Making the most of OTC meds – ibuprofen

Ibuprofen is one of the first prescription drugs that moved to over-the-counter status approximately 25 years ago, the prescription drug being released about 10 years prior to that. In the USA, OTC ibuprofen is most commonly found in the 200 mg strength; prescription strengths are 400, 600, and 800, and are merely multiples of the OTC medicine.  Obviously, the OTC medicine could be used in higher dosing to fill prescription indications. Beware though: overdose can be fatal, from a variety of metabolic mechanisms – however, the only one I have seen is stomach/intestinal hemorrhage, as discussed further below.

The primary uses for ibuprofen are for arthritis, fever, and dysmenorrhea (painful periods).

The drug is probably used most commonly for osteoarthritis (though may be no better than acetaminophen/Tylenol for some patients). However, many patients experience excellent relief with 200-800 mg of ibuprofen, taken with food, up to 4 times daily (maximum 3200 mg), the higher dosing being prescription strength.  Because ibuprofen relieves inflammation, it is also effective for inflammatory arthritis such as rheumatoid, lupus, psoriatic arthritis, Sjogrens, gout, etc.

Other inflammatory conditions for which ibuprofen is often effective include: tendinitis, bursitis, inflamed muscles, bunions, pleurisy, pericarditis, and plantar fasciitis (heel spurs).

The pain of other, usually non-inflammatory conditions also respond to ibuprofen, including:

– tension headache, sinus headache, some migraine headaches

– earache, toothache, sore throat

– stiff neck, swollen neck glands

– chest pain due to costochondritis or rib fractures/contusions

– back strain, sometimes kidney stones, or hernia discomfort

– sacroiliac pain, hip pain, sciatica

– knee pain, knee sprain, ankle sprain, fractured arm/leg/finger/toe

Basically ibuprofen can help almost any sort of pain, at least to a degree EXCEPT for internal sorts of pain, such as stomach inflammation and intestinal irritation.

However, there are problems with using high dose (and often even low dose) ibuprofen, the most common of which is stomach or esophageal irritation. Really, anywhere along the GI tract, including the intestines, may experience irritation from ibuprofen or other NSAIDs, causing pain, bleeding, or both. When these symptoms occur, doctors usually recommend stopping the medication, which is generally the best advice.

Certain patients, though, for example, those with true rheumatoid arthritis, may need to take the drug to function adequately.  What can they do?

The most basic answer is to make absolute sure the drug is always, always, always taken with food (at least half a sandwich, not just a cracker). If this isn’t sufficient to prevent GI (stomach) distress, then taking a medication that lowers stomach acid production an hour prior to taking ibuprofen is advisable.  When Tagamet first came out, it was like a wonder drug, allowing many patients to tolerate ibuprofen and similar drugs (naproxen, aspirin, Indocin, salsalate, and others). Tagamet led to somewhat safer drugs, with fewer drug interactions and side-effects: Zantac, Pepcid, and Axid to start.  All these were initially prescription medications, but now are available at lower dose without a prescription.

Then came the next generation of stronger acid-lowering drugs, two of which are currently available OTC (Prilosec and Prevacid, and generics of both). Most patients can tolerate ibuprofen if taken correctly, and possibly with one of these acid-lowering drugs. However, middle-age and older patients may develop an ulcer from any anti-inflammatory drug, and may have no symptoms until bleeding occurs – so be careful.

(Largely because many patients are intolerant of chronic ibuprofen/NSAID administration, another class of anti-inflammatory drugs was developed, the Cox-2 inhibitors (Celebrex and Vioxx, the later now voluntarily withdrawn from the market due to heart conditions in some patients with prolonged administration). Celebrex, being prescription only, is much more difficult to stockpile, not to mention prohibitively expensive for most preppers.)

Another problem with ibuprofen is fluid retention, especially in the elderly, as well as disturbance of kidney function (a really bad thing). I would try to avoid ibuprofen in patients who develop swelling.

Related to fluid retention is elevation of blood pressure in certain patients. Anyone taking ibuprofen on a chronic basis should check their blood pressure periodically, and discontinue the drug if their pressure becomes too high.

Due to these last two side-effects, the drug could be used to raise blood pressure in a patient suffering symptoms of hypotension (low blood pressure). (I have never used it for this reason, however.) Generally speaking, it is better to correct the underlying cause of low blood pressure (dehydration, fluid loss, diarrhea, heart arrhythmia, etc.).

Many women experience painful or heavy periods. Ibuprofen can help both. Also, pregnant women taking ibuprofen are at an increased risk of miscarriage (about 2.4 times more likely).

One of the more important uses of ibuprofen at TEOTWAWKI is as a substitute for narcotics, either alone or in combination with Tylenol/acetaminophen.  Certain pains actually respond better to anti-inflammatory medicines than to narcotics.  I myself would save narcotics for truly unbearable pain that precludes functioning.  Full dose ibuprofen and full dose Tylenol may be used together if necessary, and as such, are generally as strong as Tylenol with Codeine, Vicodin, or Tramadol for most problems in most patients.

Some asthma patients will find ibuprofen causes them to wheeze. In a few patients it is photosensitizing (can make a person more likely to sunburn). Not uncommonly patients will complain of bruising.  Taking it with alcohol increases the risk of stomach bleeding.

Despite these risks, I would definitely recommend stockpiling ibuprofen for yourself, your family, your group, and your community. At $10 for 500-1000 generic tablets, it’s well worth it.

Perhaps some of our pediatric professionals would like to comment on the use of ibuprofen in children.

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About Cynthia J. Koelker, MD

CYNTHIA J KOELKER , MD is a board-certified family physician with over twenty years of clinical experience. A member of American Mensa, Dr. Koelker holds degrees in biology, humanities, medicine, and music from M.I.T., Case Western Reserve University School of Medicine, and the University of Akron. She served in the National Health Service Corps to finance her medical education.
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3 Responses to Making the most of OTC meds – ibuprofen

  1. Mojoron says:

    I recently read an article on MedPage about a study (I don’t remember where) that listed all of the non-steroidal drugs as to their relation to using as a anti-inflammatory and pain medication for patients who have heart disease. There was only one drug that was considered safe and that is Napracin. All the others, including high dose ASA, were not recommended. Ibuprofin was not to be given more than 1200 mgs per day over a long period of time. As you know, many people that take statins oftentimes have periodic muscle and joint pain due to the statins–a contraindication of sorts–and need to take an anti-inflammatory to improve their daily mobilization; often these patients are known heart patients. What are your suggestions on the use of non-steroidals and heart patients?

    • For any heart patient it is probably best not to take an anti-inflammatory (NSAID) daily for months and years at a time. That said, in over 20 years of practice, I’m not sure I’ve ever seen such a patient suffer a heart attack as a result of daily NSAID use.

      What I have seen, however, is plenty of patients with life-threatening GI bleeds, and a few with NSAID-related kidney failure. By far the biggest problem is stomach-related: ulcers, gastritis, irritation, heartburn, pain. For me, these are the reason I avoid long-term NSAIDs not only in heart patients, but ALL patients.

      – Doc Cindy

  2. Chris MD says:

    In Pediatrics we use ibuprofen for all the same things that adults do, at a dose of 5-10mg/kg. It is available in liquid form as well as more concentrated infant drops. We generally avoid use in infants under 6 mos of age, and minimize dosing due to concerns about renal toxicity, esp as kids seem more prone to this. Also there is concern about total lifetime exposure, another reason to use the lowest dose you can get away with.

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