Because ibuprofen exhibits greater anti-inflammatory effects at higher doses, as opposed to just pain relieving effects at OTC doses. If you need to treat inflammation, you need to take more. The downside is that you get worse side effects with higher doses. Stomach ulcers, swelling/water retention, cardiovascular and kidney issues, etc. are all worse at higher doses. NSAIDs like ibuprofen are actually one of the leading causes of prerenal acute kidney injury. Despite being OTC, certain drugs need to be monitored more closely at higher doses.
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