From the Guidelines
Motrin (ibuprofen) may increase cardiovascular risk after as little as one week of regular use, though the risk generally increases with higher doses and longer duration of treatment. For most people, short-term use (less than 7 days) at recommended doses is considered relatively safe from a cardiovascular perspective. However, the risk becomes more significant with continuous use beyond 7-10 days, particularly at higher doses (above 1200mg daily) 1. This cardiovascular risk includes increased chances of heart attack, stroke, and heart failure, especially in those with pre-existing cardiovascular disease or risk factors. The mechanism behind this increased risk involves ibuprofen's inhibition of prostaglandins, which can lead to increased blood pressure, fluid retention, and altered platelet function that promotes clotting.
Key Considerations
- The risk of cardiovascular events is proportional to COX-2 selectivity and the underlying risk in the patient 1.
- Nonpharmacological approaches are recommended as the first line of treatment, followed by a stepped-care approach to pharmacological therapy 1.
- Analgesic doses of aspirin may be a reasonable option for some patients, but it confers a higher risk of bleeding than low-dose aspirin plus another analgesic 1.
- Ibuprofen can interfere with aspirin’s ability to irreversibly acetylate the platelet COX-1 enzyme, which may reduce the protective effect of aspirin on risk for atherothrombotic events 1.
Recommendations
- Use the lowest effective dose for the shortest duration possible to minimize risk.
- Consider acetaminophen (Tylenol) as an alternative for pain relief if you have cardiovascular concerns.
- Those with existing heart disease, high blood pressure, or other cardiovascular risk factors should consult their healthcare provider before using Motrin regularly.
- Patients taking immediate release low-dose aspirin and ibuprofen 400 mg should take the ibuprofen at least 30 minutes after aspirin ingestion, or at least 8 hours before aspirin ingestion to avoid any potential interaction 1.
From the FDA Drug Label
Cardiovascular Thrombotic Events Nonsteroidal anti-inflammatory drugs (NSAIDs) cause an increased risk of serious cardiovascular thrombotic events, including myocardial infarction and stroke, which can be fatal. This risk may occur early in treatment and may increase with duration of use [see WARNINGS and PRECAUTIONS]. The FDA drug label does not answer the question.
From the Research
Duration of Motrin Use and Cardiovascular Risk
There is no direct evidence in the provided studies that specifically addresses the duration of Motrin (ibuprofen) use and its impact on cardiovascular risk.
Related Evidence
- A study from 2 found that long-term use (≥ 180 days) of nonselective NSAIDs, including ibuprofen, was not significantly different from celecoxib in terms of cardiovascular risk.
- Another study from 3 found that current diclofenac use was associated with a two-fold increased risk of myocardial infarction, but the risk associated with ibuprofen use was concentrated in new PPI users.
- The study from 3 also found that the risk of MI in ibuprofen users rose with increasing prescriptions, but there was no material increased risk in naproxen users, nor in past users of most NSAIDs in the absence of PPIs.
Key Findings
- History of cardiovascular disease played a significant role in recurrence during the period studied, with higher HRs for AMI, angina, CVA, and TIA in patients with a history of CVD 2.
- Preexisting medical conditions, such as hypertension, dyslipidemia, diabetes mellitus, congestive heart failure, and chronic renal disease, also significantly affected the risk for CVEs 2.
- The risk of MI was elevated in current diclofenac users, particularly in new concomitant PPI users, but the findings for ibuprofen users may be explained by reverse causality bias 3.