Recognizing the Risks of Chronic Nonsteroidal Anti-Inflammatory Drug Use in Older Adults

Ann Longterm Care. Author manuscript; available in PMC 2011 Aug 19.

Published in final edited form as:

Ann Longterm Care. 2010; 18(9): 24–27.

PMCID: PMC3158445

NIHMSID: NIHMS315767

PMID: 21857795

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Older adults commonly take nonsteroidal anti-inflammatory drugs (NSAIDs) chronically. Studies of older adults show that chronic NSAID use increases the risk of peptic ulcer disease, acute renal failure, and stroke/myocardial infarction. Moreover, chronic NSAID use can exacerbate a number of chronic diseases including heart failure and hypertension, and can interact with a number of drugs (eg, warfarin, corticosteroids). Preferred analgesics in older adults that may have a lower risk of these adverse drug reactions include acetaminophen, a nonacetylated salicylate (eg, salsalate), a short half-life NSAID (eg, ibuprofen), or low-dose opioid/opioid-like agents in combination with acetaminophen (in appropriate patients).

Nonsteroidal anti-inflammatory drugs (NSAIDs) are a common class of analgesics used chronically for persistent pain due to osteoarthritis and other musculoskeletal disorders in older adults.^1-3 Specifically, an estimated 40% of people age 65 years and older fill one or more prescriptions for a NSAID each year.⁴ Considering that NSAIDs are also currently available over the counter, it is clear to see that even larger numbers of older adults are exposed to NSAIDs in the United States.

While these agents can be effective in treating inflammation and pain, older adults are at increased risk for adverse drug reactions (ADRs) due to age-related loss of physiological organ reserve, increased comorbidities, polypharmacy, and changes in pharmacokinetics.⁵ As a result, NSAID use causes an estimated 41,000 hospitalizations and 3300 deaths each year among older adults.² Some specific ADRs of concern with chronic use of NSAIDs include gastrointestinal (GI), renal, cardiovascular (CV), cerebrovascular, and central nervous system (CNS) adverse effects. ⁶ This review will begin by describing key evidence for these organ-specific ADRs associated with the chronic use of NSAIDs in older adults and finish with general recommendations for healthcare providers to avoid/minimize these ADRs.

The spectrum of potential NSAID-related GI adverse effects is wide, ranging from dyspepsia to life-threatening gastric bleeding.² A nested case control study from nearly two decades ago (before the introduction of cyclooxygenase-2 [COX-2] selective NSAIDs) showed that NSAIDs increase the risk of fatal peptic ulcers by nearly fivefold in older adults;⁷ other studies have shown that the risk of peptic ulcer complications is increased by three- to fivefold in older adults using NSAIDs.² This risk is much more pronounced in those taking concomitant systemic corticosteroids and warfarin.^8,9 In addition, the risk is increased as early as within the first month of treatment and is sustained over time.^3,10 Often, these peptic ulcers are asymptomatic but can lead to significant morbidity and mortality. The evidence for which NSAIDs are less risky is limited. One retrospective cohort study found that celecoxib, as compared to nonselective NSAIDs (ibuprofen, diclofenac, naproxen) carried the least risk of hospitalization for GI bleeding among elderly persons.¹¹ Of note, all NSAIDs (ie, nonselective and COX-2 selective) carry a boxed warning for adverse GI events. Overall, the rate of hospitalizations for peptic ulcer disease (PUD) increases with age, from 1 per 1000 per year in populations younger than age 50 years to 2-6 per 1000 per year in older adults (> 65 yr), with an estimated 15-35% of all peptic ulcer complications being due to NSAID use.^2,12

Similar to NSAID-related GI adverse effects, NSAID-induced renal dysfunction has a wide spectrum of negative effects, including decreased glomerular perfusion, decreased glomerular filtration rate, and acute renal failure (ARF). While it is important to recognize that ARF can develop at any point during long-term NSAID therapy, the risk may be highest among those who have recently initiated therapy. Specifically, in a nested case control study of older adults, the risk of ARF was increased nearly twofold for all NSAIDs (nonselective and COX-2 selective NSAIDs) within 30 days of initial use/prescribing.¹³ This is consistent with previous studies reporting that NSAIDs increase the risk of ARF in the elderly.^14,15 This risk is further increased in those older adults with preexisting chronic kidney disease (CKD) and in those who use long half-life NSAIDs.¹⁶ Thus, diligent monitoring of renal function (eg, blood urea nitrogen/serum creatinine to estimate creatinine clearance) is critical in older adults receiving NSAIDs, especially those who are at increased risk.¹⁴ Of note, salsalate may be preferred among the NSAIDs as it is rarely associated with nephrotoxicity.⁵ Overall, it is estimated that 2.5 million individuals in the United States experience adverse renal effects from NSAID use annually,¹⁷ with older adults being in the highest-risk group in the population.

NSAIDs have been shown to worsen/increase the risk of various CV and cerebrovascular outcomes, with some studies suggesting a greater risk associated with COX-2 selective NSAIDs as compared to nonselective NSAIDs.^11,18-23 One retrospective cohort study of older adults showed that naproxen carried the least risk of hospitalization for acute myocardial infarction (MI) among users of aspirin as compared to other nonselective NSAIDs (ibuprofen, diclofenac) and COX-2 selective NSAIDs (celecoxib, rofecoxib) used with aspirin.¹¹ In contrast, a prospective, population-based cohort study found an increased risk of stroke with the use of nonselective NSAIDs (including naproxen), as well as with COX-2 selective NSAIDs (including celecoxib) in those not taking aspirin. On an individual NSAID analysis, naproxen users were found to have more than a twofold increased risk of stroke.²⁰ Of note, all NSAIDs (ie, nonselective and COX-2 selective) carry a boxed warning for adverse CV events, including MI and stroke. Further research is needed to confirm individual NSAID adverse CV risk profiles.

