Q: I often take a couple of over-the-counter ibuprofen before I go out for a jog to help the muscle aches afterward. I usually run for 45 minutes to one hour. Is there any danger?
A: Ibuprofen (Motrin, Advil, generics) is one of the many non-steroidal anti-inflammatory drugs (NSAIDs) primarily to reduce pain. These drugs can also reduce inflammation and lower body temperature when someone has a fever.
The safety profile of NSAIDs is generally quite good, especially when taken in small doses for short periods of time. That’s why several of them, including ibuprofen and naproxen, are available in low doses over the counter in this country and elsewhere.
However, as is true for any drug, NSAIDs can cause trouble. Upset stomach, intestinal bleeding, kidney injury and increased heart attack risk are among the most important side effects.
NSAID use is common among people who deal with aches and pain during and after exercise. In fact, many marathoners and other endurance athletes take NSAIDs preventively to reduce pain and possibly improve performance.
However, these same athletes are at particular risk for kidney injury. Dehydration and muscle damage are common among endurance athletes and can also contribute to kidney injury. Will taking an NSAID put these athletes at even higher risk for kidney damage?
A recently published study on ultra-marathoners (155 miles in less than a week) shed some light on this question. The researchers did indeed find that ultra-marathoners who took 400mg of ibuprofen (equivalent to two over-the-counter Advil) every four hours for three or four doses toward the end of the race were more likely to show evidence of kidney injury compared to those taking a placebo.
Most of us will never attempt to run 155 miles in one week, so the results of this study probably do not apply to a more typically exercising adult. Still, this study raises some serious concerns about the wisdom of taking ibuprofen during exercise, at least among endurance athletes.
If you are taking an NSAID regularly, you should be having regular blood monitoring, including measures of kidney function and blood counts. And if you have significant kidney disease, a history of stomach ulcers or bleeding, you should probably avoid NSAIDs (other than a baby aspirin) altogether. Ask your doctor whether you are a good candidate for NSAID use. They can be quite helpful, and many of their side effects can be avoided with proper precautions.
(Robert H. Shmerling, M.D., is associate professor of medicine at Harvard Medical School and clinical chief of rheumatology at Beth Israel Deaconess Medical Center in Boston. For additional consumer health information, please visit www.health.harvard.edu.)
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