What does too much ibuprofen do to your liver

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Last reviewed on: 2/12/2021

Reviewed by: Jesse Borke, MD, CPE, FAAEM, FACEP, Attending Physician at Kaiser Permanente, Orange County, CA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

If you pull a muscle while running, are experiencing menstrual cramps or have a killer headache, you’re likely to reach for an ibuprofen pill, such as Advil or Motrin, to reduce the inflammation and quash the pain. When taken correctly, ibuprofen is a safe and effective choice.

Available both over-the-counter and by prescription, ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that inhibits cyclooxygenase enzymes to prevent or reduce pain and inflammation.

While ibuprofen works well when you take it as directed, taking more of the medicine or taking it too often is not helpful and can actually hurt you, says gastroenterologist Gerard Isenberg, MD.

“People who take it chronically are at risk of developing problems," he says. "A recent study showed that incorrect use of NSAIDs is estimated to account for 107,000 hospitalizations and 15,600 deaths annually in the United States.”

Risks of Incorrect Ibuprofen Use

Among the risks of chronic or incorrect ibuprofen use are:

• Ulcers, with an annual incidence of 2 to 4 percent
• Worsening kidney function
• Cardiovascular issues, such as heart attack, heart failure, stroke and increased blood pressure
• Gastrointestinal bleeding
• Stomach upset and - rarely - a condition called microscopic colitis, which can cause diarrhea
• Nausea
• Complications with childbirth and in the newborn, when the mother takes ibuprofen during the third trimester (but ibuprofen use is fine when breastfeeding)

Ibuprofen is an appropriate option for most people, but Dr. Isenberg says it can cause these complications when:

• Used by someone who has liver disease
• Taken with another NSAID, such as aspirin
• Taken with a blood thinner, such as Coumadin
• Taken with other medications, such as clopidogrel, phenytoin or cyclosporine
• Dosing instructions are ignored (i.e., taking too many at a time or taking subsequent doses too soon)
• Used during the third trimester of pregnancy

If you choose to take ibuprofen to help you through an injury or other painful condition, Dr. Isenberg says you can mitigate your risk of developing side effects by following these five guidelines:

1. Take the lowest dose that is effective for your symptoms.
2. Consult your doctor before taking ibuprofen if you have a history of stomach, kidney or heart issues, or if you are pregnant.
3. Ask your doctor about using a topical NSAID gel, such as Diclofenac, instead of oral ibuprofen for musculoskeletal pain. This gel, available in a patch, is a good choice for athletes.
4. Consider taking something to reduce acid when taking ibuprofen. Check with your doctor and/or pharmacist to make sure you're not on other medications that can increase your chance for side effects.
5. Ask your physician whether ibuprofen or another NSAID best treats your symptoms and has the fewest potential side effects.

“Ibuprofen is one of the most commonly used meds in the United States,” Dr. Isenberg says. “It has many therapeutic benefits and, despite some of the risks, a very strong safety profile. You just need to be cognizant of how much you use, for how long and whether you have any issues that could cause an increased risk of side effects.”

Gerard Isenberg, MD is a gastroenterologist and associate chief and director, Clinical Operations, Division of Gastroenterology and Liver Disease, and chief medical quality officer, University Hospitals Digestive Health Institute, at University Hospitals Cleveland Medical Center. You can request an appointment with Dr. Isenberg or any other medical provider online.

If you take more than the recommended dose, you could overdose. Call an ambulance straight away by dialling triple zero (000) if you or someone else has any of these symptoms (ambulance officers don’t need to involve the police):

• confusion and disorientation
• drowsiness
• abdominal pain
• blurred vision
• tinnitus (ringing in the ears)
• diarrhea
• anxiety and paranoia
• anaemia (low red blood cell count), nausea and vomiting
• vomiting blood that may look like coffee grounds and bowel motions that look like black tar
• severe allergic reaction, including swelling of the face
• kidney and liver problems
• seizures/convulsions
• coma and death.1, 13, 4

Long-term effects

It’s best to discuss the side effects of long-term use with a medical practitioner. Regular use of ibuprofen may eventually cause:

• anaemia due to bleeding in the stomach
• impaired hearing
• kidney and liver damage
• bleeding in the stomach and bowels
• increased risk of heart attack.1

Mixing ibuprofen with other drugs

The effects of taking ibuprofen with other drugs, including alcohol, prescription medications and other over-the-counter medicines, can be unpredictable and dangerous.

Ibuprofen taken with alcohol can increase the risk of stomach irritation and discomfort.1

Ibuprofen can alter the effects of some blood pressure medicines and may increase the risk of bleeding if taken with medicines such as warfarin.1

Use of more than one drug or type of drug consumed at the same time is called polydrug use.

More on Polydrug use

‘Polydrug use’ is a term for the use of more than one drug or type of drug at the same time, or one after another5. Polydrug use can involve both illicit drug and legal substances, such as alcohol and medications.5

Getting help

If your use of ibuprofen is affecting your health, family, relationships, work, school, financial or other life situations, you can find help and support.

Call 1300 85 85 84 to speak to a real person and get answers to your questions as well as advice on practical ‘next steps’.

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