Ibuprofen (Oral)

Overview

Although Ibuprofen can be administered via intravenous injection or applied as a topical ointment, it is most commonly used as an oral medication. Predominantly used to treat inflammation, pain and/or fever, patients take this medicine to relieve conditions such as headache, menstrual pain, rheumatoid arthritis, osteoarthritis, juvenile arthritis and/or migraine. In addition to this, Ibuprofen may be used to relieve pain and discomfort following an acute injury or to reduce the fever associated with a virus.

As a nonsteroidal anti-inflammatory drug (NSAID), Ibuprofen works by inhibiting the effects of cyclooxygenase (COX) enzymes. Usually, these enzymes help the conversion process of arachidonic acid to prostaglandin H2. Following this, other enzymes convert prostaglandin H2 into thromboxane A2 and various other types of prostaglandins.

As prostaglandins are associated with fever, inflammation and pain, Ibuprofen helps to relieve these symptoms by reducing the number of prostaglandins in the patient's body. As the medication prevents cyclooxygenase enzymes from beginning the initial conversion process, fewer prostaglandins are produced and, as a result, pain, fever and inflammation can be reduced.

By inhibiting COX-1 and COX-2 enzymes, Ibuprofen can have an antipyretic effect, as well as having analgesic and anti-inflammatory properties. Due to this, many patients prefer to use Ibuprofen, rather than using medication which can only reduce pain.

Although Ibuprofen is extremely effective in treating mild to moderate pain, it isn't suitable for all patients. As the medication affects the production of thromboxane A2, it inhibits the blood clotting process and is not, therefore, suitable for patients with clotting disorders or who are taking anti-coagulants.

Patients should also be aware that Ibuprofen is not a curative agent. When used to treat long-term or chronic conditions, such as rheumatoid arthritis, Ibuprofen will reduce pain and inflammation but will not cure the condition itself.

Available as a prescription medicine and as an over-the-counter remedy, Ibuprofen is one of the most widely-used pain medications and is routinely used by patients to treat mild to moderate inflammation, fever or pain symptoms.

Conditions Treated

  • Pain
  • Inflammation
  • Fever

Type Of Medicine

  • Nonsteroidal anti-inflammatory drug (NSAID)

Side Effects

When using Ibuprofen, patients may experience some side effects. The following adverse effects normally occur when patients first start using the medication and should be reduced over time:

  • Continuing buzzing or ringing or other unexplained noise in ears
  • Runny nose
  • Hearing loss
  • Unusual sleepiness or drowsiness
  • Nervousness
  • Rapidly changing moods
  • Crying
  • Quick to react or overreact
  • Depersonalization
  • Paranoia
  • Discouragement
  • Mental depression
  • Dry eyes
  • Loss of pleasure or interest
  • Stuffy nose
  • Dysphoria
  • Trouble concentrating
  • Lack of appetite
  • Euphoria
  • Sleeplessness
  • Feeling empty or sad
  • Inability to sleep
  • Trouble sleeping
  • Sneezing

If the above side effects are fairly mild and diminish over time, patients may not require medical assistance. However, if the above adverse effects are prolonged or severe, patients should obtain medical advice.

In addition to this, patients will need to seek medical help if they experience any of the following side effects when taking Ibuprofen:

