How much ibuprofen can I take and how often?

Medically reviewed by Carmen Pope, BPharm. Last updated on Sep 6, 2022.

What is the maximum amount you can take?

Adults can take one or two ibuprofen 200mg tablets (200mg to 400mg) three or four times daily if they need to. You should only take ibuprofen every 4 to 6 hours.

You should not take more than 6 tablets (1200mg) in total in one day if you have bought them over the counter, from a supermarket or drug store. You should always try and take the smallest dose needed that gives you relief.

If your doctor has prescribed them for you on prescription, usually as a higher strength tablet, then you can take a maximum of 3200mg in one day.

How much ibuprofen is in a single dose?

A single dose of ibuprofen contains 200mg if it has been bought over the counter from a supermarket or a drug store. Extra strength tablets usually contain 400mg. Some prescription strengths of ibuprofen contain an even higher dose, such as 600mg or 800mg. Always check the label on the packet to make sure you know what dosage your ibuprofen tablets contain.

How often can you take Ibuprofen?

You can take ibuprofen every four to six hours.

How much ibuprofen can you take in a day?

You should not take more than 6 tablets (1200mg) in total in one day if you have bought them over the counter, from a supermarket or drug store.

If your doctor has prescribed them for you on prescription, usually as a higher strength tablet, then you can take a maximum of 3200mg in one day.

You should always try and take the smallest dose needed that gives you relief.

How much ibuprofen is too much?

More than 3200mg of ibuprofen in one day is too much.

What happens if you take too much ibuprofen?

If you take too much ibuprofen you may develop stomach problems, such as heartburn, indigestion, or a stomach ulcer. You may experience bleeding from your gastrointestinal tract or from anywhere in your body and you may feel dizzy.

Occasionally people who have overdosed on ibuprofen have developed kidney failure or seizures. Metabolic acidosis (a build-up of acidic by-products in the blood) has been reported and an increase in the time it takes for blood to clot can occur.

If you suspect a person has overdosed on ibuprofen, seek medical attention immediately. Usually, doctors can reverse the effects of an ibuprofen overdose if the person is seen quickly.

References

• Ibuprofen. Updated 01/2021. Drugs.com https://www.drugs.com/ibuprofen.html
• Ibuprofen (oral route). Mayo Clinic. https://www.mayoclinic.org/drugs-supplements/ibuprofen-oral-route/proper-use/drg-20070602

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Drug information

• Ibuprofen Information for Consumers
• Ibuprofen prescribing info & package insert
  (for Health Professionals)
• Side Effects of Ibuprofen
  (detailed)

Related support groups

• Ibuprofen
  (250 questions, 230 members)

Medical Disclaimer

How and when to take or use ibuprofen

Dosage and strength for tablets, capsules, granules and liquid

Each ibuprofen tablet or capsule contains 200mg, 400mg or 600mg of ibuprofen. Slow-release tablets and capsules contain 200mg, 300mg or 800mg of ibuprofen.

Each sachet of granules contains 600mg of ibuprofen.

If you’re taking ibuprofen as a liquid, 10ml contains either 200mg or 400mg. Always check the label.

The usual dose for adults is one or two 200mg tablets or capsules 3 times a day. In some cases, your doctor may prescribe a higher dose of up to 600mg to take 4 times a day if needed. This should only happen under supervision of a doctor.

If you’re taking granules, the usual dose for adults is one sachet 2 or 3 times a day. Some people might need to take it 4 times a day.

If you take ibuprofen 3 times a day, leave at least 6 hours between doses. If you take it 4 times a day, leave at least 4 hours between doses.

If you have pain all the time, your doctor may recommend slow-release ibuprofen tablets or capsules. You’ll usually take these once a day in the evening or twice a day. Leave a gap of 10 to 12 hours between doses if you’re taking ibuprofen twice a day.

How to take tablets, capsules, granules and liquid

Swallow ibuprofen tablets or capsules whole with a drink of water, milk or juice. Do not chew, break, crush or suck them as this could irritate your mouth or throat.

For people who find it difficult to swallow tablets or capsules, ibuprofen is available as a tablet that melts in your mouth, granules that you mix with a glass of water to make a drink, and as a liquid.

If you’re taking the tablet that melts in your mouth, put it on your tongue, let it dissolve and then swallow. You do not need to drink any water.

Take ibuprofen granules by emptying the contents of the sachet into a glass full of water to make an orange flavoured fizzy drink, stir and drink straight away.

