Ibuprofen (Advil, Motrin) is the most popular nonsteroidal anti-inflammatory drug (NSAID) in the United States. Available over the counter and in higher prescription strengths, this medication is used for a wide variety of ailments as a fever reducer, pain reliever and anti-inflammatory. While the U.S. Food and Drug Administration has deemed ibuprofen generally safe for short-term, low-dose use, side effects are possible. Warnings listed in the ibuprofen prescribing information include the possibility of gastrointestinal bleeding, allergic and skin reactions, and cardiovascular and kidney side effects. Adverse effects on the liver are rare in healthy adults. However, people with liver disease -- particularly those with cirrhosis -- should talk with their doctor before taking ibuprofen or a combination product that contains ibuprofen.
Elevated Liver Enzymes
Enzymes called alanine aminotransferase (ALT) and aspartate aminotransferase (AST) are present in high concentration in the liver. Elevated blood levels of these enzymes usually indicate liver inflammation. LiverTox -- an online database sponsored by the National Institute of Diabetes and Digestive and Kidney Diseases that provides information on drug-induced liver injury -- reports that over-the-counter dosages of ibuprofen pose no higher risk for liver enzyme elevations than placebo, an inert pill. However, there have been isolated reports of liver enzyme elevations associated with ibuprofen use among people with hepatitis C.
At prescription doses of 2,400 to 3,200 mg per day, up to 16 percent of ibuprofen users experience an increased ALT level. In most cases, these elevations are mild and do not cause symptoms or interfere with liver function. Significant liver damage associated with high-dose, prescription ibuprofen use is estimated to occur at a rate of 1.0 to 1.6 cases per 100,000 prescriptions, according to LiverTox.
Systemic hypersensitivity reactions to ibuprofen in the form of two diseases called Stevens-Johnson syndrome (SJS) and drug rash with eosinophilia and systemic symptoms (DRESS syndrome) are very rare, but have been reported in association with ibuprofen use. Both SJS and DRESS syndrome involve an immune system-mediated, severe reaction that typically develops 2 to 8 weeks after a person begins taking the offending drug. Skin manifestations, such as a rash or blisters, occur with both conditions although other signs and symptoms differ. Both SJS and DRESS syndrome frequently affect the liver, causing mild to severe damage. Severe cases can lead to liver failure, which may result in death or the need for liver transplantation.
Special Considerations for People with Liver Disease
While the risk of direct liver injury from ibuprofen appears to be low, people with liver disease should not take this medication without their doctor's approval. As ibuprofen is metabolized by the liver, taking the medication could overtax a person's already compromised liver function. Additionally, people with liver disease may be more susceptible to gastrointestinal bleeding and kidney injury associated with ibuprofen use. These side effects can lead to significant deterioration in the overall health of someone with liver disease.
Warnings and Precautions
In terms of potential liver injury, ibuprofen is generally considered to be among the safest NSAIDs, according to LiverTox. Additionally, a December 2009 review article published in the journal "Inflammopharmacology" concluded that ibuprofen used for a short period in over-the-counter dosages does not pose a significant risk for liver injury, especially permanent liver damage. However, rare adverse effects are possible and can be serious. Talk with your doctor if you have concerns about taking ibuprofen to determine whether it is safe for you.
If you are taking ibuprofen, watch for signs and symptoms that might indicate a serious adverse side effect. Contact your doctor as soon as possible or seek urgent medical care if you experience:
-- bloody, black or maroon stools
-- swelling of the hands, ankles, face or abdomen
-- yellow discoloration of the skin or dark urine
-- generalized itchiness or a new skin rash
-- fever or other flu-like symptoms
-- nausea, vomiting, loss of appetite or abdominal pain
-- chest pain or shortness of breath
-- sudden numbness, tingling, weakness, facial drooping or slurred speech
Reviewed and revised by: Tina M. St. John, M.D.