OTC Painkillers and dosage restrictions

So I’m back in lower-back-pain hell again. Second time this year.

God, I feel old.


My GP prescribes that I take ibuprofen and he gives me this prescription for the monstrously-sized pills. He says they’re 3 or 4 times the dosage of the standard OTC pill. Simple enough. He says I can get the prescription filled or just load up on the Advil or any OTC ibuprofen at my discretion.

OK, says I. I have a BIG bottle of Advil at work. I’ll draw that down before filling the prescription.

So I’m looking at the bottle of Advil here and it says take no more than 6 tablets in a 24 hour period. At 200mg per tablet that’s 1200mg in a day.

But the prescription that my doc wrote would have me taking like twice that in a day!

So what’s the deal on the warnings on the bottle of Advil? Are they just giving me some Tennessee windage on overdosing? Is it possible to OD on ibuprofen?

You can OD on anything…and I mean anything. Even water.

This page has the reults of a study on ibuprofen overdose.

The last line says:

For numerical simplicity, we’ll assume you’re a 100 kg man. (that’s about 220 pounds). You’d need 9900 mg to start showing symptoms, by the results of this study. That’s 50 tablets at 200mg a piece, and that’s just the minumum.

It also says:

So the average ingestion for these kids was pretty high. for a 30-kg child, that equates to 13200 mg, or 66 of those tablets.

For that 100-kg man to have a dosage like that, he’d need to ingest 220 tablets!!!

I’m trying to find links to some good sources on NSAID overdoses. I’m not coming up with much, but I will keep at it.

If I am not mistaken, you will not overdose on 3-400 mgs of Ibuprofin which your doc suggested you take. However, I remember hearing the amount of Ibuprofin it takes to induce a FATAL overdose if you combine it with alcohol and thinking that it was shockingly low…like 16 or 18 Advil. Which is a lot, I know…but for a drinking person who might forget they’d already taken meds or whatever, it seemed pretty dire.

I also know that people who attempt suicide by taking massive doses of aspirin, tylenol or advil CAN be quite successful because they end up requiring a liver transplant. Combined with alcohol, this is a terrific way to ensure you’ll never have a healthy life again. I know people who have done this to themselves :frowning:

So I think the basic dope is:

  1. The stuff is hard on your liver and should only be taken in higher doses than the OTC bottle suggests when it’s absolutely necessary, and probably only under the orders of a physician.

  2. It’s probably best only to take higher doses if you have a healthy liver to begin with.

  3. If you drink alcohol, even a small amount, you should be VERY careful about the amount of NSAIDS you take.

Now why can’t I find any internet sources to back me up!?


Well, I hardly drink (just some wine for parties) so that’s not an issue.

So the doc setting me up to take (if I wished) something near 2400mg a day isn’t that big a thing?

IANAD, but I spend a lot of time on NSAIDs. And I mean a LOT.

This summer, I was taking 1600 mg at a pop for neck pain. The only reason my doc put me on scheduled doses of something else was for fear of liver and kidney damage (mostly kidney, though) if I took it long-term.

Reviewing the label for generic prescription strength ibuprofen shows 800 mg (1 tablet) three times daily, for a total of 2400 mg per day. So if your doc okays it, there shouldn’t be a problem.


On a related note –

I have fibromyalgia, anti-nuclear antibodies, severe allergies, chronic sinus infections, etc. I’m in pain most of the time, and get lots of sicknesses quite easily and feel even worse, and almost everything in this house causes allergic reactions which make me also feel bad from coughing or sneezing for hours.

I’m prescribed as much Celebrex as I need. However this is for joint pain, and I amazingly rarely have joint pain. It’s generally muscular, or generic pain. Advil works on this stuff, Celebrex does not (at least not nearly noticeably so). I take 200mg pills, 2 to 4 a day. No alcohol, ever.

That won’t overdose me, right? My generic doctor said that I could take twice that much daily with not even any long-long-term effects, and that I could easily take Advil every day for the rest of my life (until a better NSAID comes along) and it shouldn’t give me liver problems. Um, was she right? Do I need to worry about taking it, switch to another painkiller? Its effectivity has not decreased in several years, and I don’t use it to get to sleep, so I am not worried about getting addicted to such a small-time drug. I just want to be sure I’m not going to destroy my liver or something if I keep this up for years.

I believe the law regulates the dosage on OTC drugs; the limit on the bottle is not what is considered an overdose. This is to protect consumers.

Regarding the horsepills you are taking, I took those very large doses for years for osteoarthritis and I woke up one morning with blood in the toilet. I had to have 4 units of blood transfused and had a hemoglobin of 4. And other various and assorted awful symptoms. Now I cannot take any NSAIDS of any kind, including Celebrex and asprin, or I immediately begin bleeding. I also have a very large cyst on my right kidney; don’t know if it’s related.

