Endurance runners who take ibuprofen to cope with accompanying aches and pains double their risk of acute kidney injury, doctors reported Wednesday in an analysis of ultramarathoners.
Ibuprofen belongs to the class of medications known as non-steroidal anti-inflammatory drugs, or NSAIDs, which are well-known for their ability to tamp down pain, reduce fever and decrease inflammation. They are available over-the-counter as well as by prescription, and are sold under such brand names as Advil and Motrin.
Ultramarathoners log distances well beyond the usual 26.2 marathon miles, taking on 50- and 100-mile runs, said Dr. Grant Lipman, clinical associate professor of emergency medicine at Stanford University in California.
As lead investigator of new research, Lipman said it’s important to understand that running such long distances can induce muscle pain.
“These are expedition-length ultramarathons,” said Lipman, whose research was published in the online edition of Emergency Medicine Journal. “These are not elite athletes. They’re not sponsored uber-athletes. These are folks who love the experience.”
Lipman, who is also medical director of the ultramarathon group called RacingThePlanet, said about 75 percent of these runners use ibruprofen to address pain and swelling in their joints. But in his research of 89 runners, participants were given either a 400-milligram dose of ibuprofen or lookalike sugar pills at the near-midpoint of a 155-mile ultramarathon.
According to the study’s findings, there was an 18 percent higher rate of acute kidney injury in people who took the medication. “Basically, for every five runners who took ibuprofen, there was one additional case of acute kidney injury,” Lipman said.
The medication injures the kidneys by reducing blood flow to them, Lipman said, noting that some ultramarathoners have wound up in the hospital because of kidney problems. He suggests acetaminophen, sold as Tylenol, as an alternative.
“Running is safe and running is good for you,” Lipman said. “Caution should be used when taking ibuprofen.”
Doctors, however, have long known that ibuprofen and other NSAIDs can decrease blood flow to the kidneys. The injury generally occurs when people are not well-hydrated. Other NSAIDs include aspirin and naproxen.
“There is one important thing that people should know: These medications will not harm most people,” said Dr. Steven Fishbane, chief of nephrology for the Northwell Health system on Long Island.
“Tens of millions of people take these drugs and have no problems,” added Fishbane, who was not involved in Lipman’s research.
Fishbane said hydration is the key, especially for runners who lose significant amounts of fluid during exercise, to preventing renal injury with ibuprofen or any other NSAID.
“I am always afraid of scaring healthy people,” Fishbane said, underscoring that if the exercise is causing tremendous pain, then perhaps the person is exercising too much. He noted that hydration is always important when taking ibuprofen or other NSAIDs.