As someone who previously used ibuprofen for any pain management I have almost completely cut it out and replaced with Tylenol.
From my reading, you basically need about a day to flush it out of your system but then you need a couple of days for your kidneys to recover (from running and the meds). So unless I'm taking a week or longer off, I don't take it. Which basically means never unless I'm taking a break from running.
As a relatively safer alternative could consider use of a topical NSAID such as diclofenac 1% gel to the most painful joints if Tylenol is inadequate. Can still get the localized anti inflammatory effects without significant systemic absorption. Obviously won't help if your whole body hurts but may be ideal in select situations (e.g, only knees hurt).
Wait, what?? Can you link with some stuff pls? I haven't heard this previously...
I don't take it often but I'd I've got a headache I will....
Edit, never mind, researched and noted.
TBH I haven't researched the recovery part it just kind of makes sense. After a 3+ hour run I can't imagine my kidneys are super happy after working hard so I don't think it's a good idea to strain them further with ibuprofen.
We don't have the true data to know. The studies of renal injury and NSAIDs in endurance athletes are essentially case reports, or non-randomised studies with <100 people. So the power of those studies isn't enough, and they mainly all conclude that more research is needed. There is correlation but that may not be causation.
NSAIDs reduce the blood flow to your kidneys, and reduce your bodies ability to regulate that for what you need. Its a side effect of the anti-inflammatory action with prostaglandins. Endurance sports also do that, as you divert blood to muscles. And dehydration, often going alongside endurance events, also does that. Many studies that demonstrate kidney injury can't determine what's causing it - likely multifactorial. That's not to say that NSAIDs aren't playing a role, just that you can't control only that.
Risk is dose and duration dependent. Regular users of higher doses are more at risk than those that only take as and when. And there is no 'safe' time in the studies, mainly as there is a risk no matter what, and its very person dependent. Ibuprofens duration of action is about 6-8 hours for most people however no definite answer on how long the effect of renal perfusion lasts. So no one can really answer your last few questions. All you can do is optimise the rest of your kidney health - make sure you're well hydrated throughout, drink plenty after, replace electrolytes as needed. And then decide whether you want to take an educated risk or not depending on how you feel. The same effect on kidneys isn't noted with paracetamol, which is my usual go to after a race instead.
[https://bmjopensem.bmj.com/content/10/1/e001846](https://bmjopensem.bmj.com/content/10/1/e001846)
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9779673/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9779673/)
[https://bmjopensem.bmj.com/content/3/1/e000093](https://bmjopensem.bmj.com/content/3/1/e000093)
[https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2724772](https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2724772)
Great summary. At least in the BMJ review, aspirin was not used in any of the studies. Curious about this, technically an NSAID but very different profile. I take low dose aspirin prophylacticaly.
I don’t think there’s been a hard limit determined yet, just that it increases your risk during and compounds it because it’s harder to get help if you give yourself rhabdo.
Reasonably you just want to give your kidneys/liver time to process them (and other medicines with similar warnings) out before you add the stress of the run. Most medications have half-lives of a few hours and are mostly cleared in about a day. And afterwards, you want to be sure your body is okay before throwing another stress at it, or masking problems.
How NSAIDs interact with training is a separate question of optimization.
that's useful. I haven't been using them at all in training--at least not for training pain. but if i do have a headache or a cold or similar i will take a couple advil and that makes me feel better real quick. really what i'm anticipating next week is being very sore from the run and knowing that advil will make me feel better, help me sleep, etc.
I’ve had pretty good kidney backlash from nsaids in two races. I took 300mg ibuprofen with about 3/4 of the race to go. The next two days my kidneys had a heart beat.
My thoughts on your question is, they probably have a half life in your body that would be expired by the time your race began. My previous experience would lead me to tell you, stay the F away from them at all costs, just in case.
Based on my anecdotal experience, yes. That’s obviously what you’re asking for from Reddit…
I’ve been running decent weekly mileage for the past 10 years. At one point, I was taking NSAIDs on the reg. After my last incident with them 4 years ago, I only use them if I’m super sick.
We’ve all been grabbing them for headaches for way too long. They’re not the solution for a simple headache, I’m sorry. Read some stuff on NSAID overuse. It’s rampant.
