BMA Concise Guide to Medicine & Drugs

Ibuprofen

Brand names Anadin Ultra, Brufen, Calprofen, Fenbid, Hedex, Ibugel, Ibuleve, Ibumousse, Nurofen, and many others

Used in the following combined preparations Nurofen Plus, Nuromol, Solpadeine Migraine, and others

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Drug group Analgesic and non-steroidal anti-inflammatory drug

Overdose danger rating Low

Dependence rating Low

Prescription needed No (some preparations)

Available as generic Yes

GENERAL INFORMATION

Ibuprofen is a non-steroidal anti-inflammatory drug (NSAID) which, like other drugs in this group, reduces pain, stiffness, and inflammation. It is an effective treatment for the symptoms of osteoarthritis, rheumatoid arthritis, and gout. In the treatment of rheumatoid arthritis, ibuprofen may be prescribed with slower-acting drugs. Other uses of the drug include the relief of mild to moderate headache (including migraine), juvenile arthritis, menstrual and dental pain, ankylosing spondylitis, pain resulting from soft tissue injuries, or the pain that may follow an operation.

Ibuprofen has fewer side effects (especially at low doses) than many of the other NSAIDs, and a lower risk of gastrointestinal bleeding and ulceration.

Ibuprofen is also available as a cream or gel that can be applied to the skin for muscular aches and sprains.

INFORMATION FOR USERS

Follow instructions on the label. Call your doctor if symptoms worsen.

How taken/used Tablets, SR tablets, capsules, SR capsules, liquid, granules, cream, mousse, gel.

Frequency and timing of doses 1–2 x daily (SR preparations); 3–4 x daily (topical preparations and other oral preparations). Take all oral preparations with or after food.

Dosage range Adults 600mg–2.4g daily. Children Dosage varies according to age and/or body weight.

Onset of effect Pain relief begins in 15 minutes–2 hours. The full anti-inflammatory effect in arthritic conditions may not be felt for up to 2 weeks.

Duration of action 5–10 hours.

Diet advice None.

Storage Keep in original container at room temperature out of the reach of children.

Missed dose Take as soon as you remember. If your next dose is due within 2 hours, take a single dose now and skip the next.

Stopping the drug When taken for short-term pain relief, the drug can be safely stopped as soon as you no longer need it. If it is given for long-term treatment of arthritis, seek medical advice before stopping it.

Exceeding the dose An occasional unintentional extra dose is unlikely to be a cause for concern. But if you notice any unusual symptoms, or if a large overdose has been taken, notify your doctor.

POSSIBLE ADVERSE EFFECTS

Gastrointestinal problems, such as heartburn, indigestion, nausea, and vomiting, are common. More rarely, ibuprofen may cause headache, dizziness, drowsiness, swelling of the feet or legs, and weight gain. Discuss with your doctor if any of these effects are severe. If a rash or itching occur, you should stop taking the drug and consult your doctor. If you experience wheezing, breathlessness, or black or bloodstained faeces, you should stop the drug and contact your doctor without delay.

INTERACTIONS

General note Ibuprofen interacts with a wide range of drugs, including other NSAIDs, aspirin, oral anticoagulants, and corticosteroids, to increase the risk of bleeding and/or peptic ulcers.

Ciprofloxacin Ibuprofen increases risk of seizures with this and related antibiotics.

Antihypertensive drugs and diuretics The beneficial effects of these drugs may be reduced by ibuprofen; rarely, diuretics can also increase the risk of adverse effects on the kidneys.

Ciclosporin and tacrolimus increase the risk of adverse effects on the kidneys.

SPECIAL PRECAUTIONS

Be sure to consult your doctor or pharmacist before taking this drug if:

· You have a long-term kidney or liver problems.

· You have high blood pressure, heart problems, or coronary artery disease, or have had a previous stroke.

· You have had a peptic ulcer, oesophagitis, or acid indigestion.

· You are allergic to aspirin or other NSAIDs.

· You have asthma.

· You are taking other medicines.

Pregnancy The drug may increase the risks of adverse effects on the baby’s heart and may prolong labour if taken in the third trimester. Discuss with your doctor.

Breast-feeding The drug passes into the breast milk, but at normal doses adverse effects on the baby are unlikely. Discuss with your doctor.

Infants and children Reduced dose necessary.

Over 60 Reduced dose may be necessary.

Driving and hazardous work No problems expected.

Alcohol Avoid. Alcohol may increase the risk of stomach disorders with ibuprofen.

Surgery and general anaesthetics Ibuprofen may prolong bleeding. Discuss with your doctor or dentist before any surgery.

PROLONGED USE

There is an increased risk of bleeding from peptic ulcers and in the bowel with prolonged use of ibuprofen. There is also a small risk of a heart attack or stroke. To minimize these risks, the lowest effective dose is given for the shortest duration.