can be dangerous if you take them frequently.  And frequently may mean fewer than you think.

Also see An Overview of Clinical Pharmacology of Ibuprofen, Full Ibuprofen Dosage information for All Ages and ibuprofen, Advil, Children’s Advil/Motrin, Medipren, Motrin, Nuprin, PediaCare Fever etc.

Study: Anti-inflammatory during Pregnancy – What’s the Risk?

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These “painkillers” are often used during pregnancy – but they may significantly increase the danger of miscarriage.

This study is quite a few months old now, but it’s worth taking a look at.  The study, published in the CMAJ (Canadian Medical Association Journal), looked at nonsteroidal anti-inflammatory drugs (NSAIDs).  This would include ibuprofen (ie Advil, Motrin), naproxen (ie Aleve, Treximet), and celecoxib (Celebrex).

Non-steroidal anti-inflammatories during pregnancy

The summary from the CMAJ was this:

The risk of miscarriage is 2.4 times greater for women who took any type and dosage of nonaspirin nonsteroidal anti-inflammatory drugs (NSAIDs) in early pregnancy, according to a study in CMAJ(Canadian Medical Association Journal).

“The use of nonaspirin NSAIDs during early pregnancy is associated with statistically significant risk (2.4-fold increase) of having a spontaneous abortion,” writes Dr. Anick Bérard, from the University of Montreal and the Director of the Research Unit on Medications and Pregnancy at CHU Ste-Justine. “We consistently saw that the risk of having a spontaneous abortion was associated with gestational use of diclofenac, naproxen, celecoxib, ibuprofen and rofecoxib alone or in combination, suggesting a class effect.”

Researchers made some interesting notes about this study.  First, studies are not entirely consistent.  This isn’t unusual, but it does indicate that further study is needed.

One of the possible reasons for the inconsistency is that some women may be taking NSAIDs for cramps that come before a miscarriage – in other words, other problems were already to blame, not the NSAIDs themselves.

That being said, in this study there did not seem to be a difference between taking the medication eary in the pregnancy and long before the miscarriage or right before the miscarriage.

Strengthening the case further, other studies have shown the same thing, and have also shown an increased risk of birth defects (congenital malformations).

Second, dosage didn’t seem to matter.  In other words, this isn’t only a danger for women taking especially high dosages.

However, researchers did think that the greatest danger was around the time of conception.  This study focused on women who took NSAIDs around the time of conception up to 20 weeks.

So what can we learn from this study, and where do we go from here?

  1. There is a significant risk to taking NSAIDs such as ibuprofen and naproxen during pregnancy.  This is a risk that varies from NSAID to NSAID and from person to person.  You need to talk with a doctor who knows your medical history – not simply buy something over the counter and take it.
  2. There may be a higher risk earlier in the pregnancy.  That doesn’t mean you should take the medications later on – it does mean that we need to research the reasons why this may be.  In this study, the researchers suggested some possibilities.  If we can confirm this and measure the risk, we may be able to get medications to women who are at low risk.

For more about taking drugs during pregnancy, particularly in the case of migraine, read Can Pregnant Migraineurs Take Drugs?

If you’d like to know more about this study – its methods and limitations, here are some resources:

Ibuprofen and Potassium Deficiency

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Can too much ibuprofen (in products such as Advil) cause potassium deficiency?  A new study suggests that it can, but only at very high doses.

Potassium deficiency (hypokalemia) is a condition that can be life threatening.  MedlinePlus has this to say about the condition:

A deficiency of potassium (hypokalemia) can happen in people with certain diseases or as a result of taking diuretics (water pills) for the treatment of high blood pressure or heart failure. Additionally, many medications — such as diuretics, laxatives, and steroids — can cause a loss of potassium, which occasionally may be very severe. You should have your blood levels of potassium checked from time to time if you take any of these medicines. Diuretics are probably the most common cause of hypokalemia.

Based on research at three hospitals in Australia, the series in the Medical Journal of Australia found four patients with potassium deficiency who were long term regular users of ibuprofen.  Lead researcher Dr Jennifer Ng expressed concern that ibuprofen alone or with codeine can become toxic.

But before you panic, you need to realize these patients were on very high doses of ibuprofen.  One patient, according to this article, was taking "fewer than 10 tablets per day".  One woman was taking 50 tablets per day

These are very high doses, and these patients should have been under a doctor’s constant care, including regular tests.

Be sure to check out this ibuprofen dosage information here.

For the average headache sufferer, any kind of regular ibuprofen consumption can be dangerous.  The earliest danger is rebound headache, or medication overuse headache.  You can soon find that, with regular ibuprofen, the occasional headache turns into regular chronic headache (as Kerrie reminded us here).

If you have regular headaches, please don’t just keep popping over-the-counter medication.  See your doctor.  Even taking over-the-counter medication a few times a month may cause more problems than it solves.

And if you’re taking even higher doses of ibuprofen, remember there can be more dangers than just potassium deficiency.

Tylenol and Advil for children

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One of the studies about children and migraine that was mentioned in the December 28 issue of Neurology compared ibuprofen and acetaminophen.  Ibuprofen was found to be effective, using the same dosage that you’ve already read about on our ibuprofen dosage page – 7.5-10mg per kg of body weight (that’s 2.2lbs).  Ibuprofen does have it’s problems, though, especially if used on a regular basis.  It’s always good to check with your doctor if you find your child needs ibuprofen often.

Acetaminophen was termed probably effective.  However, statistically it did reduce pain and was well tolerated by the children, in dosages of 15 mg/kg.  There has been some danger of acetaminophen overdose, because so many different medications for children contain it.  Be sure to read labels!

Be sure to read more about child migraines here, or general child headaches here.

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