Ibuprofen is a household staple in Spain – and the country’s most-requested painkiller among adults aged 26 to 50.
According to available data, ‘almost nine out of 10 people (88.5%) request it directly’ without a prescription. It relieves pain, lowers fever and is widely perceived as harmless.
But cardiologist Aurelio Rojas is warning that its routine use is far from risk-free.
In a video published on Instagram, the specialist describes ibuprofen as ‘one of the worst drugs for the heart’, urging people with cardiovascular risk factors to use it cautiously.
Rojas explains that, like other non-steroidal anti-inflammatory drugs (NSAIDs), ibuprofen works by blocking the COX-2 enzyme. This ‘reduces prostacyclins, vasodilating and anti-aggregant substances’ that help protect the arteries.
As a result, he says, it can create the ‘perfect environment for heart attacks and thrombosis’, increasing platelet aggregation and causing vasoconstriction.
Risks for the kidneys – and for blood pressure
The cardiologist also highlights ibuprofen’s impact on kidney function. The drug can raise blood pressure and worsen heart failure by encouraging the ‘retention of sodium and water in our kidneys’. For people with cardiac issues, this excess fluid can be ‘a serious problem’.
By inhibiting renal prostaglandins, ibuprofen also reduces glomerular perfusion, effectively lowering blood flow through the kidneys. That, Rojas warns, triggers a vicious cycle of more hypertension, more fluid overload and, in the medium term, a higher risk of heart attack or stroke.
Still, he stresses that the level of danger depends on three factors: dose, duration, and the person taking it.
For healthy people, occasional use is generally low-risk.
‘In young, healthy people using it occasionally, for example for a headache, the risk is minimal,’ he says.
Both the European Medicines Agency (EMA) and Spain’s own medicines regulator, the AEMPS, have long analysed ibuprofen’s cardiovascular profile. Their conclusions are aligned: the greatest risk occurs at high daily doses.
The AEMPS states clearly that the increased risk of heart attack or arterial thrombosis ‘is mainly associated with high doses of ibuprofen, equal to or greater than 2,400 mg per day’.
By contrast, occasional moderate use does not appear to pose a significant danger. According to the agency, ‘no increase in cardiovascular risk has been observed with doses of up to 1,200 mg/day’ – essentially the standard over-the-counter dosage in Spain (typically two 600 mg tablets per day).
The regulator also warns that ibuprofen can reduce the anti-platelet effect of low-dose aspirin – a widely used protective therapy for those at cardiovascular risk. Although the clinical significance is still debated, experts recommend avoiding long-term combined use unless medically supervised.
Who should avoid it?
The Spanish Heart Foundation (FEC) advises that people with hypertension, cardiac arrhythmias, heart failure or kidney disease should avoid ibuprofen wherever possible, since it ‘can worsen the patient’s baseline condition’.
Rojas suggests safer alternatives such as paracetamol or low-dose naproxen, but stresses they should still be used under medical guidance.