One clinical trial of patients with hypertension (HTN) showed that piroxicam and ibuprofen blunted the effects of antihypertensive drugs (lisinopril/hydrochlorothiazide), significantly increasing systolic blood pressure (SBP) by 7.7-9.9%. An acetaminophen (APAP) period (in place of the NSAID) led to a significant decrease in blood pressure toward baseline, and a second exposure to the NSAIDs led to another significant increase in SBP of 7.0-7.7%, adding strong support to the evidence of causality.²¹ In addition, a cohort study of community-dwelling elderly individuals

The NSAID should be used at the lowest effective dose for the shortest period of time.

found that those who were taking antihypertensive therapy and NSAIDs had SBPs approximately 5 mmHg higher than those not taking NSAIDs, and were more likely to have SBP higher than 140 mmHg.¹⁸

NSAIDs have also been shown to cause or exacerbate heart failure (HF) in older adults. Specifically, a cohort study of older adults found that rofecoxib and nonselective NSAIDS (naproxen, ibuprofen, and diclofenac), but not celecoxib, were significantly associated with an increased risk of admission for HF as compared to those not taking NSAIDs.¹⁹ In contrast, another cohort study found that among patients who had survived their first hospitalization because of HF, subsequent use of any NSAID (including celecoxib, as well as ibuprofen, diclofenac, naproxen, and other NSAIDs) led to a significantly increased risk of death.²²

Finally, an important point of clinical debate is the interaction between low-dose, cardioprotective aspirin and NSAIDs potentially interfering with the antiplatelet effect of aspirin. The American Geriatrics Society⁵ recommends avoiding the coadministration of aspirin and ibuprofen based on a 2006 Food and Drug Administration warning. However, it is important to recognize that evidence suggests that this warning should also apply to naproxen, but not celecoxib. ^23,24

NSAID use has been shown to be associated with a number of CNS effects including aseptic meningitis, psychosis, and cognitive dysfunction.^1,2 This latter point may seem to be inaccurate, but the literature suggests otherwise. At the time of this writing, the studies to date have not consistently shown a benefit from chronic NSAID use in reducing the risk of dementia or cognitive impairment.²⁵ Interestingly, though, several studies have shown that high-dose NSAIDs (ie, anti-inflammatory doses) may actually increase the risk of cognitive impairment.^26,27 In particular, indomethacin appears to cause more CNS effects than other NSAIDs in the elderly.²⁸

One approach to reducing ADRs associated with NSAIDs is to avoid the use of specific agents and use preferred alternative analgesics (). This is particularly important in those older adults with preexisting HTN, CKD, HF, and/or PUD, or those taking concomitant warfarin or corticosteroids. An alternative option would be to use APAP, which has been shown to be equally effective to NSAIDs in a number of studies of patients with mild-to-moderate osteoarthritis pain. Of note, patients who say that APAP does not work for them may not have used an optimal dose (3-4 g/day in divided doses for at least 2 wk), which would be required in order to show a lack of effectiveness. If APAP does not work and NSAID use is not contraindicated, a trial of analgesic dosing of a nonacetylated salicylate (eg, salsalate) or ibuprofen or celecoxib may be acceptable. For those with moderate-to-moderately severe osteoarthritis pain, a trial of a low-dose opioid or opioid-like agent (eg, codeine, tramadol) in combination with APAP is another option. The rationale for this approach is to combine two different mechanisms of analgesic action. In those elderly persons who require chronic NSAIDs, a proton pump inhibitor or misoprostol should be used to avoid the risk of PUD.^9,12 In general, long half-life NSAIDs (eg, naproxen, oxaprozin, piroxicam) and specific other NSAIDs (eg, indomethacin, ketorolac) should be avoided because their risk outweighs their potential benefits. ²⁸

Table

Preferred Analgesic Agents for Treatment of Nociceptive Pain in Older Adults

Drug	Initial Dosing	Special Considerations in Older Adults
Mild-to-Moderate Pain
APAP	325-500 mg every 4 h or 500-1000 mg every 6 h; maximum daily dose of 4000 mg	Does not interfere with platelet function; reduce maximum dose 50% to 75% in patients with hepatic insufficiency or history of alcohol abuse
Celecoxib	100 mg daily	Higher doses associated with higher incidence of GI and CV side effects; patients with indications for cardioprotection require aspirin
Ibuprofen	200 mg 3-4 times/day; maximum daily dose of 3200 mg	Risk of GI bleeding increased in persons > 75 yr; misoprostol or PPI should be prescribed for long-term users
Salsalate	500-750 mg every 12 h; maximum daily dose of 3000 mg	Does not interfere with platelet function; GI bleeding and nephrotoxicity are rare
Moderate-to-Moderately Severe Pain
APAP/Codeine	325/30 mg every 6 h; maximum daily dose of 12 tablets	Monitor for constipation, confusion, and falls; same considerations for APAP as listed above
APAP/Tramadol	325/37. 5 mg every 6 h; maximum daily dose of 8 tablets	Renally adjusted dose when estimated creatinine clearance < 30 mL/min: maximum of 2 tablets every 12 h; treatment should not exceed 5 days; same considerations for APAP as listed above

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APAP = acetaminophen; GI = gastrointestinal; CV = cardiovascular; PPI = proton pump inhibitor.

Contains information from references ⁵and ⁶.

This review has summarized the potential risks associated with chronic NSAID use in older adults, including GI, renal, CV/cerebrovascular, and CNS adverse effects. Although only ADRs affecting these four organ systems were discussed in this review, it is important to recognize that NSAIDs can cause various other adverse effects (eg, hepatotoxicity, cutaneous toxicity).² Moreover, it is important to note that nonpharmacological approaches (weight reduction, increasing physical activity) may also help patients who are experiencing musculoskeletal pain. ²⁹ For patients already taking NSAIDS chronically, healthcare providers should assess whether the patient could switch to APAP or salsalate. If the patient still requires a NSAID, GI prophylaxis should be considered in all older patients, especially those with other risk factors; importantly, the NSAID should be used at the lowest effective dose for the shortest period of time.

As the aging population rapidly grows over the next few decades, the risks associated with chronic NSAID use will remain an important public health issue. Hopefully, health-care providers armed with the above information who carefully and consistently monitor chronic NSAID use in their older patients will avoid these preventable complications.

The writing of this paper was supported by National Institute on Aging grants (R01AG027017, P30AG024827, T32 AG021885, K07AG033174, R01AG034056), a National Institute of Mental Health grant (R34 MH082682), a National Institute of Nursing Research grant (R01 NR010135), and an Agency for Healthcare Research and Quality grant (R01 HS017695).

The authors report no relevant financial relationships.

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Frequently Asked Questions About Advil Products for Pain Relief

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Ibuprofen and COVID-19

• I recently read an article that said you shouldn’t take ibuprofen/Advil if you have coronavirus (COVID-19), is this true?

  The Centers for Disease Control and Prevention (CDC) is currently not aware of scientific evidence establishing a link between NSAIDs (e.g., ibuprofen, naproxen) and worsening of COVID-19. We recommend you speak with your healthcare providers if you have any questions about the appropriate treatment for your unique individual needs when seeking to prevent or manage symptoms or conditions.

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  Ibuprofen, as well some other OTC analgesics may reduce fever due to their anti-pyretic properties. We advise you should speak directly with your doctor or healthcare provider if you have questions about your individual treatment needs.