If you’re taking liquid, it will come with a plastic syringe or spoon to measure your dose. If you do not have a syringe or spoon, ask your pharmacist for one. Do not use a kitchen spoon, as it will not measure the right amount.

Take ibuprofen tablets, capsules, granules or liquid with a meal or snack, or with a drink of milk. It will be less likely to upset your stomach. If you take it just after food, ibuprofen may take longer to start working.

How long to take it for

If you’re taking ibuprofen for a short-lived pain like toothache or period pain, you may only need to take it for a day or two.

You may need to take ibuprofen for longer if you have a long-term health problem, such as rheumatoid arthritis.

If you need to take ibuprofen for more than 6 months, your doctor may prescribe a medicine to protect your stomach from any side effects.

If you forget to take ibuprofen tablets, capsules, granules or liquid

If you are prescribed ibuprofen as a regular medicine and forget to take a dose, take the missed dose as soon as you remember, unless it’s almost time for your next dose. In this case, skip the missed dose and take your next dose at the usual time.

Never take a double dose to make up for a forgotten one.

If you often forget doses, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to help you remember to take your medicine.

If you take too much ibuprofen tablets, capsules, granules or liquid

Taking too much ibuprofen by mouth can be dangerous. It can cause side effects such as:

• feeling and being sick (nausea and vomiting)
• stomach pain
• feeling tired or sleepy
• black poo and blood in your vomit – a sign of bleeding in your stomach
• ringing in your ears (tinnitus)
• difficulty breathing or changes in your heart rate (slower or faster)

Urgent advice: Contact 111 for advice now if:

• you’ve taken more than it says on the packet of ibuprofen tablets, capsules, granules or liquid

Go to 111. nhs.uk or call 111

Immediate action required: Go to A&E now if:

you’ve taken more than it says on the packet of ibuprofen tablets, capsules, granules or liquid and:

• your heart rate (pulse) has slowed down or got faster
• you’re having difficulty breathing

If you go to A&E, do not drive yourself. Get someone else to drive you or call for an ambulance.

Take the ibuprofen packet, or the leaflet inside it, plus any remaining medicine with you.

Dosage for ibuprofen gel, mousse or spray

The amount of ibuprofen you put on your skin depends on the product you’re using. Check the package leaflet carefully for how much to use.

How to use ibuprofen gel, mousse or spray

Gently massage the ibuprofen into the painful area 3 or 4 times a day. Leave at least 4 hours between applications.

Most products must not be used more than 4 times in 24 hours. Check the instructions that come with the medicine to see how many times a day you can use it.

Never use ibuprofen gel, mousse or spray on your eyes, mouth, lips, nose or genital area. It may make them sore. Do not put it on sore or broken skin.

Do not put plasters or dressings over skin you’ve applied ibuprofen to.

Wash your hands after using it, unless you are treating your hands.

Do not smoke or go near naked flames as clothes that have been in contact with ibuprofen gel, mousse or spray burn more easily, even if they have been washed.

If you forget to put it on

Do not worry if you occasionally forget to use ibuprofen gel, mousse or spray, just carry on using it when you remember.

If you put on too much ibuprofen gel, mousse or spray

Putting too much ibuprofen on your skin is unlikely to cause problems.

If you swallow the gel, mousse or spray

If you swallow ibuprofen gel, mousse or spray, you may get symptoms including:

• headaches
• being sick (vomiting)
• feeling sleepy or dizzy

Urgent advice: Contact 111 for advice now if:

• you swallow ibuprofen gel, mousse or spray and you feel unwell

Go to 111.nhs.uk or call 111

Ibufen – instructions for use, doses, side effects, reviews of the drug:

Description of the drug Ibufen (oral suspension, 100 mg / 5 ml) is based on the official instructions, approved by the manufacturer in 2004

Date approval: 27. 07.2004

Contents

• Active substance
• ATX
• Pharmacological group
• Nosological classification (ICD-10)
• Composition and form of release
• Description of the dosage form
• Pharmacokinetics
• Indications
• Contraindications
• Dosage and administration
• Side effects
• Interaction
• Overdose
• Precautionary measures
• special instructions
• Storage conditions
• Best before date
• Reviews

Active ingredient

Ibuprofen* (Ibuprofen*)

ATX

M01AE01 Ibuprofen

Pharmacological group

NSAIDs – Derivatives of propionic acid

Nosological classification (ICD-10)

ICD-10 code list

Composition and formulation

in orange glass bottles of 100 g; in a box 1 bottle (a measure with a scale is attached to the package).

