Ibuprofen is one of the most common over-the-counter (OTC) medications used to treat pain, inflammation, and fever. It’s been around for nearly 50 years.
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID), and works by blocking cyclooxygenase (COX) enzyme activity. COX activity is responsible for prostaglandin production.
Whether ibuprofen is safe to take on an empty stomach really depends on the individual and certain risk factors.
Let’s take a closer look at the best way to take ibuprofen to improve symptoms while minimizing risks.
Ibuprofen has a low risk of causing severe gastrointestinal (GI) side effects overall. However, risks do exist and depend on a person’s age, length of use, dosage, and any existing health concerns.
Ibuprofen can affect prostaglandin levels and cause GI side effects. One function of prostaglandin is its stomach protection. It reduces stomach acid and increases mucus production.
When ibuprofen is taken in large doses or for a long time, less prostaglandin is produced. This can increase stomach acid and irritate the stomach lining, causing problems.
GI side effects can depend on several factors, including:
- Length of use. When taking ibuprofen for a long time, risks of GI-related problems increase, as compared to short-term use for immediate needs.
- Dose. Taking higher doses for long periods of time increases the risks of GI-related problems.
- Other health conditions. Having certain health conditions, such as the following, can increase risks of side effects or adverse reactions:
- history of GI complaints
- bleeding ulcers
- chronic inflammatory bowel disease
- Individual factors. Older people have a higher risk of GI and other side effects with ibuprofen use.
- Be sure to discuss ibuprofen’s benefits versus any risks with your doctor before taking this medication.
- If you have heart, kidney, high blood pressure, or other chronic medical conditions, ask your doctor about ibuprofen use.
There are two distinct types of COX, and they have different effects on the body. COX-2, when activated, blocks prostaglandin release in response to pain, fever, and inflammation. COX-1 has a protective effect on the stomach lining and surrounding cells.
Ibuprofen affects both COX-1 and COX-2 activity, providing symptom relief and at the same time increasing risks of certain side effects.
When you take a medication can make a difference with absorption, effectiveness, and side effects. This includes taking it with food or on an empty stomach.
One of the challenges with ibuprofen is that when you take it orally, it doesn’t absorb quickly. It takes around 30 minutes to work. This matters when you want immediate pain relief.
Ibuprofen can cause several GI side effects, including:
- ulcer
- heartburn
- nausea and vomiting
- bleeding
- tear in the stomach, small intestine, or large intestine
- diarrhea
- constipation
- cramps
- feeling of fullness
- bloating
- gas
Upper and lower GI risks must be considered before using ibuprofen. Ibuprofen is not recommended if there’s a lower GI risk, even with proton pump inhibitor medications like Nexium as protection.
Risks of GI side effects are higher with:
- people over 65, as the risk of GI bleeding quadruples
- history of indigestion or heartburn
- use of corticosteroids, anticoagulants like warfarin (Coumadin), selective serotonin reuptake inhibitors (SSRIs) like sertraline (Zoloft), antiplatelets like aspirin or clopidogrel (Plavix)
- peptic ulcer or ulcer-related bleeding
- alcohol use, as it can irritate the stomach lining, and using ibuprofen with alcohol can increase the risks of bleeding in the stomach
Remember, some medications interact with ibuprofen and health conditions. Be sure to discuss the best options to lower your risk of GI problems with your doctor first.
If you experience mild symptoms of stomach upset, certain protective medications might help:
- A magnesium-based antacid can help with mild symptoms of heartburn or acid reflux. Avoid taking aluminum-based antacids with ibuprofen, as they interfere with ibuprofen absorption.
- A proton pump inhibitor such as esomeprazole (Nexium) can help with acid reflux. Be sure to check with your pharmacist about any side effects or drug interaction.
Caution: Don’t take multiple types of acid reducers at the same time. If your symptoms don’t improve or get worse, talk to your doctor.
The best way to take ibuprofen depends on your age and risk factors. Studies show taking ibuprofen with a stomach protectant such as a PPI is an effective way to avoid peptic ulcers, if you’re taking it in higher doses for a long time.
If you’re taking ibuprofen for temporary pain relief and have no risk factors, you may be able to take it on an empty stomach to get faster symptom improvement. A protectant containing magnesium may help with faster relief.
It’s important to seek medical attention right away if you:
- have black tarry stools
- are vomiting blood
- have severe stomach pain
- have persistent nausea and vomiting
- have blood in your urine
- have chest pain
- have trouble with breathing
IF you have an allergic reactionCall 911 right away if you experience:
- rash
- swelling of face, tongue, throat, or lips
- difficulty breathing
- wheezing
Gastrointestinal side effects are the most common problem reported with ibuprofen. It’s important to understand serious or severe GI problems, such as bleeding, can happen without any warning signs.
Be sure to discuss your history of GI-related concerns with your healthcare provider before taking ibuprofen on your own. If you’re pregnant, talk to your doctor before taking ibuprofen.
In limited cases, for fast relief of pain symptoms, taking ibuprofen on an empty stomach may be fine. A magnesium-containing antacid may offer some protection and help provide faster relief.
For long-term use, it’s helpful to take a protectant to avoid GI side effects. In some cases, your doctor will choose a different medication option.