• Will taking ibuprofen/Advil worsen the symptoms of coronavirus (COVID-19)?

  Research has been ongoing and the Centers for Disease Control and Prevention (CDC) is currently not aware of scientific evidence establishing a link between NSAIDs (e.g., ibuprofen, naproxen) and worsening of COVID-19.

  When asked if Advil makes COVID-19 symptoms worse, Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, responded, “no.” Read the full Aug. 13 article here: ABC News: Matthew McConaughey grills Dr. Anthony Fauci in Instagram interview on COVID-19.

  We advise you speak directly with your doctor or healthcare provider if you have questions about your individual treatment needs.

• Should I stop taking ibuprofen/Advil?

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  Ibuprofen is a well-established medicine that has been used safely for many years as a fever and pain reducer. Our ibuprofen products are effectively used by millions of consumers across 40 markets and have been available as over-the-counter medicines for more than 35 years. All medicines are strictly regulated to ensure they comply with local healthcare authority requirements.

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  We recommend you speak with your doctor or pharmacist if you have any questions about the best treatment for your individual needs when seeking to prevent or manage symptoms or conditions. At this time, the CDC and WHO among other health agencies do not recommend against the use of ibuprofen.

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  As a leader in the OTC pain category, GSK Consumer Healthcare is committed to consumer safety, and we are constantly re-evaluating the rapidly evolving COVID-19 situation alongside public health authorities. Based on currently available information, The World Health Organization (WHO) does not recommend against the use of ibuprofen, and the Centers for Disease Control and Prevention (CDC) is currently not aware of scientific evidence establishing a link between NSAIDs (e.g., ibuprofen) and worsening of COVID 19.

  Consumer safety is our number one priority. Ibuprofen is a well-established medicine that has been used safely for many years as a fever and pain reducer. Our ibuprofen products are effectively used by millions of consumers across 40 markets and have been available as over-the-counter medicines for more than 35 years. All medicines are strictly regulated to ensure they comply with local healthcare authority requirements.

• What are health agencies saying about the safety of ibuprofen/Advil?

  GSK continues to monitor the rapidly evolving COVID-19 situation alongside public health authorities, including Centers for Disease Control and Prevention (CDC), World Health Organization (WHO), U.S. Food and Drug Administration (FDA) and European Medicines Agency (EMA), and medical experts. None of these agencies currently recommend that individuals should stop taking ibuprofen/Advil.

• What is GSK’s position regarding the use of Ibuprofen/Advil to help treat the symptoms of COVID-19?

  Ibuprofen is listed as an essential medicine in the WHO guidelines for treating pain and fever associated with mild COVID-19. (Clinical Management of COVID-19 Interim Guidance). The CDC, FDA and NIH continue to acknowledge the lack of scientific evidence connecting ibuprofen with worsening COVID-19. As always, we advise people speak directly with their doctor or healthcare provider regarding individual treatment needs.

• What are health agencies saying about the use of Ibuprofen/Advil to treat COVID-19 symptoms?

  Health agencies, medical experts, and other global public health authorities have already acknowledged the lack of scientific evidence that NSAIDs worsen COVID-19 symptoms (Centers for Disease Control and Prevention (CDC), World Health Organization (WHO), U.S. Food and Drug Administration (FDA) and European Medicines Agency (EMA)).

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  No, ibuprofen/Advil can be used safely and effectively to relieve pain and reduce fever in COVID-19 patients based on the growing body of evidence and general medical consensus. *

  *When used as directed

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   The CDC recommends talking to your doctor about taking an over-the-counter medication, such as ibuprofen, for possible pain or discomfort from a COVID-19 vaccination.

Products

• Can I get samples of Advil?

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• What are the best options for over the counter pain relief?

  You have a lot of over-the-counter options when it comes to pain relief, which can be overwhelming. Your best option may depend on your specific pain needs and the advice of your doctor.

  However, it’s important to know the difference between Advil and other pain relievers. The pain ingredient in Advil is ibuprofen, which is part of a class of drugs called non-steroidal anti-inflammatory drugs (also known as NSAIDs). When you take Advil you get relief right at the site of pain. Wherever it is, Advil stops pain right where it starts.

  The makers of Advil do not produce store brand ibuprofen pain medicine.

• What type of closure is on the bottle? Is it child-resistant?

  Advil products are available with child-resistant caps. For those who may suffer from joint pain, Advil Tablets and Advil Liqui-Gels are also available with a non-child resistant, Easy Open Arthritis Cap. Since it is easier to open, make sure to keep the Easy Open Arthritis Cap products out of reach from children.

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  No. Single ingredient Advil products do not contain an antihistamine. The active ingredient in Advil is ibuprofen which is part of a class of drugs called NSAIDs (nonsteroidal anti-inflammatory drugs). Check out the Ingredients section of this FAQ to learn more about what is in Advil. If you are interested in an antihistamine, check out our Advil Cold Allergy Products.

• Where can I find information about other Advil products?

  In addition to the pain relieving power of Advil there are a variety of other Advil products that provide relief. We’ve included links to more information for those products below:

  • Advil PM
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  Advil Liqui-Gels minis patented technology enables us to concentrate the powerful pain relief of Advil Liqui-Gels into a 33% smaller capsule. Advil Liqui-Gels minis don’t contain a special form of ibuprofen, just a more concentrated dosage form.

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  Source: https://www.chpa.org/Monograph_FSA_CARES.aspx

Dosage

• How many Advil should I take?

  It depends. For most Advil products you can take 1 capsule/tablet every 4 to 6 hours. For Advil Migraine take 2 capsules with a glass of water every 24 hours. For Advil Dual Action take 2 caplets every 8 hours. Click on a product to learn more.

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• Can I take Advil every day?

  Advil should be used only as directed on the label. Stop taking Advil and talk to your doctor if your pain gets worse or lasts for more than 10 days, or if your fever gets worse or lasts for more than 3 days.

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  Signs of overdose are known to occur at 40x the maximum daily dose (1200mg). This low toxicity profile makes Advil a safe and effective pain reliever for multiple aches and pains.

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  RX ibuprofen (the active ingredient in Advil) has a higher dosage than OTC and must be prescribed by a doctor.

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  No. While no studies have shown a tolerance build up (or weakening of pain relieving power), over-the-counter pain relievers (including Advil) should not be used for longer than 10 days unless directed by a physician.

Usages

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  Advil Tablets, Gel Caplets, Liqui-Gels and Liqui-Gels minis contain an active ingredient, called ibuprofen, which temporarily reduces fever, as well as relieves minor aches and pains due to the common cold.

