Ibuprofen (Motrin) alternatives: What can I take instead of ibuprofen?

Compare ibuprofen alternatives | Tylenol | Celebrex | Qdolo | Qutenza | Voltaren gel | Natural alternatives | How to switch meds

Ibuprofen is a generic non-steroidal anti-inflammatory drug or NSAID. It is available in lower strengths over-the-counter, and higher-strength tablets require a prescription. If you’ve ever experienced mild-to-moderate acute pain, such as from a muscle pull or a procedure associated with inflammation, you’ve probably taken ibuprofen before. It also has antipyretic properties, making it helpful as supportive care in combating the aches, pains, and fevers associated with viral conditions like the common cold.

Since it’s widely available over-the-counter, ibuprofen is easily accessible and is often used for more chronic pain management, like joint pain associated with osteoarthritis or lower back pain. Despite being widely available, ibuprofen has some serious side effects, and certain groups of people should use it with caution while others should avoid it altogether. NSAIDs can decrease blood flow to the kidneys, resulting in harm. A patient’s risk for kidney damage should always be considered, including a review of other medications they are taking that might be a “double whammy” to kidneys—such as an angiotensin-converting enzyme inhibitor (ACEi) or angiotensin II receptor blockers (ARBs). While an occasional over-the-counter dose should be safe in patients with mild to moderate risk for kidney disease, NSAIDs should be avoided entirely in patients with severe kidney disease. 

Also, it is important to understand the type of pain you are trying to treat; ibuprofen will have minimal to no effect on neuropathic pain, and chronic pain may require different medications like opioids to manage the discomfort. Here, we will discuss some ibuprofen alternatives. 

What can I take in place of ibuprofen?

Other options are available to provide pain relief either acutely or for other types of pain, like nerve pain or inflammatory pain associated with medical conditions like rheumatoid arthritis. These alternative medications include different types of NSAIDs, medications that are applied topically for very localized relief, and other analgesic painkillers. These options may be more suitable for certain individuals due to their different mechanisms of action, routes of administration, side effect profiles, and dosages.

Other alternatives to ibuprofen

• Toradol (ketorolac)
• Diflusinal
• Lodine (etodolac)
• Flurbiprofen
• Aspirin
• Meclofenamate
• Relafen DS (nabumetone)
• Salsalate
• Sulindac

Top 5 ibuprofen alternatives

The following are some of the most common alternatives to ibuprofen.

1. Tylenol (acetaminophen)

NSAIDs, including ibuprofen, are known to result in an increased risk of cardiovascular effects, including high blood pressure and heart failure. The mechanism behind this hypertension is the construction of blood vessels and sodium retention caused by prostaglandin inhibition. Patients with and without high blood pressure at baseline are both at risk, and the elevation in blood pressure is patient-specific depending on individual risk factors and the specific NSAID used. Level of dosing contributes to risk, such that lower doses of ibuprofen carry a lower risk in causing elevations of blood pressure. Also, patients treated with an NSAID like ibuprofen in the first year following a myocardial infarction (MI, or heart attack) are more likely to die than patients who do not take an NSAID. For patients with cardiovascular disease or risk factors for ischemic heart disease, alternatives like acetaminophen should be considered before moving to an NSAID. 

2. Celebrex (celecoxib)

NSAIDs can result in gastrointestinal (GI) ulceration and bleeding. The chance of such a serious event is slight, but the consequences can be devastating. Medications within the NSAID class may have more or less of a propensity to cause these significant adverse effects, and no single NSAID is entirely free of the risk of causing stomach ulcers. NSAIDs work by inhibiting an enzyme known as COX-2; prostaglandins produced by COX-2 play a role in inflammation, pain, and fever; therefore, inhibition of this enzyme can prevent the pathways that result in these symptoms. NSAIDs also inhibit, to varying degrees, the COX-1 enzyme—especially with high doses. Prostaglandins produced by COX-1 protect the GI tract, increasing mucosal blood flow, mucus production, and cell growth. 

Celebrex is unique from ibuprofen and other NSAIDs because it selectively inhibits COX-2, so it only interferes in the pathways associated with pain, not those associated with protecting the GI mucosa. Celebrex is associated with as much as a 20% lower risk of bleeding compared to other NSAIDs. It may be safer than nonselective NSAIDs in patients requiring long-term use (greater than six months) or in patients taking other medications that may also have similar GI effects, like concurrent aspirin use.

3. Qdolo (tramadol)

Qdolo (tramadol) is an alternative to stronger opioids in certain patients. It is a synthetic codeine analog; it is a weak agonist at mu opioid receptors and also a weak SNRI. Given its weak activity at opioid receptors, it became a controlled substance in 2014 because available data suggests it has abuse potential similar to other controlled substances. The maximum daily dose of Ultram is 400 mg; doses that exceed this amount may produce subjective effects like morphine. In patients with impaired renal function, dose reductions should be employed. In addition to the typical side effects of opioids, tramadol can cause seizures and low blood sugar, among other adverse events. 

4. Qutenza (capsaicin patch 8%)

Topical agents for pain relief provide an additional alternative to ibuprofen. Qutenza effectively manages localized peripheral neuropathic pain, including postherpetic neuralgia and diabetic neuropathy of the feet. A benefit of this medication is that targeted relief can improve. It is applied in a clinic every three months (one to four patches to the affected area for 30 to 60 minutes, depending on the indication). The downside of Qutenza is its expense compared to alternatives, and there is some concern with long-term use in that it may damage epidermal nerve fibers. Additionally, before application, patients must receive a topical anesthetic and undergo blood pressure monitoring due to the potential for a short-term increase in pain. 

5. Voltaren gel (diclofenac 1% gel)

Another potential topical pain reliever alternative to ibuprofen is Voltaren gel. Voltaren is an NSAID, like ibuprofen. The topical application prevents some of the safety concerns observed with oral NSAIDs.Still, it does carry the same NSAID warnings as the oral agents regarding increased risk of gastrointestinal and cardiovascular adverse events, so it should always be used at the lowest dose for the shortest duration of time possible. The gel may work as well as oral NSAIDs for arthritis and acute musculoskeletal pain (like sprains and strains). However, it comes with a higher risk of localized adverse events, such as rash, compared to oral NSAIDs, and it is significantly more expensive than oral options. 

Natural alternatives to ibuprofen

The management of pain should be approached from all angles, and non-pharmacologic and more natural approaches may provide some real relief. Depending on the source of the pain, physical therapy may be one way to help manage it, especially in chronic pain after injuries or surgeries. Physical therapy aims to achieve optimal neuromuscular and skeletal function by employing therapeutic exercise. 

Other holistic approaches, such as acupuncture or aromatherapy with different essential oils like peppermint or lavender, may provide pain relief and are generally safe, natural options. Turmeric is a spice with an active component called curcumin, known to have anti-inflammatory properties; supplementation with turmeric may provide natural pain relief. Natural products, such as topical capsaicin or magnesium supplements, may relieve pain as they reduce inflammation over time. 

How to switch to an ibuprofen alternative

Pain management, be it acute or chronic, should always be implemented after receiving medical advice from a healthcare provider. If interested in exploring an alternative pain reliever to ibuprofen, it is best to have an individualized plan to manage pain before stopping it. There is no harm in abruptly discontinuing ibuprofen, but the relief provided does not last more than a few hours; having an alternative agent lined up is vital for adequate pain relief.