Advil is ibuprofen (an NSAID). Its long‑term side effects can look similar across people, but how likely or how severe they are can differ a lot based on the user’s risk factors (age, dose, other meds, health conditions, alcohol use, etc.). Here are the main long‑term risks and how they differ between users.

1) Stomach / ulcer / bleeding risk (GI)

What can happen: gastritis, ulcers, GI bleeding, black/tarry stools, anemia.
Why it differs between users:

• Higher dose and longer use → more risk.
• History of ulcers/GI bleed → much higher risk.
• Older age → increased risk.
• Also taking other meds:
  • Blood thinners (warfarin, apixaban, rivaroxaban)
  • Antiplatelets (clopidogrel, high-dose aspirin)
  • Steroids (prednisone)
  • SSRIs/SNRIs (some increase bleeding risk)
• Alcohol and smoking can worsen risk.
• Some people are more “ulcer-prone” even at the same dose.

Note: Many people develop GI issues gradually and may not notice until bleeding occurs—especially if they’re using the drug regularly.

2) Kidney (renal) effects

What can happen: reduced kidney function, fluid retention, worsening chronic kidney disease, sometimes acute kidney injury.
Why it differs between users:

• Existing kidney disease → much higher risk.
• Dehydration (not drinking enough, vomiting/diarrhea, heavy sweating) → higher risk.
• Diuretics (“water pills”), ACE inhibitors/ARBs (e.g., lisinopril/losartan), or other nephrotoxic drugs increase risk (“triple whammy” with NSAID + ACE/ARB + diuretic).
• Heart failure and older age can increase susceptibility.
• Long-term daily use carries more concern than occasional use.

3) Cardiovascular (heart) risk

What can happen: increased risk of heart attack and stroke, higher blood pressure, fluid retention, worsening heart failure.
Why it differs between users:

• Higher baseline cardiovascular risk (prior heart disease, diabetes, smoking, hypertension) → greater risk.
• Long-term/high-dose use → more risk.
• Dose timing and individual biology matter—some people see BP increases or edema sooner.
• Compared with some other NSAIDs, ibuprofen can still raise risk, especially at higher doses used long term.

4) Blood pressure and fluid retention

What can happen: swelling (ankles/feet), weight gain from fluid, BP increases.
Why it differs between users:

• People with hypertension, kidney disease, or heart failure are more affected.
• Salt intake and concomitant meds (like diuretics or antihypertensives) influence outcomes.

5) Liver / systemic effects (less common)

What can happen: rare liver enzyme elevation or hepatitis-like reactions; rash or hypersensitivity.
Why it differs between users: individual susceptibility, prior liver disease, other medications, and duration/dose.

6) Increased risk of certain skin/allergy reactions (unpredictable)

What can happen: rashes, hives; rarely severe reactions (e.g., Stevens‑Johnson syndrome).
Why it differs: allergy history, underlying asthma/nasal polyps (some NSAID-exacerbated respiratory disease exists), and genetics.

7) Long-term use and “medication overuse” type headaches

If taken frequently for pain, some people develop rebound headaches (especially with regular use of analgesics).

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Why two users can have very different outcomes

Long‑term side effect profiles differ mainly due to:

• Dose and frequency (e.g., occasional vs daily)
• Duration
• Age
• Existing conditions: ulcer history, kidney disease, high BP, heart disease
• Other medications (blood thinners, steroids, ACE/ARB + diuretic)
• Alcohol use
• Hydration status
• Genetic/individual sensitivity (varies a lot)

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Practical risk-reduction (general)

• Use the lowest effective dose for the shortest time.
• Avoid combining with other NSAIDs (naproxen, diclofenac) unless a clinician advises.
• If you need it regularly for pain, it’s worth discussing alternatives (topical NSAIDs like diclofenac gel, acetaminophen in some cases, physical therapy, or other options).
• Ask a clinician whether you should use a stomach-protective strategy (e.g., a PPI) if you’re high risk for ulcers/bleeding.
• Seek prompt care for warning signs: black stools, vomiting blood, severe stomach pain, reduced urination, sudden swelling, chest pain, weakness on one side, severe shortness of breath.

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If you tell me (1) your dose (mg), (2) how often you take it, (3) how long you’ve used it, (4) age, and (5) any health conditions or other meds, I can explain which long‑term side effects are most relevant to your situation and what risk factors matter most.