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  For further questions concerning your use of Advil products, please speak with a healthcare provider. If your symptoms continue to persist or get worse, please contact a physician immediately.

• What is Advil used for?

  Advil temporarily reduces fever and relieves minor aches and pains due to headaches, toothaches, backaches, menstrual cramps, the common cold, muscular aches and the minor pain of arthritis.

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• Can Advil be used to treat inflammation or swelling?

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  For sleeplessness associated with pain, check out Advil PM.

Comparisons

• What’s the difference between Tylenol and Advil?

  The pain reliever in all Advil products is ibuprofen which targets pain at the source. Acetaminophen, the active ingredient in Tylenol, blocks off pain signals. Advil Dual Action is first and only FDA approved combination of the two. It is also the only Advil product that contains acetaminophen. Read more

• Is Advil opioid free?

  Yes, Advil is opioid free. Advil (Ibuprofen) is a NSAID (Non Steroidal Anti Inflammatory Drug) which treats acute pain and fever by blocking the formation of pain promoting chemicals at the source and is not addictive. Opioids, on the other hand, work on receptors in the brain to block the transmission of pain. They’re addictive and cause side effects like sedation and euphoria.

• What are the differences between prescription opioids and OTC pain relievers?

  Like the name implies, over-the-counter pain relievers can be bought without a prescription and are used to treat moderate pain and fever. Opioids are a different class of drug that treat severe or chronic pain and require a prescription from a doctor. If you want to learn about how Advil and opioids interact, click here.

Ingredients

• Does Advil contain sodium?

  Fast-acting Advil Film-Coated contains ibuprofen sodium-a salt form of ibuprofen that dissolves differently from standard ibuprofen. However, each tablet contains 22 mg of sodium. Even if the maximum daily dose is taken (6 tablets), the total amount of sodium ingested is only 132 mg. Per the FDA, the recommended daily value for sodium is less than 2,400 mg per day, although some people may need less due to health concerns. Speak with your doctor about your sodium intake.

  *”Sodium in Your Diet: Use the Nutrition Facts Label and Reduce Your Intake” retrieved from FDA.gov.

• Does Advil have caffeine?

  No. If pain is keeping you awake at night and you want a medication that can help you fall asleep, learn more about Advil PM.

• Is Advil gluten free?

  We cannot guarantee that Advil is gluten-free. Although gluten isn’t added to our products during manufacturing, we can’t control whether or not trace amounts of it end up in the raw materials we get from suppliers.

• What is ibuprofen?

  Ibuprofen is in a class of drugs called nonsteroidal anti-inflammatory drugs (NSAID). When your body is hurt or aching, it produces chemicals that trigger pain signals. Ibuprofen, the main ingredient in Advil, stops the production of these chemicals at the source of injury to reduce pain.

  Learn More

• What are NSAIDs?

  NSAIDs, nonsteroidal anti-inflammatory drugs, are a group of chemical compounds that often are chemically unrelated but share therapeutic actions such as analgesic (pain-relieving) and antipyretic (fever-reducing) effects.

  Learn More

• Does Advil contain aspirin?

  No. The pain reliever in Advil is ibuprofen, however both are part of the class of drugs known as NSAIDs (nonsteroidal anti-inflammatory drug).

• Does Advil contain acetaminophen?

  Advil Dual Action is the only Advil product that contains Acetaminophen. Advil Dual Action fights pain in two ways: Acetaminophen blocks pain signals while Ibuprofen targets pain at the source.

Directions

• How quickly does Advil work? How long does it last?

  It depends on which form of Advil you take as well as how your body responds to the medicine. Some Advil products are designed to deliver faster relief, so read the product label to see how often you can take a dose.

• Should I take Advil with food?

  You do not have to take Advil with food. However, if you experience an upset stomach, you can take it with food or milk. If you have a history of serious stomach problems like ulcers, be sure that you talk to your doctor before taking Advil or any NSAID.

• Should I chew Advil?

  No, Advil is designed to be swallowed. However, we do make a chewable option for children aged 6-11. 

• Can I take Advil if I have a hangover?

  We don’t recommend taking Advil if you have a hangover. NSAIDs, like Advil, can cause severe stomach bleeding, especially if taken at higher doses. Those chances become even higher if you have 3 or more alcoholic drinks a day while taking Advil.

• Can I take Advil without water?

  No, Advil should be taken with a full glass of water.

Safety

• What effect will Advil have on the kidneys?

  It’s uncommon for Advil to harm the kidneys when it’s taken as directed. But higher doses or prolonged use can cause adverse effects. It’s also important to get clearance from your doctor if you are taking a diuretic, have kidney disease or have any other concerns.

• Can Advil be taken with vitamins and supplements?

  Some vitamins and supplements contain ingredients that can interact with medications like Advil (ibuprofen) so it’s best to talk to your doctor or pharmacist before taking them together.

• Can I take Advil if I’m on a CBD therapy?

  Cannabidiol or CBD products are new to the market and not enough studies have been done to know how they interact with medications like Advil. If you’re thinking about taking CBD it’s best to talk to your doctor before using it with another drug.

• Can Advil be taken with other OTC pain relievers like Excedrin or Aleve?

  No. Do not take Advil with other pain relievers that contain ibuprofen, acetaminophen, naproxen, or aspirin. To learn more about drug interactions, click here.

• Can I take Advil if I’m taking opioid medication?

  It’s best to talk to your doctor about combining Advil with opioids since there’s possibility for drug interaction.

  It’s important to know that studies show that taking ibuprofen (Advil) can reduce the amount of opioids needed for pain relief, and in some cases they’re even prescribed together.

• Can I take Advil with alcohol?

  It’s best to not take Advil with alcohol. Advil and other NSAIDs can cause severe stomach bleeding, especially if taken at higher doses for long periods of time. Those chances increase if you have 3 or more alcoholic drinks a day while taking Advil.

• Can I take Advil if I’m on aspirin therapy?

  It’s best not to unless directed to do so by your doctor. Advil and ibuprofen, its active ingredient, have potential to interfere with aspirin’s anti-blood clotting effect, reducing its ability protect your heart and prevent stroke.

• Is Advil Safe?

  For more than 30 years, extensive consumer use and numerous clinical studies have shown that, ibuprofen, the active ingredient in Advil, when used as directed, is a safe and effective OTC pain reliever and fever reducer.

  Please refer to the full product labeling for additional safety information related to Advil.

Side Effects

• Can I take Advil if I have a heart condition?

