Can You Take Advil (Ibuprofen) on an Empty Stomach?

Advil (ibuprofen) is a common over-the-counter (OTC) nonsteroidal anti-inflammatory drug (NSAID) used to treat pain, inflammation, and fever.

Advil may irritate the gastric lining of the stomach acid due to the inhibition of prostaglandins that protect the gastrointestinal (GI) tract lining. However, for onetime, timely relief, taking it on an empty stomach should not be a problem at recommended doses.

When used in higher doses and for long periods, taking Advil with a meal may be better to prevent GI irritation. Whether you experience stomach upset while taking Advil may also depend on individual risk factors.

Do You Need to Take Advil With Food?

You do not need to take Advil with food when taking it in doses of up to 1,200 milligrams (mg) daily in three to four divided doses.

However, Advil can sometimes irritate the stomach lining when taken on an empty stomach, especially if taken in higher doses or for longer durations. If this occurs, you can take it with food or a glass of milk to prevent stomach upset.

Advil blocks prostaglandin synthesis (the process of producing the pain-associated molecules prostaglandins) to decrease pain and inflammation. This may result in decreased mucus production, a protective lining in the GI tract that protects it from acids. Taking Advil with a light snack can help protect the stomach lining. However, the onset of the drug's action may decrease when you take it after food.

The risk of gastric irritation with Advil can be increased with the following risk factors such as:

• Age, mainly in people over age 65
• Alcohol use
• Chronic health concerns, such as heart disease, liver or kidney problems, or other chronic conditions
• Dose, with higher doses of Advil (more than 1,200 mg/day) increasing the risk multiple times
• Infections: Helicobacter pylori (H. pylori) infection
• Prior medical history, especially of ulcers, stomach or intestinal bleeding, or other bleeding problems
• Smoking
• Use of other medications, such NSAIDs, selective serotonin reuptake inhibitor (SSRI) antidepressants, antiplatelets, and corticosteroids
  

What Is the Safest Way to Take Advil?

A few precautionary measures can help decrease the adverse effects of Advil.

If possible, take ibuprofen in low doses (less than 1,200 mg daily in divided doses). This is milder for the GI tract and can be used longer. You can even take it on an empty stomach.

If you take Advil in higher doses for a long time, taking it with a stomach protectant such as a proton pump inhibitor (PPI) and H2 (histamine-2) receptor antagonist is an effective way to prevent peptic ulcers.

Testing for H. pylori can also help prevent ulcers in people with a history of peptic ulcer disease before starting low-dose NSAIDs. This test is not usually recommended for people without symptoms. However, it may be recommended for people with a previous ulcer history to start low-dose NSAIDs.

Potential Gut-Related Side Effects

Advil may cause side effects to the GI tract. The risk of these side effects is higher for people with a history of stomach ulcers or older adults. These side effects may include:

• Bleeding in the stomach or intestines
• Bloating (feeling of fullness or tightness in the stomach due to gas)
• Constipation
• Diarrhea
• Dyspepsia (indigestion and discomfort in the stomach)
• Flatulence (passing gas from the intestines through the anus)
• Heartburn
• Nausea
• Perforations (holes) in the stomach or intestines 
• Stomach pain
• Ulcers
• Vomiting

GI irritation is one of Advil's most common side effects. It is associated with its mechanism of action. Advil blocks the synthesis of prostaglandins and COX (cyclooxygenase) enzymes. The reduction in the mucosal levels of prostaglandins later damages the stomach and small intestine.

COX inhibition in the GI tract also inhibits the production of gastric mucus and bicarbonate. These reduce cell proliferation and promote adequate blood flow throughout the GI mucosa.

How to Manage Side Effects

Some precautions can be helpful to manage stomach side effects from Advil:

• Take Advil with a glass of water or milk and food. 
• Drink lots of water and fluids while taking Advil.
• Take an antacid or PPI to avoid stomach irritation.
• Take the lowest dose of Advil for the shortest duration, if possible.
• Only take the recommended dose.
• Take Advil later in the day if you experience stomach pain in the morning.

You should also avoid:

• Drinking alcohol and smoking, which can exacerbate stomach problems
• High-calorie foods while taking Advil
• More than the recommended dose or double dose
• Medications that can increase the risk of stomach problems when taken with Advil

Advil's side effects may go away as the body adjusts to the medicine. Call your healthcare provider if you experience constant pain and other symptoms. 

Summary

In most cases, you can safely take Advil on an empty stomach within the recommended dosing amounts.

Advil's mechanism of action can cause GI irritation in some people by affecting the protective lining of the GI tract. Different precautionary measures can be taken to prevent these adverse effects. Taking your dose with a meal might help.

Always consult your healthcare provider if you have any severe symptoms.