Can Ibuprofen Cause Anemia? Here's What We Know

Ibuprofen is a non-steroidal anti-inflammatory drug (NSAID) used to treat symptoms such as pain, inflammation, and fever. It is available over the counter under several brand names — including Motrin and Advil — and it is most commonly taken orally in tablets, capsules, or liquid suspensions.

Just like any medication, ibuprofen can cause side effects. Among the most common of these are stomach pain, headache, dizziness, gas, heartburn, nausea, vomiting, constipation, diarrhea, and rash.

Another common side effect that is of particular concern to people who may be taking ibuprofen every day or using large doses is anemia. Anemia is a condition in which the body doesn't have enough healthy red blood cells or hemoglobin to properly transport oxygen to the body's tissues. It can manifest itself with symptoms such as fatigue, weakness, shortness of breath, pale skin, dizziness, cold hands and feet, and headache.

How ibuprofen can cause anemia

According to a 2021 article in the Clinical Medicine Journal, NSAIDs like ibuprofen can cause stomach ulcers as well as damage, irritation, and swelling in the small intestine. This can lead to gastrointestinal bleeding and perforation. The study authors further note that bleeding can either be overt — causing dark, sticky poop due to the presence of blood — or hidden, detectable only by the resulting iron deficiency.

A 2013 article in Case Reports in Hematology further states that in very rare instances, ibuprofen can induce autoimmune hemolytic anemia (AIHA). With this condition, the body's immune system mistakes its own red blood cells for foreign invaders and begins to attack them causing them to burst. As shown in this case study, it can lead to quite serious anemia within a matter of days. If people with AIHA do not stop taking the offending medication right away, it can potentially lead to death.

It should be noted, however, that this condition is estimated to only affect one person out of every million. Additionally, other drugs can also cause AIHA and it is thought that NSAIDs comprise less than 15% of all cases.

How to avoid anemia when taking ibuprofen

According to the Cleveland Clinic, you should only take ibuprofen for a short time unless your doctor advises otherwise. This will minimize your risk for anemia and other complications of long-term NSAID use. They state that three days is the limit for fever and 10 days for pain.

The Hospital for Special Surgery advises that you can reduce stomach irritation and prevent the occurrence of ulcers by taking NSAIDs at the end of a meal or along with an antacid. You should also limit your intake of alcoholic beverages since drinking can also irritate your stomach.

If you do develop gastrointestinal issues, they state that your doctor may elect to switch you to another drug like a COX-2 inhibitor. While they are also NSAIDs, they work in a different way than ibuprofen does and there is a lesser risk of bleeding and ulcers.

Another option may be taking a drug that reduces stomach irritation such as a proton pump inhibitor like omeprazole (Prilosec), esomeprazole (Nexium), or lansoprazole (Prevacid). These medications can significantly reduce your risk.