Description of dosage form

Suspension of orange color with an orange smell and sweet taste, with a slightly perceptible burning aftertaste. There may be a separation into a liquid layer and a precipitate, which, after mixing, constitute a homogeneous suspension.

Pharmacokinetics

After oral administration, more than 80% is absorbed from the gastrointestinal tract. max “> C _max in blood plasma is achieved when taken on an empty stomach – after 45 minutes, when taken after a meal after 1.5–2.5 hours. Protein binding – 90%. It slowly penetrates into the joint cavity, but in the synovial fluid it creates concentrations higher than in the blood plasma (C _max in the synovial fluid is reached after 2-3 hours). Metabolized mainly in the liver. It undergoes pre- and post-systemic metabolism. After absorption, about 60% of the pharmacologically inactive R-form is slowly transformed into the active S-form. Excreted by the kidneys (60-90% in the form of metabolites and products of their combination with glucuronic acid, to a lesser extent – with bile, unchanged – no more than 1%). Has biphasic elimination kinetics with 1/2″>T _1/2 2–2.5 hours, after administration in a single dose, completely eliminated within 24 hours. The antipyretic effect of Ibufen develops after 30 minutes and lasts 6–8 hours. colds, acute respiratory viral infections, influenza, tonsillitis (pharyngitis), childhood infections accompanied by fever, post-vaccination reactions.

As an analgesic: for toothache, painful teething, headache, migraine, neuralgia, muscle and joint pain, trauma and burns.

Contraindications

Hypersensitivity (including to acetylsalicylic acid or other NSAIDs), peptic ulcer of the stomach and duodenum, severe insufficiency of the liver, kidneys, cardiovascular system, arterial hypertension, hemophilia, hypocoagulation, hemorrhagic diathesis, glucose deficiency -6-phosphate dehydrogenase, bronchospastic reactions after the use of acetylsalicylic acid or other NSAIDs (“aspirin asthma”), Quincke’s edema, nasal polyps, hearing loss, infancy (up to 6 months, with body weight – below 7 kg).

Dosage and administration

Information for healthcare professionals only.
Are you a healthcare professional?

By mouth , after eating. The average single dose is 5-10 mg/kg of body weight 3-4 times a day. Children aged 6 months – 1 year (7-9 kg) – 2.5 ml (50 mg) 3 times a day, the maximum daily dose is 7.5 ml (150 mg). 1-3 years (10-15 kg) 2.5 ml (50 mg) 3-4 times a day, maximum daily dose is 7.5-10 ml (150-200 mg). 3-6 years (16-20 kg) – 5 ml (100 mg) 3 times a day, the maximum daily dose is 15 ml (300 mg). 6-9 years (21-30 kg) – 5 ml (100 mg) 4 times a day, the maximum daily dose is 20 ml (400 mg). 9-12 years (31-41 kg) – 10 ml (200 mg) 3 times a day, the maximum daily dose is 30 ml (600 mg). Over 12 years (more than 41 kg) – 10 ml (200 mg) 4 times a day, the maximum daily dose is 40 ml (800 mg). The dose can be repeated every 6-8 hours. Do not exceed the maximum daily dose. For children from 6 months to 1 year, the drug is prescribed on the recommendation of a doctor.

Side effects

From the side of the central nervous system: headache, dizziness, sleep disturbance, anxiety, drowsiness, depression, agitation, visual impairment (reversible toxic amblyopia, blurred vision or double vision).

From the side of hematopoiesis: heart failure, tachycardia, increased blood pressure; anemia, thrombocytopenia, agranulocytosis, leukopenia.

From the digestive tract: nausea, vomiting, loss of appetite, heartburn, abdominal pain, diarrhea, constipation, flatulence, abnormal liver function, peptic ulcers, gastric bleeding.

From the urinary system: acute renal failure, allergic nephritis, nephrotic syndrome (edema), polyuria, cystitis.

Allergic reactions: itching, rash, bronchospastic syndrome, allergic rhinitis, angioedema, Steven-Johnson syndrome, Lyell’s syndrome.

Interactions

Information for healthcare professionals only.
Are you a healthcare professional?

