NSAIDs · Pain & inflammation
Ibuprofen
Advil® · Motrin®(brand names vary by market)
The everyday NSAID, and pharmacy's most instructive over-the-counter risk profile.
Also: capsule, oral liquid, topical
Mechanism
Non-selective COX-1/COX-2 inhibitor: less prostaglandin means less pain, fever, and inflammation, and less gastric mucosal defense, renal perfusion support, and platelet function.
Indications
- Mild-moderate pain
- Fever
- Inflammatory conditions
Formulations
Dosing concepts
Lowest, shortest
The NSAID rule: lowest effective dose, shortest necessary duration; risk accumulates with dose and time.
Who should not
The counter conversation: kidneys, ulcers, anticoagulants, heart failure, third-trimester pregnancy, and the triple-whammy combination.
Concepts, not prescribing instructions. Practice numbers live in current references and local protocols.
Pharmacokinetics
- Bioavailability
- ~80-100%
- Half-life
- ~2 h
- Elimination
- hepatic
Adverse effects
- Dyspepsiacommon
- GI ulceration and bleedingserious
- Acute kidney injury (hemodynamic)serious
- Blood pressure elevation, fluid retentioncommon
- Cardiovascular thrombotic risk with sustained useserious
Contraindications & precautions
Contraindications
- Active GI bleeding or ulcer
- Third trimester of pregnancy
- Severe heart failure
- Post-CABG pain
Precautions
- CKD
- Anticoagulants and SSRIs
- RAAS blockade plus diuretic
- Asthma with aspirin sensitivity
- Older age
Interactions
- Warfarin + NSAIDs (e.g. ibuprofen, naproxen)avoidMajor GI bleeding risk multiplies while the INR looks reassuring.
- ACE inhibitor / ARB + diuretic + NSAID (the 'triple whammy')avoidAcute kidney injury, classically in a dehydrated older adult who bought ibuprofen for a sore knee.
- SSRIs + NSAIDs / anticoagulantsmonitorUpper GI bleeding risk roughly doubles versus either alone.
- NSAIDs + LithiumcautionLithium rise within days of regular NSAID use.
- NSAIDs + Methotrexate (especially high-dose)cautionMethotrexate toxicity: mucositis, cytopenias, renal injury (chiefly with high-dose oncology regimens).
Monitoring
Blood pressure with regular use
NSAIDs quietly undo antihypertensives
Renal function in at-risk users
Hemodynamic AKI is dose- and context-dependent
GI symptoms, black stools
Bleeding announces late
Counselling points
- Take with food; use the lowest dose that works for the shortest time.
- Check with us before regular use if you have kidney, stomach, heart, or blood-pressure problems, or take blood thinners.
- Black stools or coffee-ground vomit are emergencies.
Clinical pearls
- Topical NSAIDs achieve meaningful local effect with a fraction of the systemic exposure. The deprescriber's friend in osteoarthritis.
References & review
- Ibuprofen product monograph (consult the current version for your market) (monograph)
- Goodman & Gilman's The Pharmacological Basis of Therapeutics, 14th ed. (reference-work)
Last reviewed 2026-08-15 · jurisdiction: global · drug information changes; verify against current references before practice use.