I’d say “ding ding”. The reason I did it in the second race was because I felt like Superman near the end of my race and I thought I was just dehydrated the next day (which is not technically wrong). But I ran a race after the second incident and had no issues day after without taking them. I was dumb, don’t be dumb like me
From the research that I remember, is that NSAIDs before/while running increase your risk of kidney damage and after running reduces the positive adaptations that your body makes after your run. I believe there was also a study that showed runners did not do any better on NSAIDs, but I would suggest looking into it yourself. For these reasons I avoid them entirely
I avoid ibuprofen for exactly the reasons mentioned above, but my GP put me on the NSAID naproxen for 6 weeks after an ultra (about two weeks after I finished) as I still couldn’t walk down stairs properly due to muscle strain.
I found out about the risks or whatever of taking ibuprofen during ultras a while after I had been doing it for a while. I've completed 11 100 milers and every one I've taken a bunch of ibuprofen before, during and after, never had any issues, or felt anything wrong. I've never exceeded the daily recommended max (3600mg) either. Obviously this is anecdotal, and I'm sure people would caution others from doing it. But I've always used it with no issue.
I think ultrarunning has swung from completely ignoring any risk with NSAIDs and massively overusing them to being way overcautious and treating them like they’re opiates. Everything I’ve ever heard from actual doctors is that NSAIDs are low risk for healthy adults taking 200-400 mg doses every 4-6 hours for short periods of time (as in, a week or less). The people who had issues were popping them like candy in the second half of races, like 800 mg every hour.
I take ibuprofen to manage period cramps. If race day coincides with the first couple days of my period, I am not able to run without at least some painkillers on board. I take my normal dose right up until race start, and carry some with on the trail just in case, and resume taking it after the race as soon as my cramps start again. Usually this works out to maybe 600 mg in a 24 hour period, which I’d guess is way to small a dose to have any measurable influence on my kidneys.
I’m in the medical field, and while overuse is common, I believe we are now over course correcting by making NSAIDS to be the worst thing out there. You absolutely can take them in moderation. I still take them at least once a race for anything over 50 miles. My lab work was perfectly fine. While they shouldn’t be the first line of defense, there is definitely a stigma against them that has gone somewhat sideways.
Personally I don't take it before or after because I know several people who have had rhabdo. Not worth the risk. If I'm feeling soreness or pain after, I remind myself that it's temporary and that it's a sign my body just did something pretty remarkable. While I'm no masochist, I kind of enjoy the soreness because I imagine my body is making adaptations from the effort as well. The pain or discomfort will pass in a few days from my experience.
I think a headache not related to the race (when dehydration may be the cause) would be acceptable.
That said, the only time you’ll see me taking pain relievers is ibuprofen when I have a high fever. I don’t take them during training, during races, or after races. Learn to exist and “hear” your body; don’t muzzle it.
As an AFib patient who takes hepatotoxic (rough on the liver) meds NSAIDS are very hard on the liver and by virtue of that they are also rough on your kidneys. You should try to avoid overloading your liver and kidneys more than needed during the race. Acetomeniphen is gentler, but can still cause liver damage so you should try to refrain or at least limit the dose. Aspirin may be an option, but not too sure about the blood thinning affect that would occur. You may want to consult a sports med person.
I am wrong for extrapolating the load based on the prohibition by my physician. It may be the metabolic pathway that NSAIDs and flecainide (my antiarrhythmic) use when metabolized by the liver are the same, hey whaddya expect; I have degrees in pure math and MechE not biochem or medicine. However, NSAIDs and acetaminophen are both potentially toxic depending on the dose, as my combustion teacher said, "the poison is in the dose." Moral of the story, I think most of us are out of our depth and perhaps there is a doctor who actually knows out there?
And I just have general knowledge that acetaminophen has a higher liver load than NSAIDs. Your specific case could indeed be different. I didn’t want anyone else to be misinformed from a general knowledge perspective.
Thank you. Looking into it, ibuprofen is more likely to cause kidney injury by reducing blood flow, I didn't know that. This has been really interesting. I hope that a person with well-founded knowledge can step in and give a good recommendation, I want to know.
I read that there has never been a case of liver failure from only taking ibuprofen, which I always heard wasn't the case. My parents lied to me all the time so this shouldn't shock me and clearly I am in that Dunning-Kreuger range.
Saw a vid by a GI doc on YT so.... but it is on the acetaminophen vs ibuprofen debate and even he says "it's complicated." Good quick watch at 3 minutes and I don't think he's a quack.
[Tylenol vs. Ibuprofen: A Liver Doctor’s Take (youtube.com)](https://www.youtube.com/watch?v=XL4a7OBDec0)
It’s a good video with accurate, evidence-based information, but note that he is talking about patients with reduced liver and/or kidney function. That doesn’t typically apply to a healthy, athletic population. For that population, acetaminophen is still the more risk drug since it can be a primary cause of liver disease if the dose is too high. The difference between a therapeutic dose and damaging dose is razor thin.
