By Kenneth Kronlund, MD, FACP
Associate Medical Director, Quality and Risk Management

Most people occasionally take pain relievers whether for a headache, back pain, arthritis or other problems. However, not everyone carefully reads the label and makes sure they aren’t taking too much in a given time period. Two popular pain relievers, ibuprofen and naproxen, are known as nonsteroidal anti-inflammatory drugs (NSAIDs). While they are effective at relieving pain for many people, NSAIDs need to be used carefully to avoid potential side effects, including:

• Stomach upset
• Heartburn and ulcers
• Kidney injury
• Easy bruising or bleeding
• Allergic reactions
• Liver injury
• Increased risk of heart problems

NSAIDs work by inhibiting an enzyme in your body. This helps decrease inflammation, pain and fever. Different types of NSAIDs have different dosage limits:

• The maximum safe recommendation for over-the-counter ibuprofen (Advil) is 1,200 mg per day. The maximum dose for ibuprofen with a prescription is higher and ranges from 1,200 mg to 3,200 per day.
• For naproxen (Aleve) the dosage depends on a number of factors including your age and any medical conditions you might have. Be sure to follow the directions on the label.

It’s important not to use either of these medications for more than 3-4 consecutive days for fever or more than 10 days for pain, unless directed by your doctor. If you take them for too long you will be at a higher risk for side effects. As an alternative for pain relief, many healthcare providers suggest taking acetaminophen. Known by the brand name Tylenol, this medication works quickly and is safer to take for longer periods of time since it is not a NSAID.

Here are some tips on how to best take NSAIDs:

• Always read the label carefully and follow the recommended dosage and time limits of the medicine you are taking.
• Ibuprofen is known to cause stomach upset, so it’s best to take it with at least a few bites of food or milk to prevent problems.
• Remember that NSAIDs are sometimes added to cold medications. Be sure to check labels carefully to make sure you are not taking too much.
• Be especially careful of these medications if you have kidney or liver disease. NSAIDs reduce inflammation by blocking certain enzymes. However, these same enzymes also help keep your kidney and liver functioning properly.
• If you are taking ibuprofen, talk to your healthcare provider if you are at high risk for stomach ulcers, heart attack or stroke, and bleeding problems. Too much ibuprofen can make your stomach vulnerable to irritation and damage.
• Many popular prescription and over-the-counter medications can interact with NSAIDs. Always consult with your doctor or pharmacist to be aware of the risks.
• It’s important for pregnant women to know that NSAIDs can harm their unborn babies. The FDA recently updated NSAID warnings for pregnant women.

Remember that no medication is completely safe. Any medication has the potential to be harmful if used improperly. So always read medication labels carefully and consult with your healthcare provider if you have any questions.