  Talk to your doctor before taking Advil if you have a history of heart problems like high blood pressure or heart disease. Ibuprofen and other NSAIDs can increase the risk of heart attack, heart failure or stroke, so it’s important to how they might affect your specific condition.

• Does Advil make you sleepy?

  Advil does not contain any ingredients or antihistamines that would make you sleepy. If you are suffering from occasional sleeplessness associated with pain, Advil PM combines the pain-relieving power of Advil with a non-habit forming sleep aid, diphenhydramine.

• Can Advil keep me awake?

  No. Advil doesn’t contain caffeine or any other stimulants that can keep you up. 

• Can Advil upset my stomach?

  Yes. Like many medications, Advil has potential to cause a minor upset stomach. However, studies have shown that there’s no significant difference between Advil and a placebo in causing an upset stomach.

• Can NSAIDS cause ulcers or stomach bleeding?

  NSAIDs may cause severe stomach bleeding. The chances are higher if you: are 60 or older; have a history of stomach problems; take a blood thinner; take other drugs containing prescription or nonprescription NSAIDs [aspirin, ibuprofen, naproxen, or others]; have more than 3 alcoholic drinks a day; or take more than directed.

• What are the long-term effects of taking Advil?

  Advil is only intended for short-term use and taking more than directed or for longer than directed can cause adverse side effects. So, make sure to talk to your doctor if your pain lasts more than 10 days, or if your fever doesn’t go away after 3 days.

• Is Advil bad for my liver?

  When used as directed, adverse effects on the liver are uncommon. Effects on the liver are rare but may include liver disorder, abnormal liver function, hepatitis and jaundice, and, they may occur at higher than recommended OTC doses.

  Consult your doctor before taking Advil if you have liver cirrhosis, or any other concerns about taking this product.

• Can Advil cause a stroke?

  If you have an existing heart condition or are at risk for it, talk to your doctor before taking Advil. NSAIDs like Advil can increase your risk of stroke and that risk becomes higher if you take more than directed or longer than directed.

• What are the side effects of taking Advil?

  As with all medications, taking Advil has potential side effects which may include:

  • Hives
  • Facial Swelling
  • Wheezing
  • Rash or blisters
  • Stomach bleeding
  • Chest pain
  • Increased risk of heart attack and stroke

  Click here to see a full list of side effects.

  If you have certain pre-existing health conditions, be aware that taking Advil can cause more serious side effects. Click here to learn more. 

  Learn More

• Is Ibuprofen addictive? Will it cause withdrawal symptoms?

  No. Advil is not habit forming, and it does not demonstrate addictive properties. Studies show that ibuprofen primarily works in the body (peripherally active), and not in the brain (not centrally active). Advil is not an opioid (it is non-narcotic).

• Is Advil bad for my stomach?

  NSAIDs like Advil can cause severe stomach bleeding. The chances are higher if you: are 60 or older; have a history of stomach problems; take a blood thinner; have more than 3 alcoholic drinks a day; or take more than directed.

Ibuprofen in the practice of a general practitioner: possibilities in the relief of pain syndromes | #01/13

Pain syndromes of various origins are often encountered in the daily practice of a general practitioner, which determines the growing need for effective painkillers. According to the independent research center DSM Group, an analysis of the pharmaceutical market in 2012 showed that painkillers turned out to be one of the most popular groups of pharmaceuticals [1]. It is analgesics that are the most widely demanded category of drugs on the pharmaceutical market [2].

The feeling of pain is familiar to everyone. Probably, there are no people who would not experience a feeling of pain during their life. A variety of causes of pain determines the high negotiability of patients for this reason to the doctor. It should be noted that the prevalence of pain syndromes in recent years, despite the development of pharmacy, has not decreased at all [3], on the contrary, there is even a tendency to increase it, especially for chronic pain [4].

Verification of the cause of pain is one of the keys to its successful treatment. Among the pain syndromes, the largest percentage is headaches, the prevalence of which reaches 90% in the population. Tension headaches (up to 60%) and migraine (up to 23%) undoubtedly dominate among them. The Global Health Survey, conducted in 54 countries with 27,000 respondents, found that headaches are the most common reason for seeking medical care and taking medicines (Fig. 1). The prevalence of primary headache in Russia (2725 respondents from 35 cities) reaches 62.9% with some predominance in the urban population, and more than 10% have a headache for more than 15 days a month. 68.1% of respondents indicated self-administration of over-the-counter drugs [5]. Headaches are the most common health complaints among drug users worldwide.

The top ten complaints, along with headache, also include back pain, sore throat and other types of pain. About 20% of the adult population suffers from recurrent back pain lasting more than three days, of which 20% of the pain lasts more than a month and is chronic. An equally acute problem is muscle pain, which in general occurs in 30–85% of the population. At the same time, myalgia can accompany vertebrogenic back pain (in 60% of patients), but it can also be primary [6].

The increase in the prevalence and incidence of pain syndromes is associated with both lifestyle changes and general aging of the population (Fig. 2).

The main trend in patients’ preferences is the possibility of self-treatment, i.e., an independent choice of an anesthetic. Therefore, as the data of epidemiological studies also show, most patients with the most common forms of pain syndromes remain outside the field of view of specialists. So, only about 10% of patients with back pain seek help from specialists. A similar situation is observed with headaches. Thus, among patients with one of the most common forms of cephalalgia – migraine – only 1/6 of them turn to specialists, the rest of the patients are out of their field of vision, preferring to be treated on their own [6].

Economic burden of pain syndromes

The increase in the prevalence of pain syndromes in the population is a significant burden for workers, employers and society, leading to loss of profit and additional costs and benefits [8]. A paradox in the pharmacoeconomics of pain is associated with the fact that cost is a potential barrier to optimal pain management, even suboptimal pain management shows an increase in overall health care costs [9].

Thus, in the United States alone, the annual costs of pain relief, as well as legal costs and compensation associated with pain syndrome, are estimated at almost 100 billion US dollars [10]. And, for example, in Sweden, the average annual cost of treating diseases associated with chronic pain (n = 840,000) is 6,400 euros per patient. Most of the costs (59%) are indirect costs (sick leave and early retirement), while the cost of analgesics is only about 1%. In general, the socioeconomic burden of diseases associated with chronic pain syndrome in Sweden alone reaches 32 billion euros per year [11].

Non-steroidal anti-inflammatory drugs (NSAIDs)

Practical experience shows that NSAIDs are most often used to relieve subjective pain manifestations. The presence of universal mechanisms of pain causes the possibility of using this group of drugs in various clinical situations. In Europe, NSAIDs are prescribed by 82% of general practitioners and 84% of polyclinic rheumatologists; in the hospital, they are used in 20% of patients [12].

