OTC spotlight: ibuprofen and other anti-inflammatories

Why this matters

Ibuprofen is one of the most useful painkillers on the counter and also one with a longer list of people who should be referred. Non-steroidal anti-inflammatory drugs (NSAIDs) affect the stomach, kidneys and heart, and interact with several common medicines. The WWHAM 'medicines' question does most of the work here.

What support staff need to know

• Ibuprofen is an NSAID. Others sold over the counter include naproxen and aspirin, and there are NSAID gels for the skin.
• Adult over the counter dose for 200 mg tablets is usually one or two tablets every four to six hours, with no more than six tablets (1,200 mg) in 24 hours. Always check the pack for the product in your hand.
• Take with or after food. Use the lowest dose that works for the shortest time.
• Children: ibuprofen liquid is licensed from three months of age and over 5 kg. Follow the age dose on the pack and refer if in doubt.
• Pregnancy: the MHRA advises avoiding NSAIDs from 20 weeks of pregnancy unless a clinician says otherwise, and they must not be used in the last three months. Refer every pregnant customer to the pharmacist.
• Ibuprofen gels applied to the skin have a different profile. Refer if someone is also taking NSAID tablets.

Refer to the pharmacist if the customer

• has ever had a stomach ulcer or bleeding from the stomach or bowel, or has indigestion often
• has asthma, especially if it has ever been made worse by aspirin or an NSAID
• has kidney problems, heart failure, heart disease or high blood pressure
• is over 65
• is pregnant, trying to conceive or breastfeeding
• takes a blood thinner, low dose aspirin, another NSAID, a steroid tablet, or an antidepressant
• takes lithium, methotrexate or medicines for blood pressure
• has chickenpox
• has been taking ibuprofen for more than a few days, or has pain that keeps coming back

WWHAM in practice

Who is it for and how old? What symptoms? How long? What have they already taken, including any other anti-inflammatory, aspirin or gel? What medicines do they take for anything else?

If the medicines question produces a blood thinner, a blood pressure medicine, a steroid or an antidepressant, hand over to the pharmacist. You do not need to know why. You need to know that it matters.

PPets learning connection

This spotlight supports the OTC consultation, WWHAM and red flags learning in the Level 2 Certificate.

Record this as CPD

Registered pharmacy technicians can use this article towards GPhC revalidation, as an unplanned CPD entry or as the starting point for a reflective account. Pharmacy assistants and trainees can use it as evidence of reflective practice. Note down three things:

1. What you learned from this article
2. How you have applied it, or will apply it, in your own role
3. The benefit to the people who use your pharmacy's services

Sources and further reading

• MHRA Drug Safety Update: NSAIDs and use after 20 weeks of pregnancy (June 2023)
• NHS: ibuprofen for adults
• MHRA best practice guidance on the sale of medicines for pain relief (March 2025)

Related from PPets

• WWHAM training
• Community pharmacy red flags
• Level 2 Certificate for pharmacy support staff

This article is for general educational purposes only. It is not legal advice, professional regulatory advice or clinical advice about an individual patient. Always follow your pharmacy's SOPs and check current official guidance and product information.

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