Should not be combined with other NSAIDs (acetylsalicylic acid reduces anti-inflammatory effect and increases side effects). When taken simultaneously with diuretics, the diuretic effect decreases and the risk of developing renal failure increases. Weakens the effect of antihypertensive drugs, incl. ACE inhibitors (simultaneously reduces their excretion by the kidneys), beta-adrenergic agents, thiazides. Enhances the effect of oral hypoglycemic agents (especially sulfonylurea derivatives) and insulin, indirect anticoagulants, antiplatelet agents, fibrinolytics (increases the risk of hemorrhagic complications), the toxic effect of methotrexate and lithium preparations, increases the concentration of digoxin in the blood.

Microsomal oxidation inducers (phenytoin, ethanol, barbiturates, zixorin, rifampicin, phenylbutazone, tricyclic antidepressants) increase the risk of developing severe hepatotoxic complications (increase the production of hydroxylated active metabolites), microsomal oxidation inhibitors reduce it. Caffeine enhances the pain-relieving effect.

Overdose

Symptoms: abdominal pain, nausea, vomiting, lethargy, headache, tinnitus, depression, drowsiness, metabolic acidosis, hemorrhagic diathesis, decreased blood pressure, acute renal failure, abnormal liver function, tachycardia, bradycardia , atrial fibrillation; convulsions, apnea and coma (especially characteristic of children under 5 years of age).

Treatment: gastric lavage, administration of activated charcoal, alkaline drink, symptomatic therapy (correction of acid-base balance, blood pressure).

Precautions

Use with caution in cirrhosis of the liver with portal hypertension, hepatic and/or renal insufficiency, heart failure, nephrotic syndrome, hyperbilirubinemia, gastric and duodenal ulcer (history), gastritis, enteritis, colitis, diseases blood (leukopenia, anemia), pregnancy (II-III trimesters), during breastfeeding. In patients with bronchial asthma or other diseases that occur with bronchospasm, there may be an increased risk of developing bronchospasm.

During long-term treatment, it is necessary to control the picture of peripheral blood and the functional state of the liver and kidneys. When symptoms of gastropathy appear, careful monitoring is indicated (conducting esophagogastroduodenoscopy, a blood test with the determination of hemoglobin, hematocrit, fecal occult blood analysis).

If there is no antipyretic effect within 2 days and no analgesic effect within 3 days, you should consult a doctor. In case of side effects, stop taking the drug and consult a doctor.

Special instructions

Shake the vial before use until a homogeneous suspension is obtained. With prolonged use, NSAIDs can cause damage to the gastric mucosa, peptic ulcers, and gastrointestinal bleeding.

Use with caution in diabetic patients – contains sugar.

If side effects occur, stop taking the drug and consult a doctor.

Storage conditions

In a place protected from light, at a temperature not exceeding 25 ° C, in the original packaging.

Keep out of reach of children.

Expiry date

3 years.

Do not use after the expiry date which is stated on the package.

Update Date: 05/24/2022

Rhodiola Rosea – An Adaptogen for Longevity, Energy & Brain Function｜ iHerb Blog

The information on this blog has not been verified by your country’s public health authority and is not intended as a diagnosis, treatment, or medical advice.
Read more

Rhodiola rosea (arctic root, rose root, golden root and royal root) is the most effective and versatile member of an elite class of medicinal plants called adaptogens. They got this name due to their influence on our ability to withstand many stress factors: physical, psychological, toxic, chemical, infectious, tumor (cancerous), aging factors, etc.

Rhodiola rosea is a wild plant growing at high altitudes from 2400 -300 m above sea level in the mountains of Siberia, Georgia and Scandinavia. People living at these heights have been collecting the roots of this plant for centuries and using them to survive in harsh conditions. The place where these plants grew was kept secret. The roots of Rhodiola rosea were exchanged for food and other goods. Chinese emperors sent expeditions to get the precious roots, which were known as “golden root” or “royal root”. Extracts of this plant have been used to treat infections and increase energy levels and physical strength, improve brain function, fertility and sexual function.

Today, due to the growing demand for adaptogens, wild Rhodiola rosea is a protected species. The plant began to be actively cultivated in Scandinavia and Eastern Europe. Although the cultivated plant is not as effective as wild Rhodiola rosea, the extract of a properly grown plant can be used to produce effective nutritional supplements. Top quality products can be found by researching the writings of herbalists or by selecting brands and brands that have been proven effective in published scientific studies.

