Ibuprofen or other NSAIDs before vigorous exercise?

A runner posted the following on our group chat:

“My knee was hurting badly, and it’s bothering me even when I am walking now. I still want to run the 50KM ultra marathon in two weeks.  Luckily, a great physiotherapist worked on me and told me that I should be ok. Just take some ibuprofen before the race”.

While many people see nothing wrong with this, I am freaking out as a pharmacist.

NSAIDS, stands for Non-steroidal Anti-Inflammatory Drugs – includes Ibuprofen (Advil), and Naproxen (Aleve). NSAIDS work by blocking certain portions of the inflammatory pathway in the body.  This inevitably creates side effects, as all drugs do. NSAIDs alter renal function, inhibit free water clearance, which may potentially cause over-hydration and hyponatremia (low sodium). And this may lead to cerebral edema especially if you’ve over-hydrated like many of us tend to do.

In a study1 of Ibuprofen use in Ultramarathon athletes (N=29), Ibuprofen did not demonstrate decreased muscle damage or soreness. Rather, it increased endotoxemia and inflammation compared to control group with no Ibuprofen. The ibuprofen group also had increased C-Reactive Protein (marker of inflammation), Cytokines (created to induce inflammation). Ibuprofen also worsened kidney function post race. Another study showed ibuprofen to have negative impact on oxidative stress, which reduces the body’s ability to detoxify and repair damage by the production of free radicals. Free radicals may cause direct damage to cells and disrupt normal energy production within cells, or even cause cell death. This study concluded “Ibuprofen use compared with non-use by athletes competing in a 160-km race was associated with significantly increased oxidative stress.”

As much I want you to crush that 50K run, you need to be aware of these potential consequences of taking Ibuprofen. Please, use with caution.  Just because you can buy it without a prescription, doesn’t mean it’s not harmful. If possible, use a topical anti-inflammatory cream or gel. Diclofenac Gel (Voltaren) is one option. If you want something stronger, you can go to a doctor and get a prescription for Diclofenac 10%, which a compounding pharmacy can make for you.

Oh, another point I forgot to mention: Frequent Ibuprofen use also depletes nutrients, including Calcium, Potassium, Zinc, Iron, B6, C, D and Folic Acid. All these nutrients are essential for your athletic performance. Next time you are tempted to take Ibuprofen before a long run or a hard workout, please think again. Perhaps an additional rest day is the best prescription!


1. Nieman, et al. (2006). Ibuprofen use, endotoxemia, inflammation, and plasma cytokines during ultramarathon competition. Brain, Behavior, and Immunity 20.

2. McAnulty, et al. (2007). Ibuprofen use during extreme exercise:  effects on oxidative stress and PGE2. Medicine and Science in Sports and Exercise (39)