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Some strong painkillers can be potentially harmful and addictive, especially when they are misused. You might be aware of what has been termed an ‘epidemic’ of fentanyl abuse in the US, with the National Institute on Drug Abuse (NIDA) reporting that fentanyl has been the main driver of drug overdose deaths in the country, with a more than 7.5-fold increase in just seven years

The UK government, meanwhile, warns that opioid medicines including codeine and co-codamol, tramadol, fentanyl and morphine all pose a serious risk of addiction, especially with long-term use

But what about other types of painkillers? Is ibuprofen addictive and can it be potentially harmful?

What is Ibuprofen and How Does It Work?

Ibuprofen is a commonly used over-the-counter painkiller and, along with paracetamol, a staple of most medicine cabinets in the UK. It is classed as a nonsteroidal anti-inflammatory drug (NSAID) and is used as an everyday painkiller for a range of complaints including back pain, period pain, toothache and symptoms of colds, flu or coronavirus (COVID-19). The anti-inflammatory properties also make ibuprofen useful for treating sprains, strains, swellings and pain from arthritis

Ibuprofen can come in several different forms including pills, tablets or a liquid you swallow, as well as a gel, mousse or spray that you rub into your skin. It can also sometimes be delivered intravenously – although generally only at a hospital and under direct medical supervision. It can also be found as an ingredient in some cold and flu remedies, or combined with other painkillers. Brand names include Nurofen, Brufen, Calprofen, Fenbid, Ibugel and Ibuleve.

In technical terms, ibuprofen works by blocking the effect of chemicals called COX (cyclo-oxygenase) enzymes. These enzymes help make hormone-like chemicals known as prostaglandins, which are produced at sites of injury or damage in the body and cause pain and swelling. By blocking the COX enzymes, ibuprofen can reduce the production of prostaglandins, which also reduces pain and swelling.

Can Ibuprofen Be Addictive?

So can you get addicted to ibuprofen? The answer to that may depend on your definition of addiction.

The manufacturers of Advil, a US brand of ibuprofen, point out that the drug is not an opioid and say: “[It] is not habit forming, and it does not demonstrate addictive properties. Studies show that ibuprofen primarily works in the body (peripherally active), and not in the brain (not centrally active).”

It may also be the case that the body does not generally build up a tolerance to ibuprofen, so a regular user will not need larger doses for the same effect. Also, there are usually no withdrawal symptoms when a person stops using it.

However, many common definitions of addiction also involves psychological as well as physical symptoms. The American Society of Addiction Medicine, for example, says that addiction is “a treatable, chronic medical disease involving complex interactions among brain circuits, genetics, the environment, and an individual’s life experiences”. Crucially, it adds: “People with addiction use substances or engage in behaviors that become compulsive and often continue despite harmful consequences.”

This second part means that compulsive behaviours such as gambling and overeating can also be seen as types of addiction. If a person becomes used to taking ibuprofen, they may develop a psychological dependence on the drug. They may continue to use it for longer than they should, take it in larger doses or to continue to take it even if the original pain or inflammation has been resolved.

One study described a HIV patient’s “moderate substance use disorder” based on her use of prescribed ibuprofen. While acknowledging that this was a rare case, the case report found that the patient met four of 11 symptoms for a substance use disorder as set out in the Diagnostic and Statistical Manual of Mental Disorders.

These were:

Developing a tolerance to ibuprofen

Using more ibuprofen than was prescribed or intended

Tried but failed to stop using ibuprofen

Strong desire to take ibuprofen

Interestingly, in this case the patient did report developing a tolerance, suggesting that this may be the case for some users.

The Risks of Overuse and Long-Term Ibuprofen Use

Over-the-counter painkillers addiction may be rare but ibuprofen misuse and overuse can still be potentially harmful.

As with all medicines, ibuprofen can cause a number of potential side effects. Relatively common side effects of ibuprofen include:

Nausea

Vomiting

Constipation

Diarrhoea

Indigestion

Abdominal pain

Less common side effects include:

Headache or dizziness

Bloating

Raised blood pressure

Inflammation of the stomach (gastritis)

Stomach ulcer

Allergic reactions

Worsening of asthma symptoms

Kidney failure

Bleeding in the stomach

It is possible to overdose on ibuprofen. This can cause symptoms including nausea, vomiting, epigastric pain (pain in the upper abdomen), and tinnitus or ringing in the ears.

It’s recommended that ibuprofen use should be avoided during pregnancy.

Some research has suggested a link between long-term use of NSAIDs including ibuprofen and gastrointestinal (GI) reactions including gastrointestinal bleeding and peptic ulcer disease. Other medications may be prescribed to protect the stomach if long-term use of ibuprofen is also prescribed.

In general, it is advised not to take ibuprofen for more than 10 days for pain or more than 3 days for fever unless directed by a doctor.

How to Use Ibuprofen Safely

You should only ever use ibuprofen as directed. This means that if you buy it over the counter for use without a prescription, you should follow the guidelines provided with the medicine – either on the packet or in an accompanying leaflet. If directed to use ibuprofen by a medical professional, make sure you follow their instructions. This could pertain to dosage, length of use and how/when to take the ibuprofen.

If you are worried about your use of ibuprofen or any other drug, including stronger prescription medications, it is always best to seek professional help. While addiction to ibuprofen is rare, dependence on other types of painkiller can be much more common.

If you have any issues with medication addiction or misuse, get in touch today to find out how we can help.

1 https://nida.nih.gov/research-topics/trends-statistics/overdose-death-rates

2 https://www.gov.uk/guidance/opioid-medicines-and-the-risk-of-addiction

3 https://www.nhs.uk/medicines/ibuprofen-for-adults/about-ibuprofen-for-adults/

4 https://www.pharmgkb.org/pathway/PA166121942

5 https://www.advil.com/faqs-en/advil-pain/

6 https://www.medicalnewstoday.com/articles/161071

7 https://www.asam.org/quality-care/definition-of-addiction

8 https://pmc.ncbi.nlm.nih.gov/articles/PMC5370578/

9 https://www.nhsinform.scot/tests-and-treatments/medicines-and-medical-aids/types-of-medicine/ibuprofen/

10 https://bnf.nice.org.uk/drugs/ibuprofen/

11 https://pmc.ncbi.nlm.nih.gov/articles/PMC8256335/