Ibuprofen Boosts Ulcer Risk, Study Says : Health: But drug is the least dangerous of 12 pain relievers tested. Researchers say low-dose users should not be concerned.

The widely used pain reliever ibuprofen doubles the risk of ulcers, according to Vanderbilt University researchers, and some experts say that people taking it may want to consider lower doses or alternatives.

But for those suffering chronic pain and inflammation, researchers said ibuprofen may be the best choice because it has the lowest ulcer risk among the drugs studied. Those drugs belong to a prescription class called non-steroidal anti-inflammatory drugs, or NSAIDs.

“Occasional low-dose users should not be concerned about the increased risk,” said the study’s lead author, Dr. Marie Griffin. “It is unlikely that taking one or two ibuprofen (pills) several times a month poses any significant risk.”

The researchers did not study aspirin, which also is a NSAID, but said that aspirin is “at least” as risky as ibuprofen. Acetaminophen, used in the pain reliever Tylenol, is not an NSAID and is not associated with ulcers.

The Vanderbilt study confirmed the increased risk of ulcers in people who used the prescription NSAIDs studied and also found that the overall risk increased with higher doses and was greatest in the first month of use.

Ibuprofen, available without a prescription since 1985, is sold under such brand names as Advil, Medipren, Motrin and Nuprin. It has captured about 20% of the $2.5-billion non-prescription pain reliever market.

The study, published in today’s Annals of Internal Medicine, involved 1,415 Tennessee Medicaid enrollees hospitalized for ulcers from 1984 to 1986 and 7,063 control patients.

At recommended dosages for treating rheumatoid arthritis, NSAIDs on average quadrupled the risk for ulcers. But of the 12 drugs studied, ibuprofen showed the lowest risk, at 2.3 times, while meclofenamate increased the risk 8.7 times.

The biggest-selling NSAID, naproxen, quadrupled the risk. Under the brand name Naprosyn, it has annual sales of $395 million, according to the National Disease and Therapeutic Index.

Ibuprofen is the only one of that group available in over-the-counter strength. Aspirin was not included in the study because it is not a prescription drug.

Ibuprofen was included because, at the beginning of the study, it was still a prescription drug and was available free under Medicaid. While ibuprofen is now available without a prescription, the Vanderbilt researchers based the risk on an average dose of 1,600 milligrams daily.

The highest recommended over-the-counter dose is 1,200 milligrams a day, while the highest recommended prescription dose is 3,200 milligrams. But even at the 1,200-milligram dose, ibuprofen probably would double a person’s risk of ulcers, Griffin said.

Griffin said a higher risk for short-term use of NSAIDs may occur because people who develop ulcers do so quickly and stop taking the drug. Another possible reason is that the stomach begins to provide protection against the drug’s side effects, she said.

NSAIDs work by interfering with the body’s production of prostaglandin, substances that affect a number of processes in the body, including pain and protection of the stomach lining. The drugs often are recommended to treat arthritis, back pain, headaches and menstrual cramps.

Side effects include fluid retention, rashes, problems with kidney function and disorientation in the elderly, Griffin said.