Ibuprofen belongs to the class of drugs known as nonsteroidal anti-inflammatory drugs (NSAIDs), which include such other over-the-counter medications as naproxen and aspirin. These drugs are very effective in relieving minor pain associated with musculoskeletal injuries and arthritis, as well as many other causes of pain. There are, however, significant potential side effects associated with both long-term and short-term use. The most common of these side effects are related to the stomach and bowels. As many as 50 percent of people, in fact, are unable to take these medications because they experience abdominal pain, diarrhea, and upset stomach. Long-term use can also increase your risk of developing an ulcer in either the stomach or the first part of the small bowel (duodenum). In fact, about 15 percent of chronic NSAID users will develop an ulcer. These ulcers may not cause symptoms until they have seriously progressed, and severe bleeding from the bowels may be the first sign of a problem. It has been estimated that in the last year more than 16,000 deaths and 100,000 hospital admissions resulted from ulcer-related bleeding caused by NSAIDs. Other potential complications can accompany long-term use — for example, kidney damage and liver impairment. People with asthma may also be sensitive to these drugs. In addition, NSAIDs may interact with other medications, including blood thinners. Ibuprofen and its cousins are valuable drugs, but it’s important to use them with caution. Even though they are available over the counter, significant potential side effects are associated with their use. If you develop any gastrointestinal symptoms such as the ones I mentioned above, stop taking the ibuprofen and see your doctor. And next time you visit your doctor, be sure to discuss your ibuprofen use with him or her. If you ever see signs of intestinal bleeding (passage of black stools or blood in the stool), seek medical care immediately. Q2. Can you drink alcohol with ibuprofen? — Sharon, Georgia While it is generally safe to take ibuprofen and drink alcohol, it is highly recommended that you limit the amount of alcohol you drink while taking any medication, especially ibuprofen. Alcohol can irritate your stomach and intestinal tract, and taking ibuprofen or other non-steroidal anti-inflammatory drugs (NSAIDs), including aspirin, for an extended period of time can also lead to stomach and intestinal irritation, as well as ulcers and potential bleeding problems. Also, depending on the medical condition for which you are taking ibuprofen, high dosage and long-term use of NSAIDs may cause gastrointestinal problems. So, make sure you read the label directions and follow the recommended dose and duration. To help minimize irritation, you should take ibuprofen with meals. Q3. Indigestion is a daily problem for me. Presently, I am taking Nexium, two Carafate (nightly), antacids when needed, and Zantac when needed. In the long run, am I harming myself by depending on and taking these medications? — Bobbi, Florida First things first. With the number of medications you are taking, you should see a gastroenterologist to make sure that your symptoms are not the result of treatable but potentially more serious conditions rather than indigestion caused by peptic ulcer disease. If other causes are ruled out and your doctor tells you that you have non-ulcer dyspepsia (the medical term used for indigestion), then I would try to simplify your regimen, using as few medications as possible. For example, most of the medications you are taking — Nexium, the antacids, and Zantac — have the same effect, that of reducing the acid load present in your stomach, although they work by means of different mechanisms. Carafate coats the stomach and promotes the healing of inflammation caused by acid or bile. Assuming that acid-blocking medicines have improved your symptoms of indigestion, I recommend increasing the dose of Nexium or Zantac to maintain minimal acid secretion, and taking over-the-counter antacids only as needed. None of these medications have been associated with dependence, but all can cause side effects, so restricting the number of medicines may reduce your risk of side effects. For example, long-term use of Nexium and other proton pump inhibitors may increase the risk of hip, wrist, or spine fractures, or can lead to a vitamin B12 deficiency. Carafate contains aluminum and can cause constipation. Bottom line: Consider seeing a gastroenterologist to get a solid diagnosis, and then work to minimize your use of medications. Learn more in the Everyday Health Digestive Health Center.
