Ibuprofen
Is It Right for You?
A complete guide to Ibuprofen — what it treats, how it works, dosages, side effects, and when a clinician may prescribe it following an online consultation.
What Is Ibuprofen?
Ibuprofen is a non-steroidal anti-inflammatory drug (NSAID) used to relieve pain, reduce inflammation, and lower fever. It is one of the most widely used medicines in the world and is available both over the counter in standard doses and on prescription in higher-strength formulations for the management of more significant pain and inflammatory conditions.
First developed in the 1960s by a team of pharmacologists at the Boots Company in Nottingham, ibuprofen was designed as a safer alternative to aspirin for the treatment of rheumatoid arthritis. It has since become one of the most extensively prescribed medications globally, valued for its efficacy across a broad spectrum of pain and inflammatory conditions, its relatively favourable safety profile compared to older NSAIDs at standard doses, and its versatility in available formulations.
Ibuprofen differs from paracetamol in a critical respect: while paracetamol is primarily an analgesic and antipyretic with minimal anti-inflammatory action, ibuprofen exerts genuine anti-inflammatory effects by targeting the biochemical pathways responsible for inflammation. This makes it particularly effective for conditions where inflammation is a significant component of symptoms, such as arthritis, sports injuries, and menstrual pain.
Ibuprofen is available in a wide range of formulations including standard tablets, modified-release capsules, oral suspension, topical gels and creams, and intravenous preparations for hospital use. It is suitable for adults and children from 3 months of age (in appropriate formulations and doses). It is available generically and under brand names including Nurofen, Brufen, and Calprofen.
Prescription-strength ibuprofen is available through The GP Service for patients requiring higher doses or longer-term management of inflammatory conditions.
What Conditions Is Ibuprofen Used For?
Ibuprofen is prescribed for a wide range of painful and inflammatory conditions:
headache, toothache, back pain, muscle aches, and general bodily pain.
reduces elevated body temperature in adults and children associated with infections, inflammatory conditions, and post-vaccination reactions.
one of the most effective analgesics for period pain due to its ability to reduce prostaglandin-driven uterine contractions.
strains, sprains, soft tissue injuries, and sports injuries where inflammation is a significant component.
reduces joint pain, swelling, and stiffness; used regularly or as needed depending on symptom severity.
reduces joint inflammation, pain, and stiffness; often used alongside disease-modifying antirheumatic drugs (DMARDs).
reduces spinal inflammation and pain; NSAIDs are a cornerstone of treatment for this condition.
reduces the intense joint inflammation and pain of acute gout attacks.
effective for migraine attacks, particularly when combined with an antiemetic such as metoclopramide.
used as part of multimodal pain management following surgery, often combined with paracetamol.
highly effective for the acute pain and inflammation of dental infections and post-extraction pain.
reduces fever and the aches and pains associated with upper respiratory tract infections.
high-dose ibuprofen is a first-line treatment for acute and recurrent pericarditis (inflammation of the membrane surrounding the heart).
intravenous ibuprofen is used in neonatal intensive care to close a persistent cardiac duct in premature infants.
Ibuprofen is contraindicated or requires particular caution in patients with a history of peptic ulcers, gastrointestinal bleeding, kidney disease, heart failure, or cardiovascular disease. It should be used at the lowest effective dose for the shortest necessary duration. A clinician will assess whether ibuprofen is appropriate for your specific circumstances.
How Does Ibuprofen Work?
Ibuprofen belongs to the non-steroidal anti-inflammatory drug (NSAID) class and exerts its analgesic, antipyretic, and anti-inflammatory effects primarily by inhibiting cyclooxygenase (COX) enzymes – specifically COX-1 and COX-2.
COX enzymes are responsible for converting arachidonic acid (a fatty acid released from cell membranes at sites of tissue damage) into prostaglandins, thromboxanes, and prostacyclins. Prostaglandins are key chemical mediators that:
- Sensitise pain receptors (nociceptors) to stimuli, lowering the pain threshold
- Promote the inflammatory response – causing vasodilation, increased vascular permeability, redness, swelling, and heat at injured sites
- Act on the hypothalamus to raise the body's temperature set-point, causing fever
- Play protective roles in the gastrointestinal tract (stimulating mucus production and bicarbonate secretion) and in maintaining renal blood flow
By inhibiting both COX-1 and COX-2, ibuprofen reduces prostaglandin synthesis at sites of inflammation and in the central nervous system, producing its analgesic, anti-inflammatory, and antipyretic effects simultaneously.
