Should you be using Ibuprofen before or during a Marathon?

With the London marathon coming up this weekend a number of clients have asked me if it is ok to use Ibuprofen before the race.

Ibuprofen is a type of anti-inflammatory otherwise known as an NSAID (Non-steroidal anti-inflammatory drug) which acts as a COX-2 inhibitor.

I have to confess and say that my initial response was "yeah, no problem" on the basis that I did it a few times whilst training for my own marathons in the past.  However, I then stopped and asked myself, “hang on, is this actually the correct information?"

It turns out I was not alone in my thoughts and actions!

Use of pre-marathon NSAID's is surprisingly common.  One study, published in the BMJ, found that of the 3,913 runners surveyed at the 2010 Bonn Marathon in Germany, 49% said they took NSAID's before the race.  Similar findings have also been reported prior to other endurance events such as triathlon  and ultra marathons.  Like me, the majority of these people had taken these medications without medical prescription and without knowing the potential side effects.

However, it turns out we really shouldn't be...

Overall the research suggests that:

a) Taking NSAID’s prior to a race will not reduce pain during a race

This is further supported by a randomised control trial published in 2015 which found that Ibuprofen did not reduce the effect of muscle damage and pain on performance. 

But more importantly taking them can...

b) Contribute to serious adverse effects including

Cardiovascular events (heart issues)
Gastrointestinal cramps/bleeds (stomach issues)
Renal dysfunction (kidney issues)

In the Bonn Marathon study they found that the people who used pain killers were almost five times as likely to suffer an adverse event as the people who didn’t, and the risk of an adverse event increased with higher analgesic dosage.

In addition, all nine cases of hospitalisation in the few days following the race came from people who had used the analgesics prior to racing. Three had markedly low or nonexistent urine output, which can be a sign of renal failure; four had gastro-intestinal bleeding; and two had cardiac infarction, or a form of mild heart attack.

Whilst you can't link these adverse events to taking ibuprofen alone it is interesting that everyone who had one had taken some medication. Further trials which account for confounding variables will have to be conducted to establish the true effects of ibuprofen whilst racing. 

The researchers in this paper concluded “that the use of analgesics before and during endurance sports may pose a serious health problem”. 

My advice - don't take ibuprofen before your marathon and always seek the advice from a Doctor.

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