Exceeding the daily dosing limit of nonsteroidal anti-inflammatory drugs among ibuprofen users

Pharmacoepidemiol Drug Saf. 2018 Mar;27(3):322-331. doi: 10.1002/pds.4391. Epub 2018 Jan 26.


Purpose: Nonsteroidal anti-inflammatory drugs (NSAIDs) are effective and very commonly used, but also have side effects. We determined prevalence of NSAID dosing exceeding the daily limit (EDL) and identified related user characteristics and dosing patterns among current ibuprofen users.

Methods: Online 1-week diary study of 1326 ibuprofen users. NSAIDs were identified by list-based prompting; respondents were not required to know their medications were NSAIDs. Details of hourly use were recorded by respondents daily. Deviations from dosing directions were programmatically determined afterwards. An exit survey obtained information on demographics, medical history, physical and mental health status, attitudes regarding label reading and dosing behavior, and knowledge of product label instructions.

Results: Most diary users (90%) took over-the-counter ibuprofen during the week; 37% also took non-ibuprofen NSAIDs. Most did not recognize all products taken as NSAIDs. EDL occurred among 11% of users for ibuprofen, 4% of users for other NSAIDs, and on 9.1% of NSAID usage days. EDL was associated with deviations from detailed dosing directions, particularly exceeding the 1-time dose, which occurred more often with medications with 1-pill doses. Personal characteristics associated with EDL included male sex, ongoing pain, poor physical function, daily smoking, having the attitudes of "choosing my own dose" and not starting with the lowest dose, and poor knowledge of the recommended 1-time and 24-hour doses.

Conclusions: The prevalence of EDL among NSAID users is nontrivial, and it is associated with potentially modifiable factors. Educating consumers about NSAIDs and their dosing directions could reduce excess dosing.

Keywords: NSAIDs; dosing behavior; drug safety; epidemiology; nonsteroidal anti-inflammatory drugs; pharmacoepidemiology; survey research.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Anti-Inflammatory Agents, Non-Steroidal / administration & dosage*
  • Anti-Inflammatory Agents, Non-Steroidal / adverse effects
  • Dose-Response Relationship, Drug
  • Female
  • Humans
  • Ibuprofen / administration & dosage*
  • Ibuprofen / adverse effects
  • Male
  • Middle Aged
  • Nonprescription Drugs / administration & dosage*
  • Nonprescription Drugs / adverse effects
  • Pain / drug therapy*
  • Patient Education as Topic
  • Prevalence
  • Prospective Studies
  • Surveys and Questionnaires / statistics & numerical data


  • Anti-Inflammatory Agents, Non-Steroidal
  • Nonprescription Drugs
  • Ibuprofen