  • Abdominal pain
  • Sour or acid stomach
  • Rattling, noisy breath
  • Belching
  • Nausea
  • Bloating
  • Passing gas
  • Cloudy urine
  • Pale skin
  • Decrease in amount of urine
  • Itching skin
  • Decrease in urine output and/or decrease in urine-concentrating ability
  • Indigestion
  • Diarrhea
  • Heartburn
  • Difficulty having a bowel movement (stool)
  • Abdominal cramps
  • Feeling of fullness
  • Excess gas or air in intestines or stomach
  • Discomfort or pain in upper stomach, throat or chest
  • Rash with small raised lesions or flat lesions on the skin
  • Blood in the stools or urine
  • Shortness of breath
  • Loosening, peeling or blistering of the skin
  • Change in vision
  • Swelling of the ankles, lower legs, feet, hands or face
  • Cough
  • Vomiting
  • Confusion
  • Bleeding gums
  • Dark urine
  • Weight gain
  • Decreased urine output
  • Troubled breathing at rest
  • Stomach, leg or back pains
  • Troubled breathing with exertion
  • Agitation
  • Unusual bruising or bleeding
  • Coma
  • Irregular, fast, racing or pounding pulse or heartbeat
  • Depression
  • Stomach discomfort or soreness
  • Chills
  • Unusual weakness or tiredness
  • Clay-colored stools
  • Tarry, black or bloody stools
  • Chest pain
  • Dilated neck veins
  • Blurred vision
  • Difficulty swallowing
  • Burning feeling in stomach or chest
  • Difficulty breathing
  • Hoarseness
  • Dizziness
  • General feeling or weakness or tiredness
  • Dry mouth
  • General body swelling
  • Lethargy
  • Extreme fatigue
  • Laboratory results which show problems with the liver
  • Fever with or without chills
  • Muscle or joint pain
  • Frequent urination
  • Itching
  • Thinning of hair or hair loss
  • Irritability
  • Headache
  • Welts or hives
  • Irritability
  • Hostility
  • Stiff back or neck
  • Light-colored stools
  • Stomach upset
  • Impaired vision
  • Stupor
  • Loss of appetite
  • Swelling or puffiness around the face, eyelids, tongue, lips or around the eyes
  • Pain in side or lower back
  • Increased blood pressure
  • Painful or swollen glands
  • Muscle twitching
  • Continuing and severe nausea
  • Increased volume of dilute, pale urine
  • Wheezing
  • Severe abdominal cramping, burning or pain
  • Yellowing of the skin or eyes
  • Difficult or painful urination
  • Unpleasant breath odor
  • Redness of the skin
  • Chest tightness
  • Irregular breathing
  • Nosebleeds
  • Upper right abdominal pain
  • Red skin lesions, sometimes with a purple center
  • Pains in side, abdomen or stomach, possibly radiating to the back
  • Vomiting of blood
  • Rash on the skin
  • Irritated, red eyes
  • Vomiting of material that looks like coffee grounds
  • Thirst
  • Red, pinpoint spots on skin
  • Tenderness in the stomach area
  • Ulcers, white spots or sores on the lips or in the mouth
  • Seizures

Although many of the above side effects occur rarely, they do warrant medical attention. Similarly, patients should seek medical help if they experience any other side effects when taking Ibuprofen.

If patients take too much Ibuprofen or take the medication for too long, an overdose may occur. This is considered a medical emergency and the patient will require urgent medical treatment. The symptoms of an overdose may include:

  • Bluish skin or lips
  • Sweating
  • Difficulty sleeping
  • Sudden fainting
  • Disorientation
  • Stomach cramps
  • Lightheadedness, faintness or dizziness when getting up from a sitting or lying position suddenly
  • Irregular or slow heartbeat
  • Drowsiness to profound coma
  • Restlessness
  • Muscle tremors
  • Hallucination
  • Deep, rapid breathing
  • Lightheadedness or fainting
  • Not breathing
  • Mood or other mental changes

If patients experience the above symptoms when taking Ibuprofen, they should obtain medical help immediately.

Dosage

When patients take Ibuprofen, their dose will depend on a number of factors. The patient's age, weight, medical history and current condition will all be taken into account before a suitable dose is prescribed.

If adult patients are taking oral Ibuprofen for pain relief, they are usually advised to take 400mg every four to six hours, as needed. If children over the age of six months are prescribed Ibuprofen for pain relief, their dose will depend on their weight. Generally, pediatric patients are advised to use 10mg per kilogram of bodyweight, every six to eight hours. However, a maximum of 40mg per kilogram of bodyweight per day should not be exceeded.

If adult patients are given Ibuprofen to treat the symptoms of osteoarthritis or rheumatoid arthritis, they are usually advised to take 1200mg-3200mg per day but this should be divided into equal doses and taken at three or four different times throughout the day. If pediatric patients are prescribed Ibuprofen to treat arthritis, they will usually be advised to take 30mg-40mg per kilogram of bodyweight per day but this should be divided into three or four doses and taken throughout the day.

