How Much Advil is Too Much?

Q: I take Advil quite regularly for pain, but how do I know if I'm taking more than is safe?

Headache. Fever. Menstrual pain. Backache.

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 without a prescription, it's no surprise that some people drop the small brownish-red tablets as soon as they feel the slightest discomfort.

“It's my favorite thing to do when I'm in pain,” says Candy Tsourounis, 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 people with kidney or stomach problems.

Here's how to feel good and stay safe.

How do you know if you are exaggerating?

If you scan the label of over-the-counter ibuprofen, you'll see that adults and children 12 years and older are advised to take one (or two, as needed) 200-milligram tablets, caplets, or gel caplets every four to six hours. symptoms persist. And those taking the drug should use no more than 1,200 milligrams (or six pills) in 24 hours.

But because doctors sometimes prescribe ibuprofen much higher dosesup to 3,200 milligrams per day, it can be difficult 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 medications because they can be taken by people with various risk factors, said Dr. Tsourounis. If you are unlikely to have a side effect, your doctor may prescribe a higher dose.

Even with over-the-counter ibuprofen, doctors sometimes advise patients to take up to 3,200 milligrams per day for short periods of time — 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 can happen after an injury or surgery, she said.

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

Because ibuprofen can cause stomach upset, consider taking it with at least a few bites of food. Dairy or non-dairy alternatives are especially helpful, Dr. Tsourounis said.

Be careful not to accidentally take more than intended. “I have patients who don't know that Advil and generic ibuprofen are the same, so they can take both,” says Dr. Sarah Ruff, a physician at UNC Family Medicine in Durham, NC.

Also keep in mind that ibuprofen is sometimes added to certain cold medications, such as Sudafed PE Head Congestion and Pain Relief, so always read the ingredients list of medications before taking them.

When to be extra careful

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, said Dr. Tsourounis. This is why you often feel better when you tamp them down.

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

Those who are at high risk for these conditions — as well as stomach ulcers, heart attacks, strokes or bleeding problems — should talk to their doctor before taking ibuprofen, said Dr. Haggerty. The same applies if you are pregnant; According to the FDA, ibuprofen is not recommended after 20 weeks as it may occur in rare cases damage the fetus's kidneys.

People taking medications such as diuretics, anticoagulants, ACE inhibitors or ARBs (angiotensin receptor blockers) to treat cardiovascular problems should also be cautious, said Dr. Tsourounis, because ibuprofen puts a strain on the kidneys and 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. “If you need it for more than two weeks, that's a good sign you should see your doctor.”

With long-term use, ibuprofen can also increase the risk of stomach ulcers, said Dr. Ruff. The drug inhibits enzymes that, among other things, help with the production of mucus lines and protects the stomach wall – so without these enzymes the stomach becomes vulnerable to irritation and damage.

And ironically, regular use of ibuprofen helps people with headache disorders (such as migraines) can cause rebound headachesfor reasons that doctors don't fully understand.

“It's really frustrating for patients because when they get into that situation, the only way to make it go away is to taper off all painkillers,” said Dr. Ruff. “And that is a painful process.”