People over 60, with a history of stomach bleeding, taking anticoagulants or steroids should consult a doctor before using painkillers like ibuprofen

3. People over 60, with a history of stomach bleeding, taking anticoagulants or steroids should consult a doctor before using painkillers like ibuprofen

Cost: No cost involved. Simply ask a doctor or pharmacist.

In plain terms: Painkillers such as ibuprofen, naproxen, and aspirin can harm the stomach. In large-scale trials, individuals taking ibuprofen faced roughly four times the risk of stomach bleeding or perforation compared to those not taking it. This risk is even higher for older adults, those with prior stomach bleeding, individuals on anticoagulants or steroids, and regular drinkers.

Benefit: These medications are classified as nonsteroidal anti-inflammatory drugs (NSAIDs); common examples include ibuprofen, naproxen, and diclofenac. A meta-analysis encompassing 280 randomized trials involving 124,513 participants demonstrated that compared to placebo, ibuprofen raised the risk of upper gastrointestinal perforation, obstruction, or bleeding by an RR of 3.97 (95% CI 2.22–7.10; roughly fourfold). Naproxen showed an RR of 4.22 (2.71–6.56), while diclofenac resulted in an RR of 1.89 (1.16–3.09). All NSAIDs also approximately double the risk of heart failure. U.S. regulations mandate that over-the-counter NSAIDs carry warnings about stomach bleeding; these warnings specifically identify six high-risk groups: individuals over 60, those with prior stomach ulcers or bleeding, people on anticoagulants or steroids, individuals concurrently taking multiple NSAIDs, drinkers consuming more than three alcoholic beverages daily, and users exceeding recommended dosages or duration.

Evidence grade: A

Sources: Coxib and traditional NSAID Trialists' (CNT) Collaboration; Bhala N, Emberson J, Merhi A, et al. (2013). Vascular and upper gastrointestinal effects of non-steroidal anti-inflammatory drugs: meta-analyses of individual participant data from randomised trials. Lancet, 382(9894):769-779. <https://doi.org/10.1016/S0140-6736(13)60900-9>; 21 CFR 201.326(a)(2)(iii)(A) Stomach bleeding warning. <https://www.ecfr.gov/current/title-21/chapter-I/subchapter-C/part-201/subpart-G/section-201.326>

Notes: The study conclusions pertain to high-dose usage. No separate figures are provided for occasional short-term use at standard doses. Many multi-ingredient cold remedies also contain NSAIDs; combining them with separate painkillers results in redundant intake. Patients prescribed low-dose aspirin long-term by physicians for thrombosis prevention must not discontinue it or self-administer additional NSAIDs without medical guidance.