Marker compounds are used to confirm that products contain true Rhodiola Rosea without impurities. Rosavins, salidroside (radioloside) and tyrosol are used as active marker compounds in standardized extracts. Unfortunately, the standardization system is not reliable. Today, companies can synthesize marker compounds and add them to herbal extract kits, enough to meet standardization requirements.

Numerous bioactive compounds

People often ask how one plant can have so many different therapeutic effects. The answer is simple. Rhodiola rosea root contains dozens of bioactive compounds that have individual and synergistic effects, such as antioxidant, antidepressant, or anti-fatigue. Genomic studies show that a single dose of Rhodiola rosea extract can affect the activity of over 800 genes. We will tell you how to use the potential benefits of this adaptogen.

Increasing and maintaining energy – reducing fatigue

An increase in energy is one of the first effects that those who start taking Rhodiola rosea notice. Unlike synthetic drug stimulants, Rhodiola rosea increases energy levels gradually. The effect lasts for about 8 hours, then the energy level gradually decreases. As a result, Rhodiola does not cause addiction or withdrawal symptoms.

In general, Rhodiola rosea increases the ability of cells to produce high-energy molecules. As a result, many types of cells – muscle cells, neurons, etc. – receive enough energy to continue to function normally for a longer time. Moreover, the cells have enough energy to maintain the mechanisms of cellular repair. In addition, Rhodiola rosea protects cells from oxidative damage, toxins, hypothermia or overheating, infections, low oxygen levels, and other forms of stress.

Rhodiola rosea may help reduce fatigue due to many different causes, including fatigue due to stress, overwork, disease, sleep deprivation and aging.

Get Smarter Naturally

Many studies have shown that Rhodiola rosea can improve cognition, memory and mental performance, especially under stressful conditions. For example, participants in randomized controlled trials (RCTs) who took Rhodiola rosea made fewer errors compared to those who were given a placebo. In addition, as the duration of testing increased over many hours, the difference in performance became even greater, which means that the subjects who took Rhodiola were able to maintain a higher level of performance without mental exhaustion for up to 8 hours.

Aging in women – changes caused by menopause

In clinical practice, we find evidence that Rhodiola rosea is especially useful for women with symptoms of “foggy mind” during and after menopause. At this stage, a woman faces several stressors at once: work pressure, family responsibilities, aging parents and numerous health problems for a woman and her loved ones. Stressors tend to increase at a time in life when a woman’s energy levels naturally decline. Lack of energy to solve the problems that life puts before us leads to fatigue, irritability and mild depression. The situation is complicated by the fact that with age it becomes increasingly difficult to multitask and keep track of information. We expect that we will cope with everything ourselves and will not make mistakes. Accordingly, when it suddenly turns out that we can no longer do everything at the usual level, this can lead to disappointment, self-doubt and low self-esteem. This state of affairs also affects relationships.

Menopause can also be a period of critical reassessment of the situation and one’s own health. Menopause can prompt us to make lifestyle changes that will help us live longer, healthier, and happier lives. Of course, Rhodiola is not a panacea, but it can significantly help, because it increases energy levels, improves concentration and mood. The authors of an interesting study involving women with depression found that Rhodiola rosea not only improves mood, but also improves self-esteem.

Aging in men – changes caused by male menopause (andropause)

Male menopause can begin as early as 35 years of age. The average age of onset of andropause is 44 years. It can manifest as hormonal, physical, psychological, interpersonal, sexual, social and spiritual changes. Add to this a decrease in energy and testosterone levels, libido, mood, fertility, self-esteem, physical strength and cognitive abilities. These changes also sometimes occur precisely when men build a career, take on additional responsibilities, which require more time and energy from men. It is often during this period that men first encounter such diagnoses as high cholesterol, hypertension, chest pain or prostate enlargement. It’s not easy to deal with all this. Rhodiola rosea can increase stamina, performance, confidence and athletic performance. Rhodiola rosea adaptive formula research Schisandra chinensis and Eleutherococcus senticosus showed a significant improvement in physical endurance and performance.

Mood improvement

Rhodiola rosea can be used to treat mild to moderate depression, especially the type of depression that makes the person feel tired and lethargic. In addition, rhodiola can be taken as an adjuvant to improve response to prescription antidepressant therapy. Only about 30% of people who take prescription antidepressants achieve complete remission. Most patients experience only partial improvement, sometimes residual symptoms persist. In many cases, it may be beneficial to introduce Rhodiola rosea into the diet.

