Will I use ibuprofen on the Appalachian Trail?

If you came to this blog post to find out if it’s safe to use ibuprofen on your hike, you’re in for a ride. But staying for the duration of the trip can be worth it, because “safe” isn’t a yes or no question. I’ll give context to the «ibuprofen increases risk» claims and key questions you may want to ask.

Disclaimer: This is not medical advice. It’s just me sharing how I made my own decision and what I learned along the way.

I started down this path while planning my resupply boxes. When it came to medication, I wanted to understand the risks of using ibuprofen on my hike. It’s not enough for me to hear “X increases my risk” and make a decision based on that. I wanted to make an informed decision. To understand my decision, let me share my thoughts.

What is “safe”?

It depends. If by “safe” you mean almost zero risk of harm, then raising the AT is not safe. If by safe you mean «no significant risk,» then we have to define «significant.» There is simply no simple, objective metric to determine “safe.” Safety is just one factor in the immensely personal balance between risk and reward.

Okay, but all things being equal: the increased risk due to ibuprofen is bad, right?

Well, again, it depends. I recently attended a research presentation and the doctor said to me, «If I said your favorite food doubled your risk of pancreatic cancer, would you stop eating it?» Stop for a moment and think about that. What would you do? Now, what if I told you that the initial risk was 0.0005% and therefore by eating your favorite food you would have a 0.001% or one-thousandth of a percent chance of getting that cancer? It is very possible that going without your favorite food for the rest of your life will involve excessive cost and 0.0005% lower risk. But maybe you’d let it. It’s a personal balance. After all, reducing inflammation and feeling less pain can improve both your experience and your chances of success.

But the example is debatable because I chose an extreme? Well yes and no. We haven’t talked about dosage and frequency yet. Taking 400 mg of something can be very different from taking 2400 mg, and taking it once is very different from taking it every day for 10 years. Iron supplements may increase risk of gastrointestinal problems and cancer⁵. Brown rice increases risk of arsenic toxicity (compared to white rice)⁴. The list goes on because all increases the risk of something. The dose makes the poison, and much of the risk from ibuprofen comes at extremely high doses.

I say all of the above to explain why this should be a specific question. It’s not just a question of «does ibuprofen increase the risk?» Dosage, frequency and total time are important. Additionally, medical history is important. For ibuprofen, age and existing conditions influence the risk. In that context, let me rephrase our title:

What are the risks of taking 200 mg to 600 mg of ibuprofen daily for four months in a healthy biological man between 40 and 50 years old?

You probably won’t be surprised to read that I had a hard time finding replicated, verified studies on my dosage levels*. Almost all of the studies showing a significant risk are done in high-dose patients, specifically those taking 2400 mg per day over a period of months. These are studies on people treating chronic pain or inflammation due to things like osteoarthritis.

So after about 12 hours of studying, I made a health decision based on incomplete information. This is what I learned:

In high-dose regimens, ibuprofen carries increased risks of gastrointestinal, renal, and cardiac complications. However, 99% of those complications occurred in patients taking daily doses of 2400 mg.¹ – or double the recommended daily maximum without a prescription. We are talking about patients taking high doses prescribed by a doctor for the treatment of long-term diseases. The few studies I found on lower doses of ibuprofen showed no increased cardiovascular risk.³. Other studies have found, with respect to the kidneys, that “NSAIDs do not cause great harm in patients without kidney disease, young people and without comorbidities.”⁷.

Bottom line: Low-dose ibuprofen is not very likely to harm me. I will carry it and use it as needed, but not as a prophylactic. I will not take more than 1200 mg per day, every day. For me, that’s the way I make decisions, based on how I weighed my risk versus my reward. Your mileage may vary.

Here are some questions you may want to consider when making your own call.²:

• Do you have decreased kidney capacity or kidney disease?
• Do you have a history of cardiovascular disease?
• Do you have a history or increased risk of stomach ulcers?
• Will you take more than the recommended daily dose?

If you want to dig deeper into kidney risk in less than 12 hours, I recommend NSAIDs in CKD: are they safe??⁸. The authors do a good job of explaining the study’s broad, often contradictory results and its flaws; in addition to providing guidance.

Final disclaimer: This is not a research paper (I spent 12 hours on it) nor is it medical advice. If you want medical advice, consult your doctor, not the Internet. Your doctor can advise you based on your personal situation.

Documents used to make my decision.

1: “Vascular and upper gastrointestinal effects of nonsteroidal anti-inflammatory drugs: meta-analysis of individual participant data from randomized trials” The Lancet, Volume 382, ​​Number 9894, 769 – 779
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)60900-9/fulltext#

2: Ho, Kok Yuen et al. «Practical advice on the appropriate use of NSAIDs in primary care.» Journal of Pain Research Vol. 13 1925-1939. August 3, 2020, doi:10.2147/JPR.S247781
Practical advice on the appropriate use of NSAIDs in primary care – PMC

3: McGettigan, Patricia and David Henry. «Cardiovascular risk with nonsteroidal anti-inflammatory drugs: systematic review of population-based controlled observational studies». PLoS Medicine Vol. 8.9 (2011): e1001098. doi:10.1371/journal.pmed.1001098
Cardiovascular risk with non-steroidal anti-inflammatory drugs: systematic review of population-based controlled observational studies – PubMed

4: Scott, C.K., and Wu, F. (2025). «Arsenic content and exposure in brown rice compared to white rice in the United States.» Risk Analysis, 45, 2183–2196
Arsenic Content and Exposure in Brown Rice Compared to White Rice in the United States – Scott – 2025 – Risk Analysis – Wiley Online Library

5: Fisher, Anna EO and Declan P Naughton. «Iron supplements: the quick fix with long-term consequences.» Nutrition Magazine Vol. 3 2. January 16, 2004, doi:10.1186/1475-2891-3-2
Iron supplements: the quick fix with long-term consequences – PMC

6: Katie M. Rieck, Darrell R. Schroeder, Michael A. Mao. “Inpatient NSAID Exposure and Development of Acute Kidney Injury in Hospitalized Medical Patients: A Retrospective Cohort Study” American Journal of Medicine Open, Volume 15, 2026, 100119, ISSN 2667-0364
Exposure to NSAIDs in hospitalized patients and development of acute kidney injury in hospitalized patients: a retrospective cohort study – ScienceDirect

7: Luke, Guillherme & Leitão, Ana & Alencar, Renan & Xavier, Rosa & Daher, Elizabeth & Silva Junior, Geraldo. (2018). «Pathophysiological aspects of nephropathy caused by non-steroidal anti-inflammatory drugs». Brazilian Journal of Nephrology. 41. 10.1590/2175-8239-JBN-2018-0
(PDF) Pathophysiological aspects of nephropathy caused by non-steroidal anti-inflammatory drugs

8: Baker, Megan et al. «NSAIDs in CKD: Are they safe?» American Journal of Kidney Diseases, Volume 76, Number 4, 546 – ​​557
NSAIDs in CKD: are they safe? – American Journal of Kidney Diseases

* I fully recognize that “I can’t find it” and “none exists” are not the same. Link any you have with the caveat that “this doctor or organization says…” is not a scientific study. That’s just expert advice. There’s nothing wrong with trusting him, but that’s not what I’m looking for.

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