Is it true that ibuprofen, a common household medicine, has serious side effects and should not be used?

Real points:

Nonsteroidal anti-inflammatory drugs do have some adverse reactions, but ibuprofen is one of the relatively milder adverse reactions and is still very safe when used in normal usage and dosage.

Verifier: Xie Wangshi | Master of Pharmacology, Zhibei Pediatric Pharmacist

As one of the most widely used drugs in the world in the past 50 years, I believe everyone is familiar with the drug "Ibuprofen". The most common problems such as headaches, fever, tooth extraction, and dysmenorrhea can be solved with ibuprofen. According to statistics, 30 million people use ibuprofen every day around the world. And as new functions of ibuprofen are constantly discovered, the number of people using it is still increasing.

However, even though such a drug has been used for such a long time and has been used by so many people, it has been reported from time to time in recent years that it has many side effects. For example, it can cause severe gastrointestinal reactions, lead to gastric ulcers, gastric bleeding, and increase the risk of cardiovascular disease... Various claims have discouraged many people from taking it. Rumors always spread faster than the truth, but what is the truth? Are the adverse reactions of ibuprofen really a disaster?

1. Nonsteroidal anti-inflammatory drugs achieve antipyretic and analgesic effects by inhibiting key enzymes in the synthesis of prostaglandins, but they cannot distinguish between "good enzymes" that neutralize gastric acid and "bad enzymes" that promote inflammation.

We know that ibuprofen is a "non-steroidal anti-inflammatory drug". To clarify this issue, we first need to understand what "non-steroidal anti-inflammatory drugs (NSAIDs)" are. The so-called steroid refers to "steroid hormone drugs". Non-steroidal drugs actually have similar effects to steroid hormones, but their structures are not similar to them. Dozens of non-steroidal anti-inflammatory drugs have been discovered so far. The ones we are more familiar with are mainly ibuprofen, aspirin, naproxen, celecoxib, etc.

When a person is sick, injured, or has dysmenorrhea, the body will secrete a lot of prostaglandins, causing pain, edema, and fever. Nonsteroidal anti-inflammatory drugs can inhibit the synthesis of prostaglandins by inhibiting the key enzymes that synthesize prostaglandins, thereby achieving antipyretic and analgesic effects. This key enzyme is mainly divided into two types, cyclooxygenase 1 (COX-1) and cyclooxygenase 2 (COX-2).

The two enzymes can be simply divided into two categories: COX-1 is a good enzyme. In the gastric wall tissue, COX-1 can produce prostaglandins, promote gastric wall blood flow, secrete mucus and bicarbonate to neutralize gastric acid, protect the gastric mucosa from damage, and maintain gastric function. COX-2 is a bad enzyme that can promote the body's inflammatory response.

Normally, we can inhibit the COX-2 enzyme alone. However, drug research, development, and evaluation are often multifaceted, and some drugs are inevitably lacking in selectivity. If the drug has an effect on both enzymes, long-term use may reduce the production of gastric mucus and bicarbonate, causing the gastric mucosa to lose protection and be damaged, leading to adverse reactions such as gastric ulcers.

Ibuprofen happens to be a drug with low selectivity. It has an inhibitory effect on both COX-1 and COX-2. Does that mean that ibuprofen can cause gastrointestinal reactions such as gastric ulcers? Not really. It is true that nonsteroidal anti-inflammatory drugs have these adverse reactions, but ibuprofen behaves differently. While ensuring excellent efficacy, the adverse reactions are relatively low and very controllable.

2. NSAIDs do have some adverse reactions, but ibuprofen is one of the relatively milder adverse reactions.

Researchers have analyzed data from the past few decades and summarized the following table. The upper part of the figure represents the selectivity of the drug for the two enzymes. The selectivity is better towards the ends, and ibuprofen is in the middle. The lower part of the figure represents the gastrointestinal disease risk and cardiovascular disease risk of the drug. It can be seen from the figure that the lower the cardiovascular risk, the higher the gastrointestinal risk, and vice versa.

Selectivity of nonsteroidal anti-inflammatory drugs for COX and cardiovascular and gastrointestinal risks

Ibuprofen is right in the middle where the two lines intersect, which means it belongs to the two drugs with a lower comprehensive risk assessment. If viewed alone, the most common adverse reactions of ibuprofen are diarrhea, nausea, and vomiting, but serious adverse reactions such as gastritis, gastric ulcer, peptic ulcer, gastric bleeding, heart failure, etc. are very rare.

In other words, ibuprofen is a non-steroidal anti-inflammatory drug that can achieve medicinal effects without causing serious adverse reactions.

Furthermore, ibuprofen is usually used for no more than 3 days to reduce fever and no more than 5 days to relieve pain. If symptoms have not been relieved after these days, it does not mean that the drug cannot be used, but it is necessary to re-evaluate the condition. This also avoids the possibility of long-term use of ibuprofen, and the possibility of serious adverse reactions is further reduced, which is similar to the risk of placebo.

3. There are some things to be aware of when using ibuprofen, but it is generally safe

Some people may worry that they often suffer from migraines and dysmenorrhea, and have to take ibuprofen from time to time. Will this increase the possibility of gastrointestinal damage?

In fact, this probability is very small. Generally speaking, as long as there are no risk factors below, you don’t have to worry too much and can use it with confidence:

1. Currently taking other drugs, such as aspirin, antiplatelet drugs, anticoagulants, hormone drugs, SSRI antidepressants;

2. Helicobacter pylori infection or other serious diseases;

3. Age ≥ 65 years old;

4. History of peptic ulcer;

5. Combination use of two or more nonsteroidal anti-inflammatory drugs;

6. Smoking and drinking.

Patient factors that increase the risk of gastrointestinal complications with NSAID use

Of course, if you really need to use several NSAIDs together, it is not impossible. For example, as can be seen from the list at the bottom of the above figure, the gastrointestinal relative risk (RR) of ibuprofen and celecoxib is below 2, which is the lowest among NSAIDs. If these two drugs are used together, it will be a good choice for people who need long-term medication, such as arthritis patients.

Long-term use of ibuprofen (more than 3 months) increases the risk of ulcers, but overall it is not very common. In the adult world, it is no longer a choice, but a weighing of pros and cons. If you really have to use the drug for such a long time, it is not a bad choice to make it for the sake of your condition.

In general, ibuprofen is very safe and there is no problem using it under normal usage and dosage. If you have the risk factors mentioned above, it is recommended that you ask a professional pharmacist or doctor to evaluate and guide your use.

In addition, it is interesting that in the process of writing this article, the author found that many people who unreasonably criticized ibuprofen often had their own purposes. They might be selling brown sugar, recommending drinking brown sugar water to treat dysmenorrhea; or they might be selling ginger products, advocating the naturalness of ginger, and recommending ginger products to treat colds or pain.

In fact, these methods have long been proven to be ineffective. The reason why a drug is a drug is that it is effective and safe. If it is ineffective, no matter how safe it is, there is no need to use it, not to mention those products that have not been tested by time and clinically. I hope that everyone will keep their eyes open when encountering similar situations in the future to avoid being deceived.

Editor of this article: Zoey