Thanks to the studied analgesic, anti-inflammatory, antipyretic mechanisms of action, various representatives of NSAIDs have found wide practical application.

NSAIDs can relieve pain of various localization – in the musculoskeletal system, headache, toothache, menstrual pain. In addition, all NSAIDs have antipyretic and anti-inflammatory properties. The variety of therapeutic effects of NSAIDs, as well as the high prevalence of clinical situations in which they are effective, make this group of drugs the most commonly prescribed to patients. The need for NSAIDs is especially increasing in the elderly, often with concomitant diseases.

The main effects of NSAIDs are associated with the mechanism of suppression of the activity of cyclooxygenase (COX) – an enzyme that regulates the conversion of arachidonic acid into prostaglandins, prostacyclin and thromboxane. Differences in the severity of anti-inflammatory, analgesic effects and toxic effects of drugs of this class are associated with their different ability to influence two isoforms of COX – COX-1 and COX-2. Analgesic and anti-inflammatory effects are mainly associated with the inhibition of COX-2, and the development of side effects – with the suppression of COX-1. Therefore, the choice of a particular representative is determined by his ability to predominantly influence COX-2.

Analgesic efficacy profile of ibuprofen

One of the most well-known representatives of the NSAID class is ibuprofen, which has been successfully used in clinical practice for over 30 years and over 10 years in over-the-counter form (Nurofen). The high clinical efficacy of this drug is also confirmed by the high demand for it among consumers. Thus, only in the last six months, in terms of the share of sales value in Russia, Nurofen has moved from 8th to 3rd place, while occupying a leading position in Moscow [13].

The analgesic efficacy of ibuprofen has been convincingly proven in various models of pain syndrome — toothache [14–16], headache [17–23], sore throat [14], musculoskeletal pain [14–16], etc.

Toothache is well recognizable and sensitive enough to assess the analgesic effect of drugs. Ibuprofen at a dosage of 200-400 mg is the “gold standard” in the treatment of moderate pain in postoperative toothache [14]. A meta-analysis demonstrated high efficacy of ibuprofen compared to placebo in 72 studies. Ibuprofen significantly reduced pain in all patients by at least 50%, at a median of 4.7 hours. Repeat analgesia was required in only 48% of patients who took ibuprofen at a dose of 200 mg and in 42% at a dose of 400 mg [15]. In another meta-analysis, based on 33 studies, ibuprofen (400 mg) was found to be superior in pain relief after tooth extraction compared with paracetamol (1000 mg), as well as a combination of paracetamol (600-650 mg) and codeine (60 mg) [ 16].

For headaches, ibuprofen as a first-line drug is included in the list of analgesics recommended by WHO, as well as the European Federation of Neurological Societies (EFNS) for the treatment of mild to moderate migraine attacks (class A) [17, 18]. The effectiveness of ibuprofen in the treatment of cephalalgia has been proven in many placebo-controlled clinical trials, as well as several meta-analyses, including in children and adolescents [19-23].

For sore throat caused by tonsillopharyngitis, a double-blind, randomized, multicenter study compared the analgesic efficacy of ibuprofen (400 mg) or paracetamol (1000 mg). The severity of pain during swallowing, difficulty in swallowing, change in pain intensity every 6 hours after taking the first dose of drugs were assessed. Ibuprofen compared with paracetamol was significantly more effective in influencing the severity of pain and difficulty swallowing, while the effect of ibuprofen began significantly earlier than that of paracetamol. Tolerability of treatment was comparable in both groups, no serious side effects were observed during the study. Thus, the study showed that ibuprofen is a more effective alternative to paracetamol in the treatment of sore throat [24].

Ibuprofen, having high efficiency and low toxicity, is widely used in the long-term treatment of various inflammatory and degenerative diseases of the musculoskeletal system.

The effectiveness of ibuprofen and its benefits have been repeatedly demonstrated in large-scale studies. An illustrative example is the IPSO (Ibuprofen, Paracetamol Study in Osteoarthritis) multicenter randomized study conducted in 2004 with the participation of 222 patients suffering from osteoarthritis (OA) of the hip (30% of patients) or knee (70%) joint. Within two weeks, according to the WOMAC scale (Western Ontario and McMaster Universities osteoarthritis index), the effect of ibuprofen (400–1200 mg/day) and paracetamol (1000–3000 mg/day) on the severity of pain and articular syndromes was assessed. The results of the study demonstrated a more significant reduction in pain in the first 6 hours after taking the drug and a more pronounced further reduction within 14 days in the ibuprofen group compared to paracetamol. The authors concluded that single (400 mg) or multiple (up to 1200 mg) ibuprofen administration has a better efficacy/safety ratio than paracetamol [25]. The greater efficacy of NSAIDs, including ibuprofen, compared with paracetamol in the treatment of OA was also demonstrated in a Cochrane review [26].

According to current recommendations, the use of NSAIDs as a symptomatic treatment is indicated for all patients with rheumatoid arthritis (RA). Patients with OA are recommended to take NSAIDs only during the period of increased pain and in lower dosages than in inflammatory arthritis [27, 28].

Ibuprofen can be used both in monotherapy and as part of combination therapy in combination with other drugs. Thus, the addition of the centrally acting muscle relaxant tizanidine to ibuprofen can not only increase the effectiveness of therapy, but also reduce the incidence of adverse events from the use of NSAIDs. Tizanidine has a protective effect on the gastric mucosa from the action of NSAIDs [29]. This effect was convincingly demonstrated in the work of Berry H. et al., who studied the addition of tizanidine 4 mg tizanidine to ibuprofen therapy 400 mg three times a day in patients with acute pain in the lumbar region. The overall efficacy of treatment in both groups was almost the same, but the safety of treatment was higher with the combined use of ibuprofen and tizanidine. Patients receiving ibuprofen/tizanidine combination therapy experienced significantly fewer gastrointestinal (GI) side effects compared with placebo/ibuprofen (p < 0.002) [30].

Topical ibuprofen

The high demand for ibuprofen preparations is also due to the variety of its dosage forms. In patients with acute or chronic musculoskeletal pain, especially with local lesions of the musculoskeletal system and with traumatic soft tissue lesions, topical application of NSAIDs in the form of gels and ointments is possible, which reduces the systemic effect and, consequently, adverse reactions.

The effectiveness of this dosage form is not inferior to that of tablets. A number of studies have shown that ibuprofen, regardless of dosage form, is a highly effective representative of NSAIDs with a good safety profile.

