How Much Advil Is Too Much?

Q: I take Advil pretty regularly for pain, but how can I tell if I’m taking more than is safe?

Headaches. Fevers. Period cramps. Back pain.

These are all symptoms that can be treated with ibuprofen, a drug better known by one of its brand names, Advil.

Given the drug’s broad pain-reducing effects, excellent safety profile and availability over the counter, it’s no surprise that some people pop the little brownish-red tablets whenever they feel the slightest twinge of discomfort.

“It’s my go-to when I have pain,” said Candy Tsourounis, a professor of clinical pharmacy at the University of California, San Francisco.

Still, ibuprofen — which is also sold under brand names like Motrin and Nuprin — can pose certain health risks, especially for those with kidney or stomach issues.

Here’s how to feel well and stay safe.

Scan the label of over-the-counter ibuprofen and you’ll see that adults and children 12 years and older are advised to take one (or two, if needed) 200-milligram tablets, caplets or gel caplets every four to six hours while symptoms persist. And those taking the drug should not exceed 1,200 milligrams (or six pills) in 24 hours.

But because doctors sometimes prescribe ibuprofen in much higher dosages, up to 3,200 milligrams a day, it can be hard to say how much is too much.

This discrepancy is rooted in safety concerns. The Food and Drug Administration sets strict dosage limits for over-the-counter drugs because they may be taken by people with various risk factors, Dr. Tsourounis said. If you’re unlikely to have an adverse reaction, your doctor may prescribe a higher dose.

Even with over-the-counter ibuprofen, doctors will sometimes advise patients to take up to 3,200 milligrams per day for a short period — up to a week or two — because the anti-inflammatory effects are better at higher doses, said Lauren Haggerty, a clinical pharmacist at Johns Hopkins Medicine. This might happen after an injury or a surgery, she said.

If you haven’t consulted a doctor about how much is safe, or if you aren’t certain about your risk factors, it’s best not to exceed the recommended limit of 1,200 milligrams a day, Dr. Tsourounis said.

Since ibuprofen can cause an upset stomach, consider taking it with at least a few bites of food — dairy, or nondairy alternative, products are especially helpful, Dr. Tsourounis said.

Be careful that you don’t accidentally take more than intended. “I have patients who don’t know that Advil and generic ibuprofen are the same, so then they might take both,” said Dr. Sarah Ruff, a physician at UNC Family Medicine in Durham, N.C.

Also keep in mind that ibuprofen is sometimes added to certain cold medications, like Sudafed PE Head Congestion and Pain Relief, so always read the ingredient list on medications before using them.

Ibuprofen belongs to a class of drugs known as nonsteroidal anti-inflammatory drugs, or NSAIDs, which reduce pain and inflammation by blocking the activity of certain enzymes, Dr. Tsourounis said. This is why tamping them down often makes you feel better.

But these enzymes also help maintain kidney and liver function and regulate the balance of fluids and electrolytes in your body, Dr. Tsourounis said. So taking ibuprofen can be dangerous for patients with kidney disease or failure; those with liver damage or cirrhosis; and people with conditions that put strain on their kidneys, like high blood pressure or heart failure.

Those at high risk for these conditions — as well as for stomach ulcers, heart attacks, strokes or bleeding problems — should talk with their doctors before taking ibuprofen, Dr. Haggerty said. The same goes if you’re pregnant; ibuprofen is not recommended at or after 20 weeks, according to the F.D.A., since it may in rare cases harm the fetus’s kidneys.

People who take medications such as diuretics, anticoagulants, ACE inhibitors or ARBs (angiotensin receptor blockers) to manage cardiovascular issues should also be careful, Dr. Tsourounis said, because ibuprofen stresses the kidneys and the heart.

To reduce these health risks, don’t take the maximum recommended dose for more than a week or two at a time, Dr. Ruff warned. “If you are needing it for more than two weeks, that’s a good sign that you need to go see your doctor.”

When taken for long periods, ibuprofen can also increase the risk of stomach ulcers, Dr. Ruff said. The drug inhibits enzymes that, among other things, aid in the production of mucus that lines and protects the stomach lining — so without these enzymes, the stomach becomes vulnerable to irritation and damage.

And ironically, regular ibuprofen use among people with headache disorders (such as migraines) can cause rebound headaches, for reasons doctors don’t completely understand.

“It’s really frustrating for patients — because if they get into that situation, the only way to make it go away is to wean themselves off all of the pain relievers,” Dr. Ruff said. “And that’s a painful process.”


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