What is the strongest anti inflammatory medication?

Ibuprofen

Ibuprofen is a painkiller available over the counter without a prescription.

It’s one of a group of painkillers called non-steroidal anti-inflammatory drugs (NSAIDs) and can be used to:

ease mild to moderate pain – such as toothache, migraine and period pain
control a fever (high temperature) – for example, when someone has the flu (influenza)
ease pain and inflammation (redness and swelling) caused by conditions that affect the joints, bones and muscles – such as rheumatoid arthritis and osteoarthritis
ease pain and swelling caused by sprains and strains – such as sports injuries

This topic covers:

Types of ibuprofen

You can buy most types of ibuprofen from supermarkets or pharmacies. Some types are only available on prescription.

Ibuprofen is available in many forms, including:

tablets
capsules
liquids
gels or creams
sprays

In some products ibuprofen is combined with other ingredients. For example, it’s sometimes combined with medicine for a blocked nose (a decongestant) and sold as a cold and flu remedy.

There is currently no strong evidence that ibuprofen can make coronavirus (COVID-19) worse.

But until we have more information, take paracetamol to treat the symptoms of coronavirus, unless your doctor has told you paracetamol is not suitable for you.

If you are already taking ibuprofen or another non-steroidal anti-inflammatory (NSAID) on the advice of a doctor, do not stop taking it without checking first.

Who can take ibuprofen

Some people should avoid using ibuprofen and others should use it with caution. If you have any queries about using ibuprofen or any other medicines, speak to your GP or pharmacist, or phone the NHS 24 111 service.

You shouldn’t take ibuprofen if you:

have a history of a strong, unpleasant reaction (hypersensitivity) to aspirin or other NSAIDs
have a current or recent stomach ulcer, or you have had one in the past
have severe heart failure
have severe liver disease
are taking low-dose aspirin for the prevention of cardiovascular disease

You should use ibuprofen with caution if you’re aged 65 or over, breastfeeding, or have:

asthma
kidney or liver problems
lupus
Crohn’s disease or ulcerative colitis
previously had any bleeding in your stomach
high blood pressure (hypertension)
narrowing of the arteries (peripheral arterial disease)
any problems with your heart, such as angina, heart attacks, or mild or moderate heart failure
had a stroke

Ibuprofen and pregnancy

Ideally, pregnant women shouldn’t take ibuprofen unless a doctor recommends it.

But ibuprofen appears in breast milk in small amounts, so it’s unlikely to cause any harm to your baby while you’re breastfeeding.

It’s best to tell your GP, pharmacist or health visitor about any medicines you’re taking.

Paracetamol is recommended as an alternative to ease short-term pain or reduce a high temperature.

Ibuprofen and children

Ibuprofen may be given to children aged 3 months or over who weigh at least 5kg (11lbs) to relieve pain, inflammation or fever.

Your GP or another healthcare professional may recommend ibuprofen for younger children in certain cases – for example, this may be to control a fever after a vaccination if paracetamol is unsuitable.

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If your baby or child has a high temperature that doesn’t get better or they continue to experience pain, speak to your GP or phone the NHS 24 111 service.

How to take ibuprofen

Make sure you take ibuprofen as directed on the label or leaflet, or as instructed by a health professional.

How much you can take depends on your age, the type of ibuprofen you’re taking and how strong it is. For example:

adults – can usually take 1 or 2 tablets (200mg) every 4 to 6 hours, but shouldn’t take more than 1,200mg (6 x 200mg) tablets in the space of 24 hours
children under 16 – may need to take a lower dose, depending on their age; check the packet or leaflet, or ask a pharmacist or doctor for advice

The painkilling effect of ibuprofen begins soon after a dose is taken, but the anti-inflammatory effect can sometimes take up to 3 weeks to get the best results.

Ibuprofen shouldn’t be used to treat conditions that are mainly related to inflammation.

Don’t take more than the recommended dose if it isn’t relieving your symptoms.

Adults can take paracetamol at the same time if necessary, but this isn’t recommended for children.

Contact your GP or phone the NHS 24 111 service if your symptoms get worse or last more than 3 days despite taking ibuprofen.

Interactions with medicines, food and alcohol

Ibuprofen can react unpredictably with certain other medicines. This can affect how well either medicine works and increase the risk of side effects.

Check the leaflet that comes with your medicine to see if it can be taken with ibuprofen. Ask your GP or local pharmacist if you’re not sure.

As ibuprofen is a type of NSAID, you shouldn’t take more than one of these at a time or you’ll have an increased risk of side effects.

NSAIDs can also interact with many other medicines, including:

some types of antidepressants – used to treat depression
beta-blockers – used to treat high blood pressure (hypertension)
diuretics – which reduce the amount of fluid in your body

Ibuprofen can also interact with ginkgo biloba, a controversial dietary supplement some people claim can treat memory problems and dementia.

There are no known problems caused by taking ibuprofen with any specific foods or by drinking a moderate amount of alcohol.