The widespread use of topical forms of ibuprofen is due to the fact that in patients taking oral forms of NSAIDs for a long time, erosive and ulcerative lesions of the gastrointestinal mucosa, including perforation and bleeding, may develop in 22–68% of cases. At the same time, up to 30% of additional costs in the treatment of arthritis can be attributed to the treatment of gastrointestinal side effects caused by oral NSAIDs [31, 32]. Given that topical forms of NSAIDs are as effective as oral forms, their more favorable tolerability profile makes them preferable in certain clinical situations, such as knee pain. Thus, the administration of oral and topical forms of ibuprofen has an equivalent effect on knee pain within a year. Due to a more favorable tolerability profile, topical forms of NSAIDs may be prescribed as an alternative to oral forms [33]. According to the results of a Cochrane review of 47 studies, the authors concluded that when using topical forms of NSAIDs, a good effect is observed compared with enteral use and a significantly lower number of complications [34].

The same efficacy of topical ibuprofen (5% gel) and oral ibuprofen 400 mg (1200 mg per day) has been proven in acute soft tissue injury for at least 7 days. In both groups, complete improvement was observed between the 3rd and 6th day of therapy. It should be noted that the treatment was well tolerated in both groups (the identified cases of adverse events were not related to the treatment) [35].

With slightly higher costs for the use of topical forms of ibuprofen compared to oral forms, the total cost of treatment is reduced by reducing the incidence of side effects, which was shown when processing the results of the TOIB study (Topical or oral ibuprofen for chronic knee pain in older people) [36] .

Safety profile of ibuprofen therapy

The main problem of patients with chronic pain is the safety of the drug used for long-term use. It’s no secret that the main serious side effect of all NSAIDs is gastrointestinal bleeding (GI bleeding). Many studies indicate that the use of ibuprofen at low doses (up to 1200 mg/day) causes only minimal damage to the gastrointestinal mucosa, even with prolonged use. Ibuprofen, as a drug with well-studied pharmacological effects, is considered the “gold standard” for safe use, which is especially important in the treatment of patients with chronic pain syndromes. Ibuprofen at low doses (800–1200 mg per day) is approved for OTC use in many countries and has a good safety profile comparable to that of paracetamol.

An increase in recommended doses (up to 1800-2400 mg per day) is used in the long-term treatment of rheumatic and some other diseases of the musculoskeletal system. Based on a meta-analysis of observational epidemiological studies from 2000–2008. the influence of various NSAIDs on the risk of bleeding from the upper gastrointestinal tract has been established. As originally expected, the lowest incidence of GI bleeding was observed in the coxibs group (hazard ratio (RR) 1.88; 95% confidence interval (CI) 0.96–3.71), among non-selective NSAIDs, ibuprofen had the best results (RR 2.69; 95% CI 2.17–3.33), while ketorolac had the highest risk (RR 14.54; 95% CI 5. 87-36.04) and piroxicam (RR 9.94; 95% CI 5.99-16.50). The authors concluded that the frequency of bleeding depends on several factors: the selectivity of the drug for COX, dosage and duration of use, as well as the half-life or use of a prolonged form of the drug [37]. Similar results were demonstrated in a number of earlier meta-analyses, according to which ibuprofen was characterized by the lowest risk of GI bleeding compared with diclofenac, naproxen, indomethacin, piroxicam and ketoprofen [37-40].

The dose-dependent effect of ibuprofen on the occurrence of serious gastrointestinal complications has been confirmed in a number of other studies. The risk of serious gastrointestinal adverse events in the treatment of NSAIDs is relatively low, the latter occur in 1% of patients per year, mainly when they are used in high doses in the long-term treatment of chronic conditions. The frequency of side effects when using ibuprofen at recommended doses in children and adults is comparable to that of paracetamol. Of all NSAIDs, ibuprofen appears to have one of the best gastrointestinal safety profiles [41, 42].

It can be unequivocally concluded that ibuprofen has the best safety profile in relation to the gastrointestinal tract among non-selective NSAIDs, as well as a relatively low risk of developing cardiovascular complications with long-term use.

In accordance with existing recommendations, there are no significant advantages in the effectiveness of various NSAIDs among themselves, including selective ones, in the treatment of rheumatic diseases, so the choice of the drug should be made based on its safety profile and the individual characteristics of the patient. Patients at high risk of cardiovascular complications should not take coxibs. To reduce the risk of gastrointestinal complications, it is recommended to use misoprostol or proton pump blockers in conjunction with non-selective NSAIDs.

Currently, the first large randomized study (n = 20,000 patients) is being conducted, the purpose of which is to establish the safety profile of celecoxib, ibuprofen and naproxen in patients with OA or RA with a high risk of developing cardiovascular complications [43]. This study will provide clearer recommendations regarding the introduction of such patients.

Conclusion

Thus, the clinical experience of using ibuprofen in the most common forms of pain syndromes demonstrates its effectiveness not only as a means for stopping pain episodes, but also for the course treatment of chronic pain. An additional advantage of this drug is its existence in several dosage forms.

The use of ibuprofen (Nurofen) meets modern standards of pain therapy. Ease of use, a variety of dosage forms of the drug and its availability determine the high compliance of patients with prescribed therapy, which is the key to successful treatment.

More than 50 years of successful use of ibuprofen in wide clinical practice in more than 80 countries as an over-the-counter drug is a clear example of its high efficacy and safety profile [44].

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T. E. Morozova, Doctor of Medical Sciences, Professor
S. M. Rykova, Candidate of Medical Sciences

First Moscow State Medical University. I. M. Sechenov Ministry of Health of the Russian Federation, Moscow

Corresponding contact information about the authors: [email protected]

Advil vs. Motrin: difference and comparison

Self-medication without a prescription has been quite common for generations. These are medicines that are already officially approved for sale to the general public, even without a doctor’s prescription.

Science quiz

Test your knowledge on science-related topics

1 / 10

Which of the following metals remains in a liquid state under normal conditions?

Radium

Zinc

Uranium

Mercury

2 / 10

What is the most plastic metal?

Gold

Silver

Copper

Iron

3 / 10

What is another name for Newton’s first law?

Action-reaction

Change of momentum

Law of inertia

Constant momentum

4 / 10

A chemical reaction that releases energy is called:

endothermic

exothermic

5 / 10

What is the purpose of a choke in lamp light?

To decrease the current

To increase the current

To decrease the voltage momentarily

To increase the voltage momentarily

6 / 10

A passenger in a moving bus is thrown forward when the bus suddenly stops. This explains

Newton’s first law

Newton’s second law

Newton’s third law

conservation of momentum

7 / 10

Quartz crystals commonly used in quartz clocks, etc. ., chemically

silicon dioxide

germanium oxide

mixture of germanium oxide and silica

sodium silicate

8 / 10

What is the pH range of acids?

