Ibuprofen is a pain reliever and fever reducer that’s available without a prescription. This drug may increase the risk of heart attack when taken often or at high doses.

Ibuprofen and other nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used to treat inflammation, pain, and fever from health issues like arthritis, headaches, and colds or flu.

While ibuprofen is available over-the-counter (OTC) and generally considered safe, it may increase the risk of heart attack for some people.

Here’s what you need to know about the relationship between ibuprofen and heart attack, how much is safe to take, and what questions you may want to ask your doctor.

Maybe. Taking ibuprofen or other NSAIDs may increase your risk of myocardial infarction (heart attack). The risk may be greater if you take high doses of NSAIDs as well.

According to the Food and Drug Administration (FDA), the risk of heart attack and stroke may increase after taking ibuprofen and other NSAIDs for only a few weeks.

In 2005, the FDA ruled that ibuprofen and all other NSAIDs must carry a warning label detailing their potential to increase heart attack and stroke risk. The federal agency strengthened its existing warning about NSAIDs again in 2015.

Labels have been revised to include the following about heart attack and stroke:

  • risk may arise within a few weeks of taking the drug
  • risk may be higher at higher doses
  • risk increases for people with and without existing heart disease (but is greatest for those with existing heart disease)
  • risk differences are unclear between NSAIDs; more research is needed to determine whether some types are safer than others
  • individuals treated with NSAIDs after a heart attack have a higher death rate within 1 year than those not treated with NSAIDs after a heart attack
  • risk may also include heart failure

NSAIDs work by reducing the production of prostaglandins in the body. To do this, drugs like ibuprofen inhibit the production of an enzyme called cyclooxygenase (COX) in the kidneys. Researchers explain that this may increase blood pressure and fluids, leading to cardiovascular events.

Again, the FDA says there’s insufficient evidence to suggest that any one type of NSAID has a greater effect on heart attack risk than another. That said, researchers point out that ibuprofen may carry less risk than other nonselective NSAIDs, like diclofenac.

Some older studies suggest that naproxen may have less cardiovascular risk than other NSAIDs

The classic symptoms of heart attack include chest pain. This “pain” may be sharp, dull, or merely feel like discomfort in the left side of the chest. For some, it may feel like fullness, squeezing, or pressure.

These sensations generally last more than a few minutes and may become worse over time or may come and go.

You may also experience the following symptoms:

  • difficulty breathing
  • pain in the jaw, neck, or back
  • pain in the arms or shoulders
  • weakness or feeling faint
  • unexplained tiredness (women)
  • nausea or vomiting (women)

A heart attack is considered a medical emergency. Seek immediate care if you experience these symptoms, whether or not you have recently taken ibuprofen.

People who already have heart disease may be at a higher risk of heart attack after taking ibuprofen because these individuals have a higher level of risk at their baseline.

They’re quick to point out, however, that even people without heart disease or associated risk factors may be at risk of a heart attack after taking NSAIDs.

Other risk factors specifically related to ibuprofen:

  • taking high doses of ibuprofen
  • taking ibuprofen for long periods of time

Other risk factors for heart attack include:

A heart attack is typically diagnosed by having an electrocardiogram (EKG) in an emergency room setting.

Additional tests may include blood tests to look for proteins associated with heart attack and chest X-rays or computed tomography (CT) scans to observe the heart.

Your doctor may or may not be able to determine whether your heart attack was caused by ibuprofen. If you have been taking high doses of the drug for long periods of time, your doctor may suspect taking it has played a role.

Treatment for heart attack aims to break up blood clots, raise blood oxygen levels, open or widen arteries, and improve blood flow to the heart.

Treatment may include:

With prompt treatment, most people who have had a heart attack go on to live relatively normal lives. Changing lifestyle factors, like diet and exercise habits, and addressing other risk factors can help prevent another heart attack.

Experts warn that individuals who have experienced heart attacks are more likely to die within 1 year of the event if they take NSAIDs.

There’s also an increased risk of heart failure with the use of ibuprofen and similar medications. Speak with your doctor if you have experienced a heart attack and plan to take NSAIDs to discuss the benefits versus risks.

How much ibuprofen is safe for the heart?

The FDA recommends taking the smallest dose of ibuprofen for the shortest period possible to address your symptoms. The smallest therapeutic adult dose is 200 milligrams every 4 hours.

Which is worse for your heart, Tylenol or ibuprofen?

Acetaminophen (Tylenol) does not have a cardiovascular risk warning on its packaging. According to the manufacturer, it also does not interfere with daily aspirin therapy for cardiovascular disease.

According to the FDA, taking ibuprofen with aspirin therapy may cause the aspirin therapy to be less effective.

Can ibuprofen cause heart rhythm problems?

Yes. There’s some evidence to suggest that ibuprofen and other NSAIDs may play a role in developing a heart arrhythmia called atrial fibrillation (AFib).

Ibuprofen and other NSAIDs may increase your risk of heart attack, even if you don’t have any risk factors. This risk may be especially heightened if you’re taking high doses for long periods of time.

Speak with your doctor if you have chronic pain or other long-term conditions you are treating with ibuprofen. Your doctor can discuss the risk factors in more detail and may suggest alternative medications that carry less cardiovascular risk.