Ibuprofen is one of the most commonly used drugs for treating pain, fever, and inflammation. However, its wide availability should not overshadow the fact that it is a medication with significant side effects and contraindications, especially when used improperly or without medical supervision. Dr. Julio Gómez, head of the Pain Unit at Vithas Las Palmas University Hospital and a specialist in Anesthesiology and Pain Management, sheds light on its use.
Regarding the practice of taking one and a half 400 mg tablets to reach the desired 600 mg dose, the specialist notes that while pharmacologically it might be equivalent if the tablet is scored and divisible, this practice should not be generalized or prolonged. The solution for persistent pain is not to increase the dose, but to review the diagnosis and treatment.
Modifying the dosage on one's own initiative can increase the risk of digestive bleeding, even without prior symptoms; cause deterioration of kidney function, especially in older or dehydrated individuals; raise the risk of cardiovascular events with high doses or prolonged treatments; and delay the diagnosis of diseases requiring a different therapeutic approach.
Ibuprofen should be used with particular caution in the elderly, hypertensive individuals, or those with chronic illnesses. It is formally contraindicated in cases of known allergy to ibuprofen or other non-steroidal anti-inflammatory drugs (NSAIDs), active peptic ulcer or recent history of digestive bleeding, severe renal insufficiency, decompensated heart failure, during the third trimester of pregnancy, and after recent cardiac surgery, emphasizes Dr. Gómez.
The most common side effects include digestive discomfort such as heartburn, epigastric pain, or nausea; fluid retention and edema; elevated blood pressure; and worsening kidney function in predisposed patients. Warning signs that necessitate stopping treatment and seeking immediate medical advice include black stools or vomiting blood, a marked decrease in urine output, sudden swelling of the legs or face, and intense abdominal pain.
To reduce the risks associated with ibuprofen, it is essential to use the lowest effective dose for the shortest possible duration, take it with food, avoid consumption with alcohol, do not combine multiple NSAIDs, and for longer treatments, consider the need for gastric protection under medical guidance.
Regarding alternatives, paracetamol is particularly indicated for mild to moderate pain and fever. Switching to another anti-inflammatory should only be done after professional advice. Non-pharmacological measures such as rest, local application of cold or heat, or physiotherapy can also be employed. If pain persists for more than a few days, a clinical re-evaluation is essential.
Ibuprofen notably interacts with anticoagulants and antiplatelet agents, increasing bleeding risk; with corticosteroids; with diuretics and blood pressure medications; and with drugs like lithium or methotrexate. Therefore, it should not be considered a 'harmless' drug simply because it is available over-the-counter, warns Dr. Julio Gómez.
For responsible use of over-the-counter medications, it is advisable to always read the leaflet, respect the indicated doses and intervals, avoid prolonged self-medication, consult a pharmacist or doctor with any doubts, and remember that relieving a symptom does not always equate to treating the cause of the problem. In many cases, 400 mg can be as effective as 600 mg with fewer adverse effects. For pain or fever, ibuprofen should not be taken for more than 3 to 5 days without consultation. In children and adolescents, the dose must be strictly adjusted to body weight, never age, and avoided in cases of dehydration.
Ibuprofen is a useful and effective medication, but its responsible use is essential to avoid unnecessary risks. Consulting healthcare professionals is always the best guarantee of safety, concludes Dr. Julio Gómez.