Attention Deficit Disorder

Rhodiola improves mental focus and may therefore be beneficial for some people with Attention Deficit Disorder with or without Hyperactivity (ADHD). Rhodiola is suitable for patients with mild ADHD or intolerance to prescription stimulants. Adding rhodiola to the diet can also be helpful for those who take prescription stimulants but cannot take enough of them to completely relieve symptoms.

Altitude sickness

Rhodiola rosea has been used for centuries by residents of the highlands to maintain strength and endurance. Research shows that Rhodiola improves the ability of animals to adapt to low oxygen environments. In our clinical practice, we have found that travelers traveling to high altitude areas can prevent symptoms of altitude sickness by taking Rhodiola before and during their trip.

Biorhythms

Traveling with jet lag can cause jet lag for many people. Taking Rhodiola rosea in the morning upon arrival at your destination and over the next few days may shorten your time to adjust to another time zone.

Reproductive

Rhodiola rosea has been used in traditional folk medicine to increase fertility in men and women. No formal human studies have been conducted, however animal studies show potential benefits of Rhodiola. For example, animal studies have shown that the addition of Rhodiola rosea to frozen semen for animal insemination resulted in improved sperm motility and viability.

In one small study, a Russian gynecologist found that about 50% of women with amenorrhea (absence of menstrual cycles) who took Rhodiola rosea regained normal menstruation, and about 50% of these women were able to become pregnant.

There is a worldwide decline in fertility, which can be caused by chemical pollutants in the environment and food. In addition, in many countries people delay conception by having children well into their 30s. Fertility declines with age in both men and women.

In our clinical practice, we sometimes combine Rhodiola Rosea with other fertility-boosting herbs, such as Peruvian Maca. Taking a daily dose of Rhodiola may prolong or improve fertility in some patients and couples who have postponed childbearing beyond 35 years of age. More research is needed on the use of Rhodiola rosea in combination with other adaptogenic herbs to enhance human fertility.

Prescription Drug Interaction Side Effects

Many commonly used drugs have unwanted side effects such as fatigue and cognitive impairment. Rhodiola rosea can eliminate these side effects and thus help patients better tolerate the treatment.

How to get the most benefit and minimize the side effects of Rhodiola rosea

Get the most out of Rhodiola rosea

Rhodiola rosea is best absorbed when taken on an empty stomach, so it should be taken at least 20-30 minutes before breakfast or lunch. Rhodiola rosea has an invigorating effect and can therefore disturb sleep if taken in the afternoon or evening.

There are references on the Internet that Rhodiola rosea loses its effectiveness when taken for 6 or 8 weeks. However, in our experience, we find that for most people Rhodiola can be effective when taken continuously for many years or as needed before and during stressful periods.

Rhodiola rosea side effects and precautions

Rhodiola rosea is generally considered safe and has relatively few side effects. However, some people may be sensitive to stimulant effects. In such people, the reaction to taking Rhodiola may manifest itself in the form of anxiety, irritability, or insomnia. Some people have vivid dreams during the first two weeks, but this does not apply to unpleasant phenomena.

People sensitive to stimulants and the elderly and debilitated should start Rhodiola at lower doses and gradually increase the dose. When taken simultaneously with caffeine or stimulant drugs, Rhodiola may increase their effect. We advise our patients to reduce or stop their caffeine intake while taking Rhodiola rosea.

Patients with bipolar disorder should only take Rhodiola under medical supervision, as the stimulant effects of Rhodiola may exacerbate agitation and irritability.

At higher doses (greater than 450 mg per day), Rhodiola may have a slight effect on platelets, which are responsible for blood clotting. If this happens, you will notice an increase in bruising. Excessive bleeding has not been reported with Rhodiola. However, if a person is taking medications that also reduce blood clotting, such as aspirin or motrin, this can make bruising and bleeding worse. If you are taking an anticoagulant such as Coumadin, you should discuss Rhodiola with your doctor, who may want to check your clotting time to make sure it is not affected by Rhodiola. It is recommended to stop taking Rhodiola rosea 10 days before major surgery.

Although Rhodiola rosea is generally good for the heart, in people with arrhythmia or tachycardia (rapid heartbeat), the stimulant effects of the plant may exacerbate symptoms of the underlying disease.

Animal studies show that Rhodiola rosea is not teratogenic, meaning it does not cause birth defects. The safety of Rhodiola when taken during pregnancy or breastfeeding has not been studied in humans.

