Ibuprofen is one of the most widely used over-the-counter painkillers, but it carries real risks for specific groups of people. Those with heart disease, kidney problems, a history of stomach ulcers, certain respiratory conditions, and anyone in the later stages of pregnancy should either avoid ibuprofen entirely or use it only under close medical supervision. The same goes for infants under six months, adults over 65, and people taking certain medications that interact dangerously with it.
People With Heart Disease or a History of Heart Attack
The FDA requires a boxed warning on all prescription NSAIDs, including ibuprofen, stating that they increase the risk of heart attack and stroke. This risk can appear as early as the first weeks of use, increases with higher doses, and grows with longer use. Estimates suggest the relative risk rises anywhere from 10 to 50 percent or more depending on the dose.
For people who have already been hospitalized for serious coronary heart disease, the numbers are more specific. Research published through the American Heart Association found that short-term ibuprofen use (under 90 days) raised the risk of another serious coronary event by 67 percent compared to not using any NSAID. Ibuprofen also performed worse than naproxen for cardiovascular safety in this population, carrying a 25 percent higher risk of serious cardiovascular events or death.
People who have undergone coronary artery bypass surgery should not take ibuprofen at all. The early period after heart surgery is considered especially hazardous for NSAID use.
People With Kidney Disease
Your kidneys rely on specific chemical signals to maintain blood flow, and ibuprofen directly interferes with those signals. For people whose kidneys are already compromised, this can push function from impaired to dangerous.
International guidelines draw a clear line: if your estimated kidney filtration rate (eGFR) is below 30, ibuprofen should be avoided entirely. For those with moderate kidney disease, with an eGFR between 30 and 59, prolonged use is also discouraged. NSAIDs carry a risk of both gradual kidney decline and acute kidney injury, making them particularly problematic for anyone already managing chronic kidney disease.
Anyone With a History of Stomach Ulcers or GI Bleeding
Ibuprofen damages the protective lining of the digestive tract. People who have previously experienced peptic ulcer bleeding or perforation are at the highest risk of it happening again. Across all NSAID users, ulcer complications like bleeding and perforation occur up to five times more frequently than in non-users. Ibuprofen specifically carries a relative risk of 2.7 for upper GI bleeding or perforation.
The damage isn’t limited to the stomach. When researchers use capsule endoscopy to examine the small intestine of chronic NSAID users, up to 70 percent show erosions, ulceration, or mucosal bleeding below the duodenum. Chronic use also increases the risk of microscopic colitis, particularly when combined with proton pump inhibitors over several months.
Certain factors stack the risk higher. An active H. pylori infection increases bleeding risk by an additional 1.2-fold in NSAID users. People on dual antiplatelet therapy after a heart attack who also take an NSAID face double the risk of GI bleeding.
Pregnant Women After 20 Weeks
The FDA warns against using ibuprofen at 20 weeks of pregnancy or later. Starting around that point, the baby’s kidneys produce most of the amniotic fluid, and ibuprofen can impair fetal kidney function. This leads to dangerously low amniotic fluid levels, which can cause complications including restricted limb development and delayed lung maturation. In some cases after birth, affected newborns have needed dialysis or exchange transfusion.
At around 30 weeks, the risks escalate further. NSAIDs can cause a fetal heart problem involving premature closure of a blood vessel that normally stays open until birth. For this reason, ibuprofen is strongly discouraged between weeks 20 and 30 and should be avoided altogether after week 30. This is a shift from older labeling, which only flagged concerns starting at 30 weeks.
Adults Over 65
Aging kidneys filter blood more slowly due to reduced renal blood flow and declining filtration rates. This is the single most important change in how older bodies handle medications, and it makes ibuprofen riskier with every passing year. On top of reduced kidney function, older adults face higher baseline risks for GI bleeding and heart disease, the two other major categories of ibuprofen harm.
Research on elderly NSAID use has found a concerning pattern: the oldest adults, who are most likely to have diminished kidney function and greater frailty, use these medications at the same rate as younger elderly people. There’s no natural tapering of use to match declining body function, which means many older adults are taking ibuprofen at doses their bodies can no longer safely handle.
People With Asthma Triggered by NSAIDs
About 7 percent of adults with asthma have a condition called NSAID-exacerbated respiratory disease, and among those with severe asthma, the rate climbs to nearly 15 percent. In these individuals, ibuprofen and other NSAIDs trigger worsening asthma symptoms along with nasal congestion and sinus inflammation. The condition is closely linked to chronic sinus disease and nasal polyps.
If you have asthma and have ever noticed your breathing worsen after taking ibuprofen, aspirin, or another NSAID, you likely fall into this category and should avoid the entire drug class.
People Taking Blood Thinners or Certain Antidepressants
Combining ibuprofen with blood-thinning medications significantly raises bleeding risk. In a large study of patients on newer oral anticoagulants, adding an NSAID increased the odds of major bleeding by 41 percent. Adding an SSRI antidepressant (such as fluoxetine, sertraline, or paroxetine) increased it by 92 percent. Taking all three together pushed the risk even higher, with a 2.67 times greater chance of major bleeding compared to taking the anticoagulant alone.
The bleeding risk isn’t confined to one area. NSAIDs combined with anticoagulants particularly increased lower GI bleeding, while SSRIs combined with anticoagulants raised intracranial bleeding risk. Both drug combinations increased urinary tract bleeding. If you’re on any blood thinner or SSRI, ibuprofen is a combination worth avoiding.
Infants Under Six Months
Ibuprofen should not be given to babies younger than six months. For children between six months and two years old, or those weighing under 12 pounds (about 5.5 kilograms), a pediatrician should guide any use. Young infants have immature kidneys and liver function, making them unable to process the drug safely at standard doses.
Before Surgery
Ibuprofen interferes with blood clotting by blocking platelet function. If you have an upcoming surgical procedure, the standard recommendation is to stop taking ibuprofen one week before your surgery date. This gives your platelets enough time to recover normal clotting ability and reduces the risk of excessive bleeding during and after the operation. Your surgical team will typically provide a list of medications to pause, and ibuprofen is consistently on it.