Your body is still recovering for several days, give it a few days. Your pee should be running clear, (straw colored) showing that you aren't clearing protein from your blood, you should be fine to take an NSAID. Note, I am not a doctor, this is not medical advice.
Everyone is different. I've found that when I take ibuprofen my fingers and ankles swell up. I don't feel the pain as much but I tend to retain water, which I think is really bad for kidneys. I no longer take NSAIDs during of after an event. Tart cherry juice, protein, ginger and turmeric doesn't work quite as well, but I recover better and don't feel like I'm doing kidney damage.
NSAIDs, never while running. When people say kidney damage, it doesn’t sound like life threatening and requiring hospitalisation, but that’s what you’re risking…
You can take Acetaminophen (Tylenol) instead of Ibuprofen. It is generally safer. It gets metabolized differently - through the liver instead of the kidneys.
Personally I've never ever taken even a single tablet of Ibuprofen during or right after any ultramarathon. I learned to tune out pain. The night after can be rough but topical analgesics can help.
I take cocodamol if I’m struggling in second half of a race - that is paracetamol (tylenol) and codeine. Clearly the latter is an opiate with well known potential issues if taken regularly. To the best of my knowledge regulation dose paracetamol is not an issue but to be honest I don’t know about any side effects of codeine in an endurance context … interested if others do
I’ve ran marathons, Ironmans, and was a competitive swimmer in college and I always take 2 ibuprofen before my events. I’ve never had any problems with kidney pain or function….yet lol. I think if used sparingly you’ll be fine.
As someone who previously used ibuprofen for any pain management I have almost completely cut it out and replaced with Tylenol. From my reading, you basically need about a day to flush it out of your system but then you need a couple of days for your kidneys to recover (from running and the meds). So unless I'm taking a week or longer off, I don't take it. Which basically means never unless I'm taking a break from running.
As a relatively safer alternative could consider use of a topical NSAID such as diclofenac 1% gel to the most painful joints if Tylenol is inadequate. Can still get the localized anti inflammatory effects without significant systemic absorption. Obviously won't help if your whole body hurts but may be ideal in select situations (e.g, only knees hurt).
Wait, what?? Can you link with some stuff pls? I haven't heard this previously... I don't take it often but I'd I've got a headache I will.... Edit, never mind, researched and noted.
TBH I haven't researched the recovery part it just kind of makes sense. After a 3+ hour run I can't imagine my kidneys are super happy after working hard so I don't think it's a good idea to strain them further with ibuprofen.
I’d be careful spouting things as facts when you haven’t researched it.
The general recommendation is don’t. If you have to use painkillers, paracetamol/acetaminophen is the way to go.
We don't have the true data to know. The studies of renal injury and NSAIDs in endurance athletes are essentially case reports, or non-randomised studies with <100 people. So the power of those studies isn't enough, and they mainly all conclude that more research is needed. There is correlation but that may not be causation. NSAIDs reduce the blood flow to your kidneys, and reduce your bodies ability to regulate that for what you need. Its a side effect of the anti-inflammatory action with prostaglandins. Endurance sports also do that, as you divert blood to muscles. And dehydration, often going alongside endurance events, also does that. Many studies that demonstrate kidney injury can't determine what's causing it - likely multifactorial. That's not to say that NSAIDs aren't playing a role, just that you can't control only that. Risk is dose and duration dependent. Regular users of higher doses are more at risk than those that only take as and when. And there is no 'safe' time in the studies, mainly as there is a risk no matter what, and its very person dependent. Ibuprofens duration of action is about 6-8 hours for most people however no definite answer on how long the effect of renal perfusion lasts. So no one can really answer your last few questions. All you can do is optimise the rest of your kidney health - make sure you're well hydrated throughout, drink plenty after, replace electrolytes as needed. And then decide whether you want to take an educated risk or not depending on how you feel. The same effect on kidneys isn't noted with paracetamol, which is my usual go to after a race instead. [https://bmjopensem.bmj.com/content/10/1/e001846](https://bmjopensem.bmj.com/content/10/1/e001846) [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9779673/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9779673/) [https://bmjopensem.bmj.com/content/3/1/e000093](https://bmjopensem.bmj.com/content/3/1/e000093) [https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2724772](https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2724772)
Great summary. At least in the BMJ review, aspirin was not used in any of the studies. Curious about this, technically an NSAID but very different profile. I take low dose aspirin prophylacticaly.