Side effects of ibuprofen

Ibuprofen can cause a number of side effects. You should take the lowest possible dose for the shortest possible time needed to control your symptoms.

See the patient information leaflet that comes with your medicine for a full list of side effects.

Common side effects of ibuprofen include:

nausea or vomiting
constipation or diarrhoea
indigestion (dyspepsia) or abdominal pain

Less common side effects include:

headache or dizziness
bloating (fluid retention)
raised blood pressure
inflammation of the stomach (gastritis)
a stomach ulcer
allergic reactions – such as a rash
worsening of asthma symptoms by causing narrowing of the airways (bronchospasm)
kidney failure
black stools and blood in your vomit – this can indicate bleeding in your stomach

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If you feel unwell after taking ibuprofen or have concerns, speak to your GP or pharmacist, or phone the NHS 24 111 service.

You can also report suspected side effects using the Yellow Card Scheme.

High doses

Taking high doses of ibuprofen over long periods of time can increase your risk of:

stroke – when the blood supply to the brain is disturbed
heart attacks – when the blood supply to the heart is blocked

In women, long-term use of ibuprofen might be associated with reduced fertility. This is usually reversible when you stop taking ibuprofen.

Overdoses of ibuprofen

Taking too much ibuprofen, known as an overdose, can be very dangerous.

If you’ve taken more than the recommended maximum dose, go to your nearest accident and emergency (A&E) department as soon as possible.

It can be helpful to take any remaining medicine and the box or leaflet with you to A&E if you can.

Some people feel sick, vomit, have abdominal pain or ringing in their ears (tinnitus) after taking too much ibuprofen, but often there are no symptoms at first. Go to A&E even if you’re feeling well.

Accessing medicines self-help guide

Visit our self-help guide on accessing medicines if you have difficulty getting the medicines you need.

What is the strongest anti inflammatory medication?

Most are safe and effective for pain relief when taken as directed

It can be overwhelming deciding which over the counter (OTC) pain medicine to take for different aches and pains. There are many to choose from at your local drug store. The most appropriate usually depends on the type of pain you’re experiencing and your health.

Most nonprescription pain medicines are good at reducing pain as a symptom when taken for short periods and as recommended. But caution should still be taken.

“With any of these pain relievers, always read the labels and discuss any questions about dosage, safety, or prescription interactions with your doctor,” says David Miller, MD, a family medicine physician at Scripps Clinic Rancho Bernardo.

Contact your physician also if your pain reliever isn’t working for you. Your physician can check for any underlying condition that might be causing your symptoms.

What are OTC pain relievers?

The two main types of OTC pain relievers are acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs). They work differently on the body.

Acetaminophen blocks pain messages in the brain. NSAIDs, which include aspirin, ibuprofen and naproxen, work by reducing the level of chemicals involved in inflammation.

Acetaminophen

Acetaminophen (Tylenol, Excedrin) is particularly effective for treating headaches and reducing fevers.

“Acetaminophen is often the OTC pain reliever I recommend first for minor ailments,” Dr. Miller says.

“It is very safe when taken appropriately and is less likely to cause stomach irritation than an NSAID. Pregnant women can take it, as well as the very young, including infants and children with fever.”

As with any medication, follow instructions and stay within the daily limit allowed. Be careful not to take too much without knowing it. Acetaminophen can be found in many cough and cold products, including NyQuil and TheraFlu. Taking too much acetaminophen can harm your liver, perhaps permanently.

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Aspirin

Aspirin (Bayer, Bufferin, Excedrin) is one of the oldest pain relievers, used to reduce pain, swelling and fever. It should always be taken as directed.

Aspirin is not recommended for everyone. It may cause side effects, including nausea, vomiting, stomach pain and heartburn. Physicians nowadays recommend other more effective pain relievers.

Aspirin should not be given to children and teens as it has been linked to an increased risk of Reye’s syndrome, a rare but serious condition that causes swelling in the liver and brain.

“Adolescents and children should never be given aspirin for flu-like symptoms, chickenpox and other viral illnesses due to the risk of Reye’s syndrome,” says Dr. Miller.

Aspirin has special benefits for people with heart disease. It is widely used to help prevent and manage heart disease and stroke in people with a high risk.

Aspirin thins out platelets, the cells responsible for blood clots, which can contribute to strokes and heart attacks. Clotting can clog the arteries supplying the heart and brain. Other NSAIDs are not recommended for people with heart disease, high blood pressure or other risk factors.

Ibuprofen

Ibuprofen (Advil, Motrin) may be more effective for some symptoms or conditions, depending on the type of pain.

“I often recommend ibuprofen for menstrual cramps and sore muscles,” explains Dr. Miller.

“Ibuprofen is less of a stomach irritant than aspirin and has less of a blood-thinning effect if you have any conditions where loss of platelets would be a concern,” he says. “However, it’s important to note there have been some concerns that ibuprofen can contribute to kidney damage if not used correctly.”