COX-1 is constitutively expressed throughout the body and produces prostaglandins that protect the gastric mucosa, support platelet aggregation, and maintain renal blood flow. Inhibition of COX-1 is responsible for the main adverse effects of ibuprofen – particularly gastrointestinal irritation, ulceration, and increased bleeding tendency.
COX-2 is primarily induced at sites of inflammation and injury. Its inhibition is primarily responsible for the therapeutic anti-inflammatory, analgesic, and antipyretic effects.
Ibuprofen inhibits both COX isoforms non-selectively but with greater relative affinity for COX-1. This means it provides effective anti-inflammatory and analgesic effects but carries a risk of gastrointestinal side effects that must be managed with appropriate precautions.
Dosages & Administration
The correct dose depends on the type and severity of infection, age, weight, and kidney function. Always follow your clinician's instructions. The table below is for general reference only.
Administration Tips
Always take ibuprofen with food, milk, or immediately after eating. This is one of the most important administration instructions for ibuprofen. Taking it on an empty stomach significantly increases the risk of gastric irritation, indigestion, and ulceration. Even if you are not hungry, eat a small amount of food before or alongside each dose.
Take with a full glass of water and remain upright for at least 30 minutes after taking.
Use the lowest effective dose for the shortest necessary time. The risks of gastrointestinal, cardiovascular, and renal side effects are dose-dependent and increase with duration of use. Do not routinely take the maximum dose if a lower dose provides adequate relief.
Ibuprofen and paracetamol can be taken together or alternated for more continuous pain relief. They work through different mechanisms and are safe to use simultaneously at their respective recommended doses. This approach is particularly effective for post-operative pain, dental pain, and fever management in children and adults.
Topical ibuprofen gels applied directly to affected joints or muscles cause less systemic absorption than oral ibuprofen, significantly reducing the risk of gastrointestinal and cardiovascular side effects. Topical ibuprofen is a preferred option for localised joint or muscle pain.
For children, always use the weight-appropriate formulation and the measuring syringe or spoon provided. Do not use household spoons or adult tablets.
Side Effects of Ibuprofen
Ibuprofen is well tolerated at standard doses for short-term use. Gastrointestinal side effects are the most common. Risk of serious adverse effects increases substantially with higher doses, prolonged use, and in patients with risk factors.
- Nausea
- Indigestion and heartburn
- Abdominal pain or discomfort
- Diarrhoea or constipation
- Flatulence
- Dizziness or headache (paradoxically in some patients)
- Mild fluid retention
- Gastrointestinal ulceration and bleeding – one of the most serious risks of NSAID use; symptoms include severe abdominal pain, vomiting blood (haematemesis), or black tarry stools (melaena); can occur without warning symptoms, particularly in elderly patients
- Cardiovascular events – increased risk of heart attack (myocardial infarction) and stroke with regular use, particularly at high doses or in patients with pre-existing cardiovascular disease
- Acute kidney injury – reduced renal blood flow leading to kidney impairment, particularly in dehydrated patients, elderly patients, or those with pre-existing kidney disease
- Severe allergic reaction – hives, facial or throat swelling, difficulty breathing, collapse; ibuprofen is one of the most common causes of drug-induced anaphylaxis
- Bronchospasm – in aspirin-sensitive patients with asthma, ibuprofen can trigger severe bronchospasm and respiratory distress
- Heart failure exacerbation – fluid retention caused by ibuprofen can precipitate or worsen heart failure
- Severe skin reactions – Stevens-Johnson Syndrome or Toxic Epidermal Necrolysis; rare but serious
- Hepatotoxicity – rare; jaundice, dark urine, severe fatigue
Approximately 10–20% of adult asthma patients have aspirin-exacerbated respiratory disease (AERD), also known as aspirin-sensitive asthma. In these patients, NSAIDs including ibuprofen can trigger severe and potentially life-threatening bronchospasm. Patients with asthma should discuss with their clinician whether ibuprofen is safe for them to use before taking it.
Drug Interactions
Always disclose all prescription drugs, over-the-counter medicines, vitamins, and supplements to your clinician or pharmacist before taking prescription ibuprofen.
Ibuprofen enhances the anticoagulant effect of warfarin and significantly increases bleeding risk through both pharmacokinetic and pharmacodynamic mechanisms – inhibiting platelet aggregation and potentially causing gastrointestinal ulceration. This combination should be avoided where possible. If necessary, use the lowest effective ibuprofen dose for the shortest duration with close INR monitoring.