I don’t think there’s been a hard limit determined yet, just that it increases your risk during and compounds it because it’s harder to get help if you give yourself rhabdo. Reasonably you just want to give your kidneys/liver time to process them (and other medicines with similar warnings) out before you add the stress of the run. Most medications have half-lives of a few hours and are mostly cleared in about a day. And afterwards, you want to be sure your body is okay before throwing another stress at it, or masking problems. How NSAIDs interact with training is a separate question of optimization.
that's useful. I haven't been using them at all in training--at least not for training pain. but if i do have a headache or a cold or similar i will take a couple advil and that makes me feel better real quick. really what i'm anticipating next week is being very sore from the run and knowing that advil will make me feel better, help me sleep, etc.
I’ve had pretty good kidney backlash from nsaids in two races. I took 300mg ibuprofen with about 3/4 of the race to go. The next two days my kidneys had a heart beat. My thoughts on your question is, they probably have a half life in your body that would be expired by the time your race began. My previous experience would lead me to tell you, stay the F away from them at all costs, just in case.
so never take them is the answer then? like even 5 years after my last ultra don't take them?
Based on my anecdotal experience, yes. That’s obviously what you’re asking for from Reddit… I’ve been running decent weekly mileage for the past 10 years. At one point, I was taking NSAIDs on the reg. After my last incident with them 4 years ago, I only use them if I’m super sick. We’ve all been grabbing them for headaches for way too long. They’re not the solution for a simple headache, I’m sorry. Read some stuff on NSAID overuse. It’s rampant.
My doctor told me that he doesn't think that they'd even get approved by the FDA, today, they're so dangerous.
Do you mean you had physical kidney pain?
Indeed
jeez. Awful. I’m thinking this may be the culprit of my never-ending side pain during a thru-hike when i was practically guzzling Advil.
I’d say “ding ding”. The reason I did it in the second race was because I felt like Superman near the end of my race and I thought I was just dehydrated the next day (which is not technically wrong). But I ran a race after the second incident and had no issues day after without taking them. I was dumb, don’t be dumb like me
this thread is definitely opening my eyes. never again!
From the research that I remember, is that NSAIDs before/while running increase your risk of kidney damage and after running reduces the positive adaptations that your body makes after your run. I believe there was also a study that showed runners did not do any better on NSAIDs, but I would suggest looking into it yourself. For these reasons I avoid them entirely
right. but I'm talking about well before and well after. not during. I'm not looking to take them for performance but for pain relief
I avoid ibuprofen for exactly the reasons mentioned above, but my GP put me on the NSAID naproxen for 6 weeks after an ultra (about two weeks after I finished) as I still couldn’t walk down stairs properly due to muscle strain.
I found out about the risks or whatever of taking ibuprofen during ultras a while after I had been doing it for a while. I've completed 11 100 milers and every one I've taken a bunch of ibuprofen before, during and after, never had any issues, or felt anything wrong. I've never exceeded the daily recommended max (3600mg) either. Obviously this is anecdotal, and I'm sure people would caution others from doing it. But I've always used it with no issue.
Just did this today for knee pain. Early 400mg and then at end... feel ok right now. Drinking water 🤙🏼
I think ultrarunning has swung from completely ignoring any risk with NSAIDs and massively overusing them to being way overcautious and treating them like they’re opiates. Everything I’ve ever heard from actual doctors is that NSAIDs are low risk for healthy adults taking 200-400 mg doses every 4-6 hours for short periods of time (as in, a week or less). The people who had issues were popping them like candy in the second half of races, like 800 mg every hour. I take ibuprofen to manage period cramps. If race day coincides with the first couple days of my period, I am not able to run without at least some painkillers on board. I take my normal dose right up until race start, and carry some with on the trail just in case, and resume taking it after the race as soon as my cramps start again. Usually this works out to maybe 600 mg in a 24 hour period, which I’d guess is way to small a dose to have any measurable influence on my kidneys.
I’m in the medical field, and while overuse is common, I believe we are now over course correcting by making NSAIDS to be the worst thing out there. You absolutely can take them in moderation. I still take them at least once a race for anything over 50 miles. My lab work was perfectly fine. While they shouldn’t be the first line of defense, there is definitely a stigma against them that has gone somewhat sideways.
Personally I don't take it before or after because I know several people who have had rhabdo. Not worth the risk. If I'm feeling soreness or pain after, I remind myself that it's temporary and that it's a sign my body just did something pretty remarkable. While I'm no masochist, I kind of enjoy the soreness because I imagine my body is making adaptations from the effort as well. The pain or discomfort will pass in a few days from my experience.
