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How Much Advil Is Too Much?

Anti-inflammatory painkillers like Aleve and Advil are one of the most commonly abused over-the-counter drugs. So? They can do more damage than you might think.

If your head is pounding, you might pop a couple of Advil. If your calves are sore and swollen after an intense pickup game of basketball, you may take a few Aleve. For arthritis pain, you might reach for an aspirin. All three nonsteroidal anti-inflammatory drugs, or NSAIDs, are excellent over-the-counter painkillers and are generally quite safe as long as you don’t overdo it. So how much Advil is too much? If you aren’t reading taking the prescribed dosage, or would describe your NSAID-intake as a regimen, you’re probably taking too much.

Men are notorious for not following the instructions on the bottle. Research has shown that guys tend to either take too-high doses — swallowing four ibuprofen tablets instead of the recommended two, for example — or use two different NSAIDs concurrently. Both scenarios are super risky, potentially causing stomach bleeding, ulcers, heartburn, and easy bruising. Long-term NSAID overuse can lead to liver damage, kidney injury, or heart complications.

A recent study of 1,326 regular ibuprofen users, both male and female, confirmed how common NSAID overuse really is. Thirty-seven percent of people took a second NSAID such as naproxen (Aleve) or aspirin along with ibuprofen, though less than half realized they were doubling up on the same type of drug. Another 15 percent simply took too much ibuprofen, exceeding the maximum daily dosage of 1,200 milligrams. But when the results were broken down by gender, men were a whopping 50 percent more likely than women to overdo it on NSAIDs.

So what gives, guys? According to lead researcher David Kaufman, Ph.D., an epidemiology professor at Boston University, many men misuse NSAIDs out of sheer ignorance. They may be unaware of the dosing guidelines, not know that taking two NSAIDs too close together carries health risks, or have no clue that these painkillers are NSAIDs in the first place.

“If you don’t realize that at least one of those drugs is an NSAID and you take the maximum dose of both on the same day, you’ll get too much total,” Kaufman says. “Combined dosing can have adverse effects, the most common issue being stomach bleeding, which can be life-threatening. Cardiovascular risks have also been documented, though they are less common, or there could be kidney damage with prolonged overuse.”

As a practicing pharmacist for 23 years, Jason Varin, PharmD, now a professor at the University of Minnesota College of Pharmacy, is not surprised by the study results. “This is a generalization, but after seeing thousands of patients over the years, I can say that women tend to be more concerned about dosage and more detail-oriented in looking at directions,” he says. Men, on the other hand, assume that whatever amount they take will be fine, Varin notes, “or they think, ‘the directions say to take two 200-milligram pills, so obviously three pills will work better or faster.’”

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Now, it is true that 600 milligrams of ibuprofen will provide a stronger anti-inflammatory effect than 400 milligrams, which is why doctors prescribe 600- to 800-milligram doses for torn tendons, sprained ankles, and other acute injuries. “If you have trauma, you want to get the inflammation knocked down as quickly as possible because it can cause damage,” Varin says. The high dosage does amplify the negative side effects of NSAIDs, he adds, but it’s a reasonable tradeoff in these situations.

It is not a reasonable tradeoff for your average aches and pains, however. “You don’t really need high anti-inflammatory levels to get relief from a headache,” Varin says. The recommended dose of 400 milligrams should be powerful enough to work, and if you exceed that, the health risks start to outweigh any additional benefit.

But what happens all too frequently, says Varin, is that someone will get injured once, get prescribed a high dose of ibuprofen, and then mistakenly think they should take that same dose any time they use ibuprofen. “Whether for a mild headache or muscle aches, they just assume they should take four pills because four worked well when they had that injury,” he explains. “But the higher the dose you go, you get diminishing returns.”

The Right Way to take Advil and Other NSAIDs

To use these painkillers safely and smartly, you’ve got to read the label. “If you follow the instructions, you will be less likely to get in trouble,” says Kaufman. Sounds simple enough, but given guys’ penchant for not looking at labels, this message needs to be hammered home.

Along with how many pills to take, an important instruction that often gets overlooked is to take NSAIDs daily only for a certain number of days. “I would not recommend being on either ibuprofen or naproxen for more than two weeks without consulting a physician because the NSAIDs could be masking a bigger problem,” Varin says.

As for which NSAID to take when, both ibuprofen and naproxen work similarly to target headaches, backaches, muscle soreness, joint pain, and toothaches. The main difference is that ibuprofen is quicker-acting than naproxen but has a shorter duration—you may need to re-up after four to six hours. “When you’re looking for relief as quickly as possible, ibuprofen tends to work better,” Varin says. “Naproxen, on other hand, is better for when you need [a painkiller] to last all day long.” If you pop Aleve in the morning, for instance, you won’t have to take a second dose during the workday as you might with ibuprofen.

Though aspirin is also an NSAID, it has cardioprotective properties at low doses whereas ibuprofen or naproxen do not. It can prevent blood platelets from sticking together, which may stop the formation of blood clots that lead to heart attacks. This is why doctors often advise people who’ve survived a heart attack to take a low daily dose of aspirin to help prevent having another one. However, if you’re not at high risk of a heart attack, the blood-thinning effect isn’t necessary and could even be detrimental. Therefore, unless a doctor has ordered it, Varin cautions against using aspirin.

“Another thing I don’t think is made clear enough on the packaging is that all NSAIDs, except for enteric-coated aspirin, can affect the stomach in multiple ways,” Varin says. Along with irritating the stomach lining, he says NSAIDs hinder the formation of chemicals called prostaglandins, which cause pain, swelling, and inflammation but also protect the stomach. Therefore, by stymieing prostaglandins to temper pain, NSAIDs also leave the stomach more vulnerable to ulcers and bleeding.

The best way to protect yourself against digestive woes is to simply take NSAIDs with food. “I’ll go one step beyond that and say to take it at the beginning of a meal, when the digestive process starts,” Varin says. “If you take it after you eat, it can get trapped in the stomach until digestion occurs. But if food is coming into the body on top of it, it’ll likely be the first thing that gets through the gut.” Once it moves past the stomach, he says, you’re in the safe zone, digestively speaking.

For this same reason, Varin also cautions against taking NSAIDs before bed. “Motility and digestion slow down when you lay down, and you don’t want that medication sitting in the stomach longer than usual,” he says. “Don’t take it with alcohol either because alcohol is also a stomach irritant. But if you take ibuprofen before dinner with wine, that’s fine.”

As with any drug, prescription or over-the-counter, there are both benefits and potential side effects to NSAIDs. In order to get the max gains with minimal downsides, just swallow your pride and follow the directions before you swallow any pills.