Combining ibuprofen with other NSAIDs or high-dose aspirin dramatically increases the risk of gastrointestinal ulceration and bleeding. This combination must be avoided. Importantly, ibuprofen can block the antiplatelet effect of low-dose aspirin when taken concurrently – patients on low-dose aspirin for cardiovascular protection should take aspirin at least 30 minutes before ibuprofen to preserve its antiplatelet activity, or consult their clinician about alternative analgesics.
The combination of an NSAID with an ACE inhibitor or ARB and a diuretic – known as the "triple whammy" combination – is associated with a substantially increased risk of acute kidney injury. This combination should be avoided where possible, particularly in elderly patients and those with pre-existing kidney disease.
NSAIDs cause sodium and water retention and can reduce the effectiveness of most antihypertensive medications including ACE inhibitors, ARBs, beta-blockers, and diuretics. Regular NSAID use in hypertensive patients may require blood pressure monitoring and medication adjustment.
Ibuprofen reduces renal lithium excretion, potentially raising lithium blood levels to toxic concentrations. Lithium toxicity can cause tremor, confusion, seizures, and cardiac arrhythmias. Lithium levels must be monitored if ibuprofen is prescribed in patients on lithium.
Ibuprofen reduces the renal excretion of methotrexate and may increase its plasma protein binding displacement, leading to potentially toxic methotrexate blood levels. This combination requires careful monitoring of methotrexate levels and renal function.
Combining ibuprofen with SSRIs or SNRIs significantly increases the risk of gastrointestinal bleeding, as both reduce platelet aggregation through different mechanisms. A proton pump inhibitor should be co-prescribed if this combination is necessary.
Concurrent use of ibuprofen with corticosteroids substantially increases the risk of gastrointestinal ulceration and bleeding. This combination should be avoided where possible; if necessary, gastroprotection with a PPI is essential.
Ibuprofen can increase ciclosporin and tacrolimus nephrotoxicity, raising the risk of kidney damage in transplant patients. This combination should be used with extreme caution and close renal monitoring.
No significant adverse interaction. Paracetamol and ibuprofen can be safely taken together or alternated for enhanced pain relief.
Important Warnings
NSAIDs including ibuprofen are one of the most common causes of drug-induced gastrointestinal bleeding in the UK. Bleeding can occur even in patients without a prior history of ulcers, can develop rapidly, and may present without warning symptoms – particularly in elderly patients. Risk factors include age over 65, previous ulcer history, concurrent anticoagulant or corticosteroid use, high doses, and prolonged treatment. Always take ibuprofen with food, use the lowest effective dose for the shortest time, and consider a PPI for gastroprotection if you have significant risk factors. Seek immediate medical attention if you develop severe abdominal pain, vomit blood, or notice black or tarry stools.
All non-selective NSAIDs including ibuprofen increase the risk of serious cardiovascular events – including heart attack and stroke – particularly with high doses and prolonged use. Risk is higher in patients with established cardiovascular disease, hypertension, or multiple cardiovascular risk factors. The lowest effective dose for the shortest necessary duration minimises this risk. Ibuprofen should be avoided in patients with severe heart failure. Seek immediate emergency help if chest pain, sudden weakness, or speech difficulty develops during ibuprofen treatment.
Ibuprofen reduces prostaglandin-mediated renal vasodilation and can cause clinically significant acute kidney injury, particularly in situations of reduced renal perfusion – including dehydration, vomiting, diarrhoea, blood loss, and in patients with pre-existing kidney disease, heart failure, or liver cirrhosis. Ibuprofen should be stopped during illness involving vomiting or diarrhoea, or when the patient is unable to drink adequate fluids ("sick day rules"). Contact a clinician promptly if you notice significantly reduced urine output, ankle swelling, or breathlessness during ibuprofen treatment.
Ibuprofen can trigger bronchospasm in patients with aspirin-sensitive asthma, potentially causing life-threatening respiratory distress. Patients with asthma, particularly those who have previously reacted to aspirin or NSAIDs, should avoid ibuprofen unless confirmed safe by their clinician.
Ibuprofen should be avoided during pregnancy, particularly from 20 weeks onwards. Use in the second and third trimesters has been associated with premature closure of the ductus arteriosus (a critical fetal blood vessel), oligohydramnios (reduced amniotic fluid), and neonatal renal impairment. Paracetamol is the preferred analgesic throughout pregnancy. If ibuprofen must be used before 20 weeks, it should be at the lowest dose for the shortest possible duration under medical supervision.