0 – 7

7 – 14

1 – 7

7 – 15

9 / 10

Which instrument is used to measure atmospheric pressure?

Ammeter

Voltmeter

Seismograph

Barometer

10 / 10

What is PH H ₂ O?

your account

In addition, many types of medicines are designed to treat common diseases and problems. They, like other medicines, are not safe to use on a regular basis for an extended period of time.

Advil and Motrin Here are some textbook examples of over-the-counter drugs commonly used by the general public.

This article focuses on the differences and functionality of both drugs at the same time. Although Advil and Motrin are chemical trade names for ibuprofen, a popular NSAID, there have been some differences in their medicinal and therapeutic effects on a person’s immunity and overall health.

Key Findings

1. Both Advil and Motrin contain the same active ingredient, ibuprofen.
2. Advil is available in various forms such as tablets, softgels and liquid gels, while Motrin is available as tablets and liquid suspensions.
3. Pfizer sells Advil and Motrin sells Johnson & Johnson.

Advil vs. Motrin

Advil is manufactured by Pfizer. Motrin is manufactured by Johnson & Johnson. Some people may prefer one brand over another due to differences in inactive ingredients such as fillers or coatings, which can affect how the drug is absorbed and metabolized in the body.

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As we now know, the medicinal properties of both Advil and Motrin are one hundred percent the same, so the comparison is biased towards their brands. Advil, owned by Pfizer, is a synthetic anti-inflammatory drug.

Ibuprofen helps lower blood levels of hormones that cause irritation and discomfort.

Advil is used to relieve pain caused by a number of conditions including headache, toothache, back pain, osteoarthritis, menstrual cramps and minor injuries. Advil is prescribed for adults and children over two years of age.

Consult a physician if your child is under two years of age.

Motrin, on the other hand, Motrin is a junior version of ibuprofen that works just like Advil. The main difference may be the time it takes Motrin to provide clinical utility, as it works faster.

Motrin is owned by well-known cosmetic and medical concern Johnson and Johnson.

It is often used to treat fevers and mild muscle pain associated with colds and body aches caused by viral fevers. Motrin is an anti-inflammatory medicine that is not a corticosteroid (NSAID). It works by preventing the development of certain natural chemicals that cause inflammation throughout the body.

Comparison table

Comparison parameters	Advil	Motrin
Manufactured to	Pfizer makes advil.	Motrin is manufactured by Johnson & Johnson.
Launch Date	Advil entered the market in the early 1970s.	Motrin sold its first batch in America in 1974.
packaging	Advil has a blue rectangular box with white accents and the medicinal properties of ibuprofen.	Motrin has an orange box with a picture of a chewable tablet.
effect	Advil reacts slowly and takes time to act, although it is said that Advil can especially cure fever in a few minutes.	Motrin is more effective in less time and has been found to relieve pain and anxiety fairly quickly.
Quantity	The 200 mg pack contains 50 tablets.	200 mg sachet contains 80 chewable tablets.

What is Advil?

Advil belongs to the family of non-steroidal anti-inflammatory drugs (NSAIDs). This family includes aspirin, diclofenac (Aliv), ibuprofen (Indocin), nabumetone (Relafen), and many other drugs.

These medicines are prescribed to treat conditions associated with pain, fever and irritation.

The body’s production of molecules called prostaglandins causes pain, fever and irritation. Advil inhibits the mechanism of prostaglandin production (cyclooxygenase), reducing the concentration of prostaglandins.

Reduces friction, discomfort and fever. Ibuprofen was approved by the FDA in 1974.

Advil is the first of the popular ibuprofen companies, principally Pfizer. As a result, more time is required to establish a therapeutic effect.

Because the time it takes for a drug to work varies greatly depending on who is taking it, there is no set range for its distributed practice. Even though they are both on the same side of the comparison, Advil has been shown to lower temperatures slightly faster, however more evidence is needed to support this claim.

Some of the ideal features that Advil 300 mg has are as follows:

1. It relieves discomfort and pain in the body and is also a good substitute for aspirin.
2. Reduces swelling by acting as an anti-inflammatory agent.
3. Lasts longer than Motrin and is available as a tablet, digestible pill, or liquid.
4. To be taken with food or drink.
5. It should not be given to a child who vomits, is malnourished, or swallows little as it may cause abnormalities if the child is taking drugs that destroy the kidneys.

What is Motrin?

Motrin is another brand name of ibuprofen that is brand new and manufactured by the infamous Johnson & Johnson. If the product contains ibuprofen, this will be stated on the package at the pharmacy.

Motrin is an NSAID or non-steroidal anti-inflammatory drug with analgesic, anti-migraine, stimulant and anti-inflammatory effects in high doses.

Motrin and other ibuprofens are currently on the World Health Organization’s recognized list of essential medicines. The list defines the absolute necessity of medical requirements for rudimentary medical care.

Corticosteroids and narcotics or opiates are two other forms of pain relief. Long-term steroid use will have serious side effects that cannot be reversed or easily treated, so NSAIDs are the best alternative, and the window period, and especially the effective Motrin stage, miraculously passes quickly in about 15-20 minutes. pain can be relieved.

The Motrin long-term stay news and findings did cause Johnson & Johnson to withdraw their Motrin sub-brands for a while due to some kind of crisis that PRO J&J didn’t handle thoroughly.

The recall of Motrin Newborn Drops in September 2013, as well as the recall of Motrin Infant, Drops in the mid-2010s, was clearly a setback for the company’s Motrin-branded ibuprofen. Johnson & Johnson, maker of Motrin, was also fined $25 million and withdrawn from the tender for “supplying for re-introduction into interstate or foreign commerce of contaminated children’s and over-the-counter oral drugs. ”

Main differences between Advil and Motrin

1. Advil is slow to react and takes time to act, while Motrin is more effective in less time.
2. The effects and therapeutic aspects of Advil are stronger and longer lasting than Motrin and its sub-brands.
3. Advil is manufactured by Pfizer and Motrin is manufactured by Johnson & Johnson.
4. Advil is an older product, while Motrin was launched at the end of 2009, so it is a new product compared to Advil.
5. Advil has a blue-white pack of 50 200 mg tablets, while Motrin has an orange-yellow pack of 80 200 mg tablets.

Recommendations

1. https://www.medicalnewstoday.com/articles/161071#what-is-ibuprofen
2. https://www.vkwholesale.com/advil-ibuprofane-blister-pack-12- pk-x-2-tablets.html

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