Drug interactions

There is a misconception that Rhodiola rosea can interact with many drugs because it affects cytochrome P450 (participates in the metabolism of many drugs). This misconception comes from a study in which Rhodiola rosea extract was tested in vitro (the extract was added to other substances in vitro). The effect of medicinal plant extracts in laboratory conditions and when taken by humans and other animals (in vivo) can differ significantly. When digested, food additives are broken down into digestive enzymes and involved in metabolic processes, during which they are converted into various compounds called secondary metabolites. Secondary metabolites may not have clinically significant drug interactions or may have the opposite effect of what was found when tested under laboratory (in vitro) conditions.

The only way to prove a plant-drug interaction is to test the plant and the drug in humans. To date, clinically significant interactions of Rhodiola rosea with most drugs have not been identified. However, Rhodiola has a moderate inhibitory effect on cytochrome P450 2C9 in the human body. This may be clinically relevant when treated with cytochrome P450 2C9 substrates (drugs that are also metabolized by the same enzyme) in a narrow therapeutic range (eg, phenytoin and warfarin). In this case, any changes in the action of phenytoin or warfarin can be monitored by a doctor, the dosage can be adjusted.

What dosage of Rhodiola rosea is most effective?

The optimal dose of Rhodiola rosea depends on the needs and characteristics of the patient. The dosage also depends on the effectiveness of the chosen product.

Some people respond to as little as 50 mg/day, others may need as much as 400 mg twice daily. The average dosage for adults is 300-600 mg per day. Studies show that taking in a dosage exceeding 900 mg per day is not advisable.

It is wise to start with a moderately low dose, eg 150 mg per day, and increase by 150 mg every 3-7 days until the effect appears. If side effects occur, the dosage should not be increased, or the dosage should be increased gradually over a longer period of time.

For the treatment of treatment-resistant depression, ADHD, or cognitive impairment, dosages up to 900 mg per day may be required if there are no side effects. When taken at an increased dosage (for example, 450-900 mg/day) should be monitored to see if the patient has an increased tendency to bruise and advise the patient to refrain from taking anticoagulants such as preparations containing aspirin.

For more detailed dosing instructions for various diseases, see Brown and Gerbarg 2009 and 2017.

Sources:

1. Brown RP, Gerbarg PL, and Ramazanov Z. 2002. A Phytomedical Review of Rhodiola rosea . Herbalgram 56:40-62.
2. Brown RP, Gerbarg PL, and Graham, B. 2004. The Rhodiola Revolution. New York: Rodale Press.
3. Brown RP, Gerbarg PL., and Muskin PR. 2009. In How to Use Herbs, Nutrients, and Yoga in Mental Health Care. New York: W.W. Norton & Co.
4. Brown RP and Gerbarg PL. 2012. Non-drug Treatments for ADHD. New Options for Kids, Adults, and Clinician. New York: W.W. Norton & Co.
5. Darbinyan, VG, Aslanyan, et al. 2007. “Clinical trial of Rhodiola rosea L. extract SHR-5 in the treatment of mild to moderate depression. Nord J psychiatry 61(5): 343-348.
6. Gerbarg PL, Brown RP. 2017. Integrating Rhodiola rosea in Practice: Clinical Cases. Complementary and Integrative Treatments in Psychiatric Practice, edited by Gerbarg PL, Brown RP and Muskin PR. Washington D.C., American Psychiatric Association Publishing, pp 135-142.
7. Gerbarg PL, Brown RP. 2016. Pause menopause with Rhodiola rosea, a natural selective estrogen receptor modulator. Phytomedicine. 23(9):763-9.
8. Gerbarg PL and Brown RP. 2016. Chapter 28: Therapeutic Nutrients and Herbs. In Psychiatric Care of the Medical Patient 4th Edition. David D’Addona, Barry Fogel, and Donna Greenberg (Eds.) Oxford University Press, Inc., New York. pp 545-610. ISBN-13:978-0199731855, ISBN-10: 0199731853.
9. Panossian A, Gerbarg PL. 2016. Chapter 13. Potential Use of Plant Adaptogens in Age-Related Disorders. In Lavretsky H, Sajatovic M, Reynolds C. Complementary and Integrative Therapies for Mental Health and Aging. New York, Oxford University Press, pp. 197-212. USBN: 978-0-19-938086-2.
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