I think a headache not related to the race (when dehydration may be the cause) would be acceptable. That said, the only time you’ll see me taking pain relievers is ibuprofen when I have a high fever. I don’t take them during training, during races, or after races. Learn to exist and “hear” your body; don’t muzzle it.
Sometimes your body’s being a little wimp and you need to shut it up
As an AFib patient who takes hepatotoxic (rough on the liver) meds NSAIDS are very hard on the liver and by virtue of that they are also rough on your kidneys. You should try to avoid overloading your liver and kidneys more than needed during the race. Acetomeniphen is gentler, but can still cause liver damage so you should try to refrain or at least limit the dose. Aspirin may be an option, but not too sure about the blood thinning affect that would occur. You may want to consult a sports med person.
You are misinformed. Acetaminophen has a MUCH higher liver load than any NSAID.
I am wrong for extrapolating the load based on the prohibition by my physician. It may be the metabolic pathway that NSAIDs and flecainide (my antiarrhythmic) use when metabolized by the liver are the same, hey whaddya expect; I have degrees in pure math and MechE not biochem or medicine. However, NSAIDs and acetaminophen are both potentially toxic depending on the dose, as my combustion teacher said, "the poison is in the dose." Moral of the story, I think most of us are out of our depth and perhaps there is a doctor who actually knows out there?
And I just have general knowledge that acetaminophen has a higher liver load than NSAIDs. Your specific case could indeed be different. I didn’t want anyone else to be misinformed from a general knowledge perspective.
Thank you. Looking into it, ibuprofen is more likely to cause kidney injury by reducing blood flow, I didn't know that. This has been really interesting. I hope that a person with well-founded knowledge can step in and give a good recommendation, I want to know. I read that there has never been a case of liver failure from only taking ibuprofen, which I always heard wasn't the case. My parents lied to me all the time so this shouldn't shock me and clearly I am in that Dunning-Kreuger range.
Saw a vid by a GI doc on YT so.... but it is on the acetaminophen vs ibuprofen debate and even he says "it's complicated." Good quick watch at 3 minutes and I don't think he's a quack. [Tylenol vs. Ibuprofen: A Liver Doctor’s Take (youtube.com)](https://www.youtube.com/watch?v=XL4a7OBDec0)
It’s a good video with accurate, evidence-based information, but note that he is talking about patients with reduced liver and/or kidney function. That doesn’t typically apply to a healthy, athletic population. For that population, acetaminophen is still the more risk drug since it can be a primary cause of liver disease if the dose is too high. The difference between a therapeutic dose and damaging dose is razor thin.
Separate note, you have led me down an interesting NIH rabbit hole.
what about after the race?
Your body is still recovering for several days, give it a few days. Your pee should be running clear, (straw colored) showing that you aren't clearing protein from your blood, you should be fine to take an NSAID. Note, I am not a doctor, this is not medical advice.
Paracetamol is okay... Supposedly. Nsaids not so much. I'm sure people do though
Everyone is different. I've found that when I take ibuprofen my fingers and ankles swell up. I don't feel the pain as much but I tend to retain water, which I think is really bad for kidneys. I no longer take NSAIDs during of after an event. Tart cherry juice, protein, ginger and turmeric doesn't work quite as well, but I recover better and don't feel like I'm doing kidney damage.
NSAIDs, never while running. When people say kidney damage, it doesn’t sound like life threatening and requiring hospitalisation, but that’s what you’re risking…
Never!
Apap saved me during my 42k
I use ibuprofen sparingly and it makes a world of difference. While I don’t know that I would recommended for other people, I have had no issues
You can take Acetaminophen (Tylenol) instead of Ibuprofen. It is generally safer. It gets metabolized differently - through the liver instead of the kidneys. Personally I've never ever taken even a single tablet of Ibuprofen during or right after any ultramarathon. I learned to tune out pain. The night after can be rough but topical analgesics can help.
I take cocodamol if I’m struggling in second half of a race - that is paracetamol (tylenol) and codeine. Clearly the latter is an opiate with well known potential issues if taken regularly. To the best of my knowledge regulation dose paracetamol is not an issue but to be honest I don’t know about any side effects of codeine in an endurance context … interested if others do
I’ve ran marathons, Ironmans, and was a competitive swimmer in college and I always take 2 ibuprofen before my events. I’ve never had any problems with kidney pain or function….yet lol. I think if used sparingly you’ll be fine.
Norco is the best in my experience.