Since I can no longer take any painkillers, practically speaking, I had to find another way to keep pain free. So, I started swimming 3 years ago and now do 45 laps a week; I also do weight training and emphasize back muscles as I have had back pain myself. It took 6-7 months but now I’m mostly pain free. What seemed to help the most, other than the swimming, is pulldowns, where you pull the bar behind your head. I’m up to 100lbs.

Basically, it sucks when I have a headache or just the aches and pains we get everyday. I can’t take anything but narcotics. In other words, nothing.

So, take my word for it, don’t overdo on the NSAIDS and only use them when absolutely necessary.

I weigh 240 pounds, and my doc says I can take 4 Aleve® (220mg each) every day without causing him any concern. That’s four times the label dose. Aleve is naproxen sodium, and I take the generic. He says I can safely take 6 a day without hurting myself, but I should let him know if I start taking that much. Four does the job nicely.

I have TMJ(or TMD, if you prefer… problems with my jaw), and I was on 900 mgs of ibuprofen three times a day. It killed the pain quite well, but similar to suezeekay, it gave me gastrointestinal problems. Nothing as drastic, but my stomach hurt very badly, and I developed GERD (gastric reflux).

I wouldn’t worry so much about overdosing as screwing up your stomach. If I take Aleve or anything for more than a few days now, I have stomach pain, even with medication to take care of it (Prilosec).

Nothing like that yet.

But I think Alleve isn’t an ibuprofen, right? And my doc was specific about that.

Doesn’t ibuprofen also function as an antiinflammatory?

Both Aleve (naproxen) and ibuprofen are NSAIDs, Non-steroidal Anti-Inflammatory Drugs. And, evidently, they have their own website (?) http://www.nsaid.net/nsaiddes.html

They all work basically the same way, and I think they all have the potential to cause damage to your stomach. There are some newer drugs like Celebrex and Vioxx (prescription only) called Cox-2 Inhibitors that are supposed to be more gentle on your stomach, but personally, I’ve had trouble with Vioxx. I haven’t tried Celebrex, because anyone allergic to sulfa drugs (as I am) can’t take it.

Of course, standard disclaimer: I Am Not A Doctor.

I LOOOOVE Vioxx. I take it occasionally for post-traumatic arthritis. But it isn’t for everyone. I suppose it couldn’t hurt to ask your doc about it; it works for me when ibuprofen does absolutely zilcho.

The drug I was taking at the time I began bleeding was Indomethicin, which was a great painkiller. You can pretty much figure that everything except Tylenol (acetaminophen) and narcotics are NSAIDS. I had taken several types of NSAIDS over the years: Ibuprofen, Relafen, Naproxen, etc. I’m still not clear if it was the length of time I took them (about 8 years continuously) or the large doses that caused the problem. In my case I didn’t have problems with my stomach; they actually never found the source. The dr said blood was just seeping into my GI tract and there was no break or ulcer that they could discover (or fix, which was terrifying). This experience put me off most drugs (except natural ones) forever. My son is taking a BP medication and his body reacted like he had taken poison; the dr said he would have to wait 3-4 weeks for his body to get used to it and hopefully the side-effects would go away. It gives one pause, doesn’t it?

Acetaminophen (generic Tylenol) can be hard on the liver, especially when combined with alcohol. Aspirin and ibuprofen don’t cause liver failure. In fact, aspirin and ibuprofen are among the least toxic of drugs. It is very hard to kill yourself with them, unless you have problems with bleeding or blood clotting (most NSAIDs are blood thinners). Aspirin can also cause Reye’s syndrome, so it’s not a good idea to give it to children who are recovering from viral illnesses like flu or chicken pox.

I had lower back problems several years ago, and my doctor told me to take up to 600 mg of ibuprofen every four hours. He said that this was the therapeutic limit - that increasing the dose beyond 600 mg wouldn’t do any more good. Since then, I’ve treated the 200 mg dosage limit as a suggestion, and take more if I think I need it.

Do you people read? If you look at the bottle, and I’ve examined my Aleve, Ibuprofen, Tylenol and several others that say

Do not take X amount unless DIRECTED BY A PHYSICIAN.

The OTC dosages are almost never equal to the prescription dose. Why? Cause they want you to go to the doctor if you need more.

But ibuprofen, at least, is not anti-inflammatory in the standard dose. You need to ~triple it to get that effect, so it’s possible that is why the large dosing was recommended.

It doesn’t say anything about it not being an NSAID here:

But that might not be what you meant (?). I think its harmful effects are really only seen in those who take large doses that need the anti-inflammatory property the most.

(once again, IANAD.)

This link refers to a low/analgesic and high/antiinflammatory dose for ibuprofen, and I’ve been told by more than one physician that you need to take higher than the OTC indicated dose to get the antiinflammatory effects.

I stand corrected. :slight_smile:

After my hurt tummy incident a few years ago, I stay away from it at any dosage unless absolutely necessary. But it’s interesting to know that at low dosages it’s not very anti-inflammatory.