Alternatively, patients may be prescribed Ibuprofen to reduce a fever. If so, adult patients are usually advised to take Ibuprofen at a dose of 400mg every four to six hours, as needed. Pediatric patients over the age of six months can be given Ibuprofen to reduce a fever but their dose will depend on their weight and their exact temperature.

As Ibuprofen is associated with gastric side effects, patients may want to take their dose of medicine with food or milk as this can help to lessen stomach upsets.

If patients forget to take a dose of Ibuprofen, they should take it as soon as they remember to do so. However, if their next dose is almost due, they should skip the missed dose and continue with their next dose as normal. Patients should not attempt to take a double dose of Ibuprofen, even if they have forgotten to take an earlier dose.

Although the above information is indicative of a general dosing schedule, patients should be given specific instructions when they are prescribed Ibuprofen. Depending on the patient's condition, Ibuprofen may be prescribed at higher doses than stated above.

When taking prescription Ibuprofen, patients should follow their physician's instructions and, if patients are taking over-the-counter Ibuprofen, they should not exceed the dose stated in the medication guide.

If patients are unsure how much Ibuprofen to take or when to take it, they should seek advice from their physician or pharmacist.

Potential Drug Interactions

When more than one medication is taken or used, there is the possibility of interactions occurring and these may be harmful to the patient. Due to this, Ibuprofen should not be prescribed if patients are taking the following medication:

  • Ketorolac

Similarly, Ibuprofen should not usually be taken if the patient is already using any of the following medicines:

  • Abciximab
  • Etodolac
  • Aceclofenac
  • Fepradinol
  • Acemetacin
  • Fenoprofen
  • Acenocoumarol
  • Felbinac
  • Amiloride
  • Etoricoxib
  • Amineptine
  • Etofenamate
  • Amitriptyline
  • Ethacrynic Acid
  • Amitriptylinoxide
  • Escitalopram
  • Amoxapine
  • Feprazone
  • Amtolmetin Guacil
  • Eplerenone
  • Anagrelide
  • Epoprostenol
  • Apixaban
  • Enoxaparin
  • Ardeparin
  • Eptifibatide
  • Argatroban
  • Flufenamic Acid
  • Aspirin
  • Fluocortolone
  • Balsalazide
  • Fluoxetine
  • Bemiparin
  • Floctafenine
  • Bendroflumethiazide
  • Feverfew
  • Benzthiazide
  • Milnacipran
  • Beta Glucan
  • Morniflumate
  • Betamethasone
  • Nimesulide Beta Cyclodextrin
  • Bismuth Subsalicylate
  • Nimesulide
  • Bivalirudin
  • Niflumic Acid
  • Bromfenac
  • Nabumetone
  • Budesonide
  • Nefazodone
  • Bufexamac
  • Nadroparin
  • Bumetanide
  • Nepafenac
  • Cangrelor
  • Naproxen
  • Celecoxib
  • Indomethacin
  • Certoparin
  • Lithium
  • Chlorothiazide
  • Lofepramine
  • Chlorthalidone
  • Levomilnacipran
  • Choline Magnesium Trisalicylate
  • Lepirudin
  • Choline Salicylate
  • Ketoprofen
  • Cilostazol
  • Indapamide
  • Citalopram
  • Imipramine
  • Clomipramine
  • Iloprost
  • Clonixin
  • Ibuprofen
  • Clopamide
  • Pemetrexed
  • Clopidogrel
  • Pentoxifylline
  • Cortisone
  • Pentosan Polysulfate Sodium
  • Cyclopenthiazide
  • Phenindione
  • Cyclosporine
  • Phenylbutazone
  • Trichlormethiazide
  • Dabigatran Etexilate
  • Phenprocoumon
  • Dalteparin
  • Phenyl Salicylate
  • Danaparoid
  • Salicylic Acid
  • Deflazacort
  