Potential Risks of Advil (Ibuprofen) You Should Know

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The FDA required that manufacturers of non-steroidal anti-inflammatory drugs (NSAIDs) strengthen the warnings on their prescription drug labels in 2015. This included both prescription and over-the-counter NSAIDs. The revised warnings now indicate that nonsteroidal NSAIDs can increase the risk of a heart attack or stroke. 

Among the drugs of concern is Advil (ibuprofen), one of the most popular over-the-counter NSAIDs. It is also sold under the brand names Motrin, Brufen, and Nurofen. Like any other medication, Advil has benefits and risks. As far as risks go, some are minor while others can be fatal.

Heart Attack Risk

According to the FDA, NSAIDs (with the exception of aspirin) increase the risk of cardiovascular events such as a heart attack or stroke The bad news is that even if you’re a first-time user, the risk is ever-present.

According to a 2017 study published in the journal Cureus, NSAIDs can cause potentially severe increases in blood pressure within weeks in some people, particularly those on diuretics ("water pills").

The sudden increase in blood pressure can be significant in people with underlying cardiovascular diseases such as atherosclerosis ("hardening of the arteries"). It can dislodge unstable fat deposits on the wall of a blood vessel and cause the blockage of blood flow in the heart (leading to a heart attack) or the brain (leading to a stroke).

Because of this, the FDA warns against the use of ibuprofen just before or immediately after coronary bypass surgery.

With regards to Advil specifically, a 2017 study in BMJ concluded that ibuprofen taken for one to seven days increased the risk of a heart attack by 50%. The risk was further increased with higher doses.

Stroke Risk

All NSAIDs pose an increased risk of stroke with the exception of aspirin. However, unlike other over-the-counter NSAIDs, Advil is especially concerning to people at risk of stroke, especially the most common type known as an ischemic stroke.

According to a 2018 study in PLoS ONE, which assessed the incidence of ischemic stroke in 32 million people, Advil was the fourth most likely NSAID to cause stroke of the 32 available options.

Of the top four culprits—which included, in descending order, Voltaren (diclofenac), Tivorbex (indomethacin), and Vioxx (rofecoxib)—Advil was the only one available over the counter.

Stomach Ulcer Risk

Because Advil is an NSAID, you may be subject to side effects that affect the lining of your stomach and digestive tracts. These include the development of peptic ulcers, gastric bleeding, and intestinal perforation. These problems can develop at any time during treatment.

The risk is higher if you take NSAIDs over the long term, are older, are in poor health, or drink three or more alcoholic drinks per day while taking Advil.

Generally speaking, COX-1 inhibitors like Advil and Aleve (naproxen sodium) pose a lesser risk of ulcers than COX-2 inhibitors like Vioxx and Celebrex (celecoxib).

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  1. U.S. Food and Drug Administration. FDA strengthens warning of heart attack and stroke risk for non-steroidal anti-inflammatory drugs. June 9, 2015.

  2. Varga Z, Sabzwari SRA, Vargova V. Cardiovascular risk of nonsteroidal anti-inflammatory drugs: an under-recognized public health issue. Cureus. 2017;9(4):e1144. doi:10.7759/cureus.1144

  3. Bally M, Dendukuri N, Rich B, et al. Risk of acute myocardial infarction with NSAIDs in real world use: bayesian meta-analysis of individual patient data. BMJ. 2017;357:j1909. doi:10.1136/bmj.j1909 

  4. Schink T, Kollhorst B, Varas lorenzo C, et al. Risk of ischemic stroke and the use of individual non-steroidal anti-inflammatory drugs: A multi-country European database study within the SOS Project. PLoS ONE. 2018;13(9):e0203362. doi:10.1371/journal.pone.0203362

  5. Drini M. Peptic ulcer disease and non-steroidal anti-inflammatory drugs. Aust Prescr. 2017;40(3):91-3. doi:10.18773/austprescr.2017.037