Handle with care

Just because a medicine is sold over the counter doesn't mean it is completely free of side effects.

- Nicky Pellegrino

Since ibuprofen is available on supermarket and pharmacy shelves, it is reasonable to assume it must be a safe method of pain relief. However, the drug, a non-steroidal anti-inflammatory (NSAID) commonly sold as Nurofen, carries risks, just like any other medication.

"Because it is available over the counter, there is a sense that Nurofen is familiar and okay," says Alan Fraser, a gastroenterologist and associate professor of medicine at the University of Auckland. "It is probably the safest of the anti-inflammatories, but they are all potentially able to cause gastrointestinal problems."

Over-the-counter Nurofen contains 200mg of ibuprofen per tablet. Take a couple of those in a day, and you are at low risk of developing a stomach bleed or gastroduodenal ulcer.

"But if you've got really serious pain, then that dose might not be enough to supply the effect you need and you're going to be taking three or four a day, putting you in a higher-risk category," says Fraser.

The recommendation with ibuprofen and another frequently used NSAID, diclofenac (Voltaren), has been to mitigate the risk of stomach irritation by taking the drugs with a meal or snack. But the thinking around this is changing.

These drugs work by inhibiting production of prostaglandins, a group of fatty acids that play an essential role in various body processes, and can increase pain sensitivity and inflammation.

Prostaglandins are found in high concentrations in the stomach lining, where they reduce acid production and protect against damage.

"Unlike aspirin, ibuprofen isn't a direct irritant," says Fraser. "It has a systemic effect, and it doesn't matter whether you take it with or without food, the risk is still there."