Ibuprofen: uses, side effects and who should avoid it

The NHS places ibuprofen among the non-steroidal anti-inflammatory drugs and lists headaches and migraines, joint and muscle pain, pain after an injury, toothache and period pain as typical uses. It can also reduce a high temperature.

The same page makes a point that is easy to miss: ibuprofen can cause more side effects than paracetamol, so if paracetamol is suitable for you it is sensible to try that first.

Ibuprofen comes as tablets and capsules, liquid, granules to mix with water, and gels or sprays. Strength matters more than brand, so read how much ibuprofen each tablet contains. Some products behave differently, such as tablets that dissolve on the tongue and long-lasting capsules taken less often.

Gel and spray users should avoid eyes, mouth and broken skin, wash their hands afterwards and wait at least 4 hours between applications, with no more than 4 applications in 24 hours. The NHS also warns not to smoke or go near naked flames, because clothing that has touched gel or spray can burn more easily. Side effects are less likely with gel or spray than with tablets.

Common effects of tablets, capsules, liquid and granules are indigestion, stomach ache, nausea, vomiting, headache, rash, dizziness, and diarrhoea or constipation. Taking tablets with or after food can help the stomach. If a side effect bothers you or will not go away, the NHS suggests speaking to a pharmacist or doctor.

Serious problems are less common and more likely with high doses or long use. The NHS describes stomach ulcers or bleeding (tummy pain, breathlessness, pale skin, vomiting blood, or black sticky tar-like stools), an allergic reaction with a swollen throat or tongue, and kidney problems with breathlessness, blood in the urine or swollen ankles, feet or hands. Those need urgent medical help.

• Black, tarry stools or vomiting blood: seek urgent care.

• Swollen lips, tongue or throat, or difficulty breathing: call 999.

• Swelling in ankles, feet or hands with blood in your urine: get medical advice promptly.

The NHS says ibuprofen may be unsuitable if you have had an allergic reaction to ibuprofen, aspirin or another NSAID; have or have had a stomach ulcer; have asthma or allergies such as hay fever; have chickenpox; have a heart, liver or kidney condition; have a blood clotting problem; have had a stroke; or are pregnant or trying to get pregnant.

That list is a prompt to check rather than a diagnosis. A pharmacist can look at your medicines and conditions together and say whether a different painkiller is a better fit.

During pregnancy the NHS says to avoid ibuprofen unless a doctor or pharmacist advises it, and names paracetamol as the usual choice. While breastfeeding, check with a pharmacist or doctor first; paracetamol is usually the best option, but ibuprofen can often be used when needed. Gel or spray users should use the smallest area they can and keep the baby away from treated skin.

Some medicines may not mix well with ibuprofen, including certain blood thinners such as warfarin, steroid medicines, antidepressants and blood pressure medicines. It can be taken with paracetamol, but not with other NSAIDs. On alcohol, the NHS says you can drink normally but should avoid heavy drinking because it raises the risk of side effects.

Ibuprofen will not usually affect driving, cycling or machinery, but if it makes you dizzy wait until that passes. The NHS says to use the smallest dose for the shortest time, and not to take tablets or capsules beyond 10 days without a doctor.

Pain that gets worse or does not go away is a reason to see a GP. Taking an extra dose is unlikely to cause problems, but the NHS says to get medical advice if you take more than the packet allows, and to take the packaging with you if you are sent to A&E.