Like paracetamol, Ibuprofen is also a commonly prescribed drug and also available as over the counter medicine in many countries. It is commonly used to treat fever, pain, swelling and rheumatoid arthritis.
Name of drug
Ibuprofen is widely and easily available over the counter medicine across the world.
Class of drug
Ibuprofen belongs to non steroid anti-inflammatory drugs which are commonly called NSAIDs.
Used for
Ibuprofen is a drug of NSAIDs class commonly used to treat following conditions:
- Fever: Being an NSAID drug it is antipyretic by action and effective in reducing fever.
- Pain: As other NSAIDs drugs it is an effective pain killer.
- Anti-inflammatory: Ibuprofen is anti-inflammatory drug used to treat any inflammatory condition causing fever, pain and swelling.
- Rheumatoid arthritis: This is an inflammatory condition and Ibuprofen is very effective treating pain, fever and inflammation caused by this disease rheumatoid arthritis.
- Menstrual pain: Ibuprofen is used as a painkiller alone or in combination with paracetamol or antispasmodic drug to treat menstrual pain.
- Ibuprofen is also used to treat headache of migraine and other causes.
- Ibuprofen can reduce pain and swelling after surgery and injury.
- Ibuprofen can be used to reduce muscular pain and body ache caused by various infections.
- To close the patent ductus arteriosus in premature babies.
Mechanism of action
Ibuprofen is an NSAID drug which works by various mechanisms of action. They are as follows:
- It inhibits synthesis of prostaglandins.
- Ibuprofen is a non selective Cox inhibitor.
- It’s anti-inflammatory effect is because of Cox-2 inhibition.
- It’s unwanted side-effects are probably due to Cox-1 inhibition.
- Cyclooxygenase (Cox) is an enzyme that converts arachidonic acid to prostaglandins and thromboxane that causes platelets aggregation.
Available as
Ibuprofen is available in following forms:
- Infant drops 50 mg/1.25 ml
- Syrups: 100 mg/ 5 ml
- Tablets: 100 mg, 200 mg or 400 mg, 600mg
- Injection: 400 mg/ 3 ml injection
Administered as
Ibuprofen is commonly used drug administered as following routes:
- Oral form is given in the form of drops, syrups and tablets in an appropriate dose and frequency.
- Injection is given intravenous route. The formula is diluted to less than 4 mg / ml given slowly over 30 minutes. The dose can be repeated after 4-6 hours as needed. Do not exceed recommended dosages.
Pregnancy
Ibuprofen is not safe in pregnancy because of the risk of closure of PDA. It is not recommended in pregnancy.
The Ibuprofen may increase risk of miscarriage.
Lactation
Being highly protein bound in usual dosages, very less amount is secreted in breast milk. It is considered as safe medicine during lactation.
Elderly
Like all other NSAIDs drug, Ibuprofen should be used cautiously in elderly people.
Liver failure
Ibuprofen may need dose reduction in liver failure and cirrhosis. It may increase chances of gastrointestinal tract bleeding in cases of liver failure.
Kidney failure
Ibuprofen may worsen kidney failure. Used chronically it may cause kidney failure.
Side effects
Some of the common side effects of Ibuprofen are as follows:
- Heartburn: Ibuprofen may cause heartburn that is abdominal pain in the upper part of the abdomen.
- Gastric ulcer: It is a probable side effect of Ibuprofen as Cox-1 inhibitor.
- Worsening of asthma is the side effect of Ibuprofen.
- Ibuprofen increases chances of heart, kidney and liver failure when used in higher doses.
- Constipation, loose motion, nausea, dispepsia are common side effects of Ibuprofen
- Headache, dizziness
- Oesophageal ulceration
- Electrolyte imbalance and hyperkalemia.
- Allergic reaction, skin rash and anaphylactic reactions.
- Red coloured urine and sometimes hematuria.
Usual combinations
Most commonly used combination of Ibuprofen is with paracetamol as antipyretic and anti-inflammatory medication.
Available common brands
Ibuprofen is available as common brands, that are as follows:
- Ibugesic
- Brufen
- Flexon
- Combiflam
- Ibuklin
- Ibukind
- Imol
Signs of poisoning
Patients or parents may give a history of intentional or accidental consumption of overdoses.
Ibuprofen given in overdoses may cause poisoning. The symptoms of poisoning are excess form of side effects and may even lead to death. They are as follows:
- Nause, vomiting
- Abdominal pain, blood in vomit and stool, gastrointestinal bleeding.
- Liver and kidney failure.
- Electrolyte imbalance and hyperkalemia
- Heart failure because of fibrillation or hyperkalemia.
- Lactic acidosis.
- CNS depression.
- Thrombocytopenia.
Antidote
There is no specific antidote for Ibuprofen poisoning or toxicity. Supportive treatment is provided. Charcoal activated can be used for stomach wash.
Other supportive treatment is provided as needed.
Patient is to be admitted and closely observed in the ICU set up.
Usual drug dosages
Oral
Infant and child (≥6 mo):
- Analgesic/antipyretic: 5–10 mg/kg/dose repeated 6–8 hr PO; max. dose: 40 mg/kg/24 hr
- JRA (6 mo–12 yr): 30–50 mg/kg/24 hr ÷ repeated 6 hr PO; max. dose: 2400 mg/24 hr
Adult
- Inflammatory disease: 400–800 mg/dose repeated 6–8 hr PO; max. dose: 800 mg/dose or 3.2 g/24 hr
- Pain/fever/dysmenorrhea: 200–400 mg/dose repeated 4–6 hr as required PO; max. dose: 1.2 g/24 hr
Intravenous
6 mo–<12 yr:
- Analgesic and antipyretic: 10 mg/kg/dose up to 400 mg/dose repeated 4–6 hr as required; max. dose: the lesser of 40 mg/kg/24 hr or 2400 mg/24 hr
12–17 yr
- Analgesic and antipyretic: 400 mg/dose repeated 4–6 hr as required; max. dose: 2400 mg/24 hr
≥18 yr and adult:
- Analgesic (see remarks): 400–800 mg/dose repeated 6 hr as required; max. dose: 3200 mg/24 hr
- Antipyretic (see remarks): 400 mg/dose repeated 4–6 hr or 100–200 mg/dose repeated 4 hr as required; max. dose: 3200 mg/24 hr