Elderly patients are at significantly higher risk of all serious adverse effects of ibuprofen – including gastrointestinal bleeding, cardiovascular events, and acute kidney injury. The lowest possible dose should be used for the shortest duration. Topical ibuprofen gel is often a preferable alternative for localised pain in older patients. Regular use of oral ibuprofen in the elderly should be reviewed by a clinician.
Ibuprofen should not be given to patients with chickenpox. There is evidence of an association between NSAID use during varicella infection and an increased risk of serious skin and soft tissue complications including necrotising fasciitis. Paracetamol is the preferred antipyretic and analgesic in patients with chickenpox.
Speak to a Clinician About Treatment
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The treatment you need, when you need it.
Ibuprofen FAQs
Yes. A licensed clinician can assess your symptoms and medical history via a telehealth consultation and prescribe higher-strength ibuprofen if it is clinically appropriate. Standard doses are available over the counter, but prescription-strength formulations (up to 800 mg) and longer-term prescriptions require a clinician assessment. Prescriptions are typically sent to your preferred pharmacy the same day.
Ibuprofen is absorbed rapidly and typically begins to take effect within 20 to 30 minutes of an oral dose, with peak analgesic effect reached within 1 to 2 hours. Modified-release formulations have a slower onset but provide more prolonged pain relief. Topical ibuprofen gels take longer to produce effects – typically 1 to 2 hours – but provide more sustained local action.
Paracetamol is primarily an analgesic and antipyretic that acts mainly within the central nervous system. It has minimal anti-inflammatory effect and is generally gentler on the stomach. Ibuprofen is an NSAID that reduces pain, fever, and inflammation by blocking prostaglandin production throughout the body. It is more effective than paracetamol for conditions with a significant inflammatory component – such as arthritis, sports injuries, dental infections, and menstrual pain – but carries greater risks of gastrointestinal, cardiovascular, and renal side effects. For many types of pain, taking both together provides superior analgesia to either alone.
Yes. Ibuprofen and paracetamol work through different mechanisms and can be taken simultaneously at their respective recommended doses, or alternated to provide more continuous pain relief throughout the day. This approach is well established and commonly recommended for post-operative pain, dental pain, and childhood fever management.
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Not always. Approximately 10 to 20% of people with asthma have aspirin-exacerbated respiratory disease (AERD), in which NSAIDs including ibuprofen trigger bronchospasm. If you have asthma and have never taken ibuprofen before, discuss with your clinician or pharmacist before using it. If you have previously taken ibuprofen without breathing difficulties, it is likely safe for you to continue.
Ibuprofen is generally contraindicated in patients with active peptic ulcer disease or a significant history of gastrointestinal bleeding due to the risk of further ulceration and haemorrhage. If ibuprofen is considered necessary for your condition despite this history, your clinician may co-prescribe a proton pump inhibitor (PPI) such as esomeprazole for gastroprotection. Paracetamol is generally the safer analgesic alternative for patients with ulcer disease.
Ibuprofen reduces prostaglandin-mediated renal blood flow, which in healthy individuals at standard doses and short-term use has minimal clinical significance. However, in patients who are dehydrated, have pre-existing kidney disease, heart failure, or liver disease, or who are taking other nephrotoxic drugs, ibuprofen can cause significant acute kidney injury. Always stay well hydrated when taking ibuprofen and stop it during illness involving vomiting or diarrhoea.
Yes. Regular ibuprofen use can raise blood pressure by causing sodium and water retention and reducing the effectiveness of antihypertensive medications. Patients with hypertension who use ibuprofen regularly should have their blood pressure monitored more closely and may require medication adjustment. Paracetamol is generally a safer analgesic for patients with hypertension who need regular pain relief.
Ibuprofen should be avoided during pregnancy, particularly from 20 weeks onwards. Paracetamol is the recommended analgesic and antipyretic throughout pregnancy. If pain relief is needed during pregnancy, always consult your clinician before taking ibuprofen.
Contact your nearest A&E or call NHS 111 for advice even if you feel well. Ibuprofen overdose can cause serious gastrointestinal, renal, and neurological effects. In severe cases, it can cause metabolic acidosis, seizures, and kidney failure. Always keep ibuprofen out of reach of children and store in the original container.