Ibuprofen and other anti-inflammatories can cause stomach ulcers and bleeding. This is the best-known risk of the class, and the part most often misunderstood is not whether it happens but who it happens to and whether there is warning.
Ibuprofen blocks chemicals that cause pain and inflammation. Those same chemicals maintain the protective mucus layer lining the stomach. With that protection reduced, stomach acid can damage the lining, and that happens whether the ibuprofen is swallowed or absorbed another way, which is why taking it with food helps comfort more than it removes risk.
Common side effects of this pharmacy medicine or category
Indigestion, heartburn and stomach discomfort are common and usually mild. The important point is that these are not a reliable early warning. A significant proportion of serious ulcers and bleeds occur in people who had no indigestion at all beforehand, and this is more likely in older adults, whose first sign may be anaemia or a bleed.
Feeling fine on ibuprofen is therefore not evidence that it is doing no harm over time.
Interactions and duplicate-ingredient risks
Risk multiplies in combination. Each of these raises ulcer or bleeding risk on its own, and together they compound:
- Another anti-inflammatory, including low-dose aspirin taken for the heart, another tablet, or a gel
- Corticosteroids such as prednisone
- Blood thinners such as warfarin or clopidogrel
- SSRI antidepressants
- Alcohol, particularly regular heavy use
Someone on aspirin and an SSRI who adds ibuprofen has stacked three separate risks without taking anything that felt significant.
Children, pregnancy, older adults and chronic medicine cautions
Higher risk applies if you:
- Are over 65
- Have had a stomach ulcer or gut bleed before, which is the strongest single predictor
- Take any of the medicines listed above
- Take higher doses, or take it for longer periods
- Have a history of Helicobacter pylori infection
- Drink heavily or smoke
If several apply, that is worth raising rather than assuming ibuprofen is fine because it is sold openly. Options include using paracetamol instead, a topical anti-inflammatory rather than tablets, the lowest dose for the shortest time, or continuing with a medicine that protects the stomach alongside.
Warning signs and overdose concerns
Get emergency help for:
- Vomiting blood, or material that looks like coffee grounds
- Black, tarry or sticky stools
- Severe or sudden abdominal pain
- Feeling faint, breathless or unusually tired, which can indicate slow blood loss
Note that iron tablets also darken stools harmlessly. What distinguishes a bleed is stools that are black and tarry or sticky, usually with other symptoms. If in doubt, get it checked. See signs of stomach bleeding.
Stop and seek advice for new persistent indigestion, pain that wakes you at night, or unexplained tiredness and breathlessness.
Questions to ask a pharmacist before using it
- Given my age and medicines, is ibuprofen suitable for me at all?
- Do I need something to protect my stomach?
- Would paracetamol or a gel be safer for this pain?
- Does anything I take already count as an anti-inflammatory?
- How many days can I take it before review?
Related OTC and medicine-safety guides
- Painkiller side effects
- NSAID side effects
- Chronic pain medication side effects
- When to see a doctor about an OTC medicine
- Report an OTC medicine side effect
See also ibuprofen side effects and ibuprofen and stomach pain.
Medical Disclaimer: This content is for informational and educational purposes only and does not constitute medical diagnosis, prescription, or professional advice. Always read the patient information leaflet and consult a qualified doctor or pharmacist regarding any medicine or health concern.