Ibuprofen

Ibuprofen side effects with short term use are generally most common in the gastrointestinal tract including gastritis, peptic ulcer disease, and gastrointestinal bleeding. With long-term use the most common serious ibuprofen side effects are on the kidney with potential progressive renal failure.
Ibuprofen side effects: ibuprofen was one of the first nonsteroidal anti-inflammatory medications to come to market, first branded as Motrin. Ibuprofen is available in 100 mg, 200 mg, 400 mg, 600 mg, and 800 mg tablets as well as in 50 and 100 mg chewable tablets and as a 40 mg per ML suspension. Common brand names include Motrin, Advil, Nuprin, and others. When used in low dosage ibuprofen is an effective medication at controlling fever and is a pain medication. In higher doses ibuprofen is a good anti-inflammatory drug. When used in high dosage for prolonged periods of time careful monitoring for proteinuria and serum creatinine should be considered to recognize progressive renal insufficiency a stage early enough to discontinue use of ibuprofen before end-stage renal failure occurs. FDA approved indications for ibuprofen include treatment of osteoarthritis, rheumatoid arthritis, dysmenorrhea, mild to moderate pain, fever, and other inflammatory conditions where an anti-inflammatory effect is desired.

Black box warnings: ibuprofen can increase the risk of serious and even fatal cardiovascular artery thrombosis leading to them my and stroke. There’s some evidence of this risk may be increased with longer duration of use and in patients with cardiovascular disease or multiple cardiovascular disease risk factors. Ibuprofen is contraindicated for use of control of pain after Curry bypass surgery. Additionally ibuprofen increases the risk of serious gastrointestinal untoward events including peptic ulcers, gastrointestinal bleeding, and perforation of the stomach or intestine. Any of these can be potentially life-threatening or fatal.

Common ibuprofen side effects: the most common ibuprofen side effects involve the gastrointestinal tract and can include dyspepsia and nausea, constipation and abdominal pain. Headache is a fairly common ibuprofen side effect and can be confusing because ibuprofen is often used to treat headache. Other central nervous system ibuprofen side effects can include dizziness, drowsiness, tinnitus, and photosensitivity. Rash, fluid retention, and bruising or ecchymosis are the common ibuprofen side effects.

Serious ibuprofen side effects: serious ibuprofen side effects are common in multiple systems including the gastrointestinal tract where gastrointestinal bleeding, ulceration and perforation are seen often enough to be a major concern. Cardiovascular problems including acute MRI, stroke, other types thromboembolism, hypertension, and fluid retention are also seen as ibuprofen side effects. Nephrotoxicity including progression to end-stage renal failure is a very serious potential ibuprofen side effect. Hematopoietic ibuprofen side effects include any of the cytopenias such as neutropenia aplastic anemia agranulocytosis thrombocytopenia and pancytopenia which is reduced blood counts of all major types. Serious dermatologic ibuprofen side effects can include exfoliative dermatitis toxic epidermal neck roll lysis and Stevens-Johnson syndrome. Hepatotoxicity is occasionally seen. Allergic reactions including anaphylaxis anaphylactoid reactions are also seen as serious ibuprofen side effects. Bronchospasm is occasionally seen as a serious ibuprofen side effect often in patients who also have aspirin allergy.

Cautions and contraindications: ibuprofen uses contraindicated in combination with most of the other nonsteroidal anti-inflammatory medications including aspirin, all of the other NSAIDs, and Cox two inhibitors. Ibuprofen you should be avoided if possible in combination with alcohol, methotrexate, tacrolimus, pepper, warfarin, as well as numerous of the medications. The list of potential drug interactions and cautions is extensive and the reader should refer to the manufacturers prescribing guidelines or consult your pharmacist or physician for details regarding specific medications. The list of medications to consider modification of treatment or monitoring is extensive. It includes the ace inhibitors and the angiotensin receptor blockers where ibuprofen can reduce the effectiveness of these drugs, acetaminophen where additive renal toxicity can occur with prolonged use, lithium, numerous herbal medications including red clover, and the SSRIs where the risk of hyponatremia and bleeding may be increased.

Pregnancy and lactation: ibuprofen is considered a category B drug in pregnancy although specific trimester issues should be discussed with your maternity care provider. Ibuprofen is considered safe for use during lactation.

Metabolism and pharmacology: ibuprofen is metabolized in the liver through the CYP 450 system especially the 2C9 substrate pathway. Very little ibuprofen is excreted unchanged in the urine.

Unusual ibuprofen side effects: headache is among the unusual ibuprofen side effects that can be confusing to patients and physicians alike. Because ibuprofen as a commonly used headache therapy it’s not usually considered by patients as a potential cause of headache. In headaches where no clear explanation is noted in where ibuprofen is being used discontinuation the ibuprofen may be appropriate see if headache improves.

Alternative NSAIDs: there are numerous NSAIDs on the market today and there’s very little evidence that for most inflammatory conditions any particular NSAID is more or less effective than the others. Ibuprofen has the advantage of being inexpensive and easily available. Some patients find the multiple daily doses inconvenient and this may lead to noncompliance with prescribed regimens. Ibuprofen should always be used with food to lower the incidence of gastrointestinal side effects and to do this most times a day can be difficult for some patients. In patients at especially high risk for gastrointestinal bleeding combining ibuprofen with either proton pump inhibitor or with misoprostol can be considered. Misoprostol is the second drug in the medication Arthrotec is combination with diclofenac. The newer product called Vimovo is a combination of Naprosyn and Nexium.

 

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