Naproxen

Naproxen (Aleve) is the most powerful anti-inflammatory pain reliever available without a prescription. It is especially effective for sprains, sunburns and arthritis and other conditions.

Similar doses of Naproxen tend to last longer than other non-prescription pain relievers. They can last eight to 12 hours, compared to four to eight hours. Fewer tablets can be taken during the day.

Naproxen is not recommended for people over 65. Older adults are more likely to have side effects, such as ulcers and bleeding.

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Over-the-counter pain relievers

Over-the-counter (OTC) pain relievers can help relieve pain or lower a fever. Over-the-counter means you can buy these medicines without a prescription.

The most common types of OTC pain medicines are acetaminophen, aspirin, and nonsteroidal anti-inflammatory drugs (NSAIDs).

Information

Pain medicines are also called analgesics. Each kind of pain medicine has benefits and risks. Some types of pain respond better to one kind of medicine than to another kind. What takes away your pain might not work for someone else.

Taking pain medicines before exercising is OK. But do not overdo the exercise just because you have taken the medicine.

Read labels to learn how much medicine you can give your child at one time and during the whole day. This is known as the dosage. Talk to your pharmacist or your child’s health care provider if you are not sure about the correct amount. Do not give children medicine that is meant for adults.

Other tips for taking pain medicines:

If you take pain relievers on most days, tell your provider. You may need to be watched for side effects.
Do not take more than the amount recommended on the container or more than your provider tells you to take.
Read the warnings on the label before taking the medicine.
Store medicine safely and securely. Check the dates on medicine containers to see when you should throw them away.

Acetaminophen (Tylenol) is known as a non-aspirin pain reliever. It is NOT an NSAID, which is described below.

Acetaminophen relieves fever and headaches, and other common aches and pains. It does not relieve inflammation.
This medicine does not cause as many stomach problems as other pain medicines do. It is also safer for children. Acetaminophen is often recommended for arthritis pain because it has fewer side effects than other pain medicines.
Examples of OTC brands of acetaminophen are Tylenol, Paracetamol, and Panadol.
Acetaminophen prescribed by a doctor is usually a stronger medicine. It is often combined with a narcotic ingredient.

Adults should not take more than 3 grams (3,000 mg) of acetaminophen in a single day. Large amounts can harm your liver. Remember that 3 grams is about the same as 6 extra-strength pills or 9 regular pills.
People with liver disease should usually not take more than 2 grams (2,000 mg) of acetaminophen in a single day. Check with your health care provider for guidance on what is safe for you.
If you are also taking pain medicine prescribed by your provider, talk to your provider or pharmacist before taking any OTC acetaminophen.
For children, follow package instructions for the maximum amount your child can have in a single day. Call your child’s provider if you are not sure about the instructions.

ASPIRIN and NSAIDS

Aspirin and NSAIDs relieve fever and pain. They also reduce swelling from arthritis or a muscle sprain or strain.
When taken for a short time (no longer than 10 days), aspirin and NSAIDs are safe for most people.
Children under age 18 years should not take aspirin due to a risk for Reye syndrome.
Some NSAIDs can be bought over the counter, such as aspirin, ibuprofen (Advil, Motrin), and naproxen (Aleve, Naprosyn).
Other NSAIDs are prescribed by your provider.

DO NOT give aspirin to children under 18 years of age. Reye syndrome can occur when aspirin is used to treat children who have viral infections, such as chickenpox or the flu.

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Talk to your provider or pharmacist before using aspirin or any over-the-counter NSAID if you:

Have heart disease, high blood pressure, kidney disease, or stomach or digestive tract bleeding.
Take other medicines, especially blood thinners such as warfarin (Coumadin),clopidogrel (Plavix), apixiban (Eliquis), dabigatran (Pradaxa), or rivaroxaban (Xarelto).
Are taking NSAIDs prescribed by your provider, including celecoxib (Celebrex) or nabumetone (Relafen).

Alternative Names

Medicines for pain non-narcotic; Drugs for pain non-narcotic; Analgesics; Acetaminophen; NSAID; Nonsteroidal anti-inflammatory drug; Pain medicine — over-the-counter; Pain medicine — OTC

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Pain medications

References

Aronson JK. Non-steroidal anti-inflammatory drugs (NSAIDs). In: Aronson JK, ed. Meyler’s Side Effects of Drugs. 16th ed. Waltham, MA: Elsevier; 2016:236-272.

Dinakar P. Pain management. In: Jankovic J, Mazziotta JC, Pomeroy SL, Newman NJ, eds. Bradley and Daroff’s Neurology in Clinical Practice. 8th ed. Philadelphia, PA: Elsevier; 2022:chap 52.

House SA. Pain. In: Kellerman RD, Rakel DP, eds. Conn’s Current Therapy 2021. Philadelphia, PA: Elsevier 2021:32-39.

Review Date 10/11/2020

Updated by: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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