I have a bottle of OTC 200mg pills of ibuprofen, which say not to exceed 1200mg (6 pills) in a 24 hour period.
However, I once had a prescription bottle of Ibuprofen with 800mg pills, which said not to exceed 3200mg (4 pills) per day.
When you google the safe dose of ibuprofen - the internet backs up both these points. Some say 1200mg, some say 3200mg.
My question is - is there any difference between the OTC and prescription pills that make it safer to take a higher dosage of the prescription pills? Or is it just that the OTC version is being conservative by only allowing 1200 mg without doctor supervision, and the prescription sort allows you to take higher dosages because your doctor has ruled out the factors that would limit you to a 1200mg daily safe dose?
Or, to simplify the question, since I’ve been prescribed ibuprofen with a 3200mg limit per day, would it be safe to exceed the 1200mg per day written on the OTC bottle?
There’s no difference - it’s just that ibuprofen can mess you up pretty badly over the long run and so I assume the OTC version is, as you guess, being conservative as an ass-covering measure.
My doctor has me taking 800mg the times a day to help with chronic pain. It helps take the edge off wwhen the opiods aren’t cutting it. (I take it with the opiods).
I’ve taken ibuprofen at various dosages since at least my teen years to deal with acute pain. Typically in doses of 400 mg for minor pain and 800 mg for greater pain (usually with 200 mg OTC pills but sometimes with 800 mg prescription pills).
Once as a young dumb adult (I would have been 20) I was working as a groundskeeper and one morning I woke up with a crippling sinus headache. I hated calling in sick (I still do) and that day there was a very important staff meeting I really didn’t want to miss, so as an attempt to “obliterate” the headache I took two 800 mg pills at once.
Fortunately I usually carpooled and had a ride because I basically acted like I was drunk and after that morning staff meeting I was sent home. Luckily I wasn’t disciplined for it (I think my boss was sympathetic about my motives in trying to make the meeting). I’ve never taken a dosage that high since.
So at least in my case there was a definite negative effect but no real harm as far as I could tell.
A couple years ago my wife was hospitalized with a severe problem and needed to be kept off any opioids after abdominal surgery. The doc wanted to give her ibuprofen 800mg per dose for pain but the hospital pharmacy didn’t want to fill the order saying that was a dangerously high dose.
After some back and forth and enough blood work to prove she had full-normal liver and kidney functions despite the surgeon poking at her guts with a real sharp stick the pharmacy backed off and filled it.
Per our doc and the hospital pharmacy the 200mg OTC pills and the 800mg prescription pills are chemically identical. The whole point of the smaller dose pills is to make it hard(er) to reach a dangerous dose. The public is stupid and will eat them like tictacs.
Bottom line: IME at 800mg you’re taking doses that can be harmful in folks with any diminished liver / kidney function. Make darn sure that’s not you. And even then they tell me you’re taking extra miles off those systems. Short term it may be worth it. Long term is a different calculation.
About nine years ago, I tore one of my Achilles tendons while vacationing in Barcelona; the pain was unbearable, every step I took. So I started taking 400mg ibuprofen. Before long, I was popping them like candy, well over a dozen a day. Of course I was still in pain, but the medication helped. Took them for about four days; then they pretty much stopped working.
I currently have stage 3 kidney disease, due to T2 diabetes. Don’t know whether all that ibuprofen exacerbated it.
From a friend who works for J&J (makers of Motrin), the product is the same. He says there are a few reasons why the max dosage is different:
The OTC dosage is conservative, because left to their own devices people assume that more is netter. If one pill works good, two will be better, three with be amazing. It’s very easy to hit the “real” dosage danger zone thinking like that. With a doctor’s counselling, they’ll presumably warn you about that incorrect thinking when you’re already at the max dosage. The guidelines on the OTC pills are more conservative because few people really read them in depth. Protection against people’s own stupidity.
A big problem with OTC painkillers is that they are quite safe at low dosage levels, but can be very dangerous at higher levels. Acetaminophen and ibuprofen now commonly appear in OTC products like cough syrup and cold meds. Unless you’re very aware, it’s easy to build up to a dangerous dosage if you take multiple products containing these. Even if you follow the correct dosage on your OTC pills and the correct dosage on your OTC cold syrup, the dosage levels are additive and you can still be in trouble.The lower dosage on a single OTC product allows people to take OTC products at the max OTC dosage from a couple sources and still be relatively safe.
If you’re prescribed the max dosage, your doctor should warn you directly about taking OTC medications that contain ibuprofen.
Your doctor (should) provide you with personal counselling around the risks of the higher dosage (signs that you may be overdosing). They’ll also know what other medications they’ve prescribed, in case of possible drug interactions.
If someone is having pain that calls for the 800mg dose (or, for that matter, anything beyond the 200mg OTC dose), they should be under a doctor’s supervision.
Occasionally taking two, or even three 200mg tablets is acceptable; this is more about long-term, chronic use.
Any industry which has been sued (and lost) as many times as the pharma business is going to do the obvious:
Assume your customers are idiots and do what you can to protect them from themselves.
This is not just pharma - remember photo film? It had that Expiration Date on it.
That date was set so that, even if the buyer puts it in the glove compartment and parks the car at the LAX terminal facing south for June through September, the film will still be good.
Different set of circumstances, but today I have T2 diabetes and CKD 2 or 3, depending on the lab results. Doctors will attribute the CKD to Diabetes, but I gotta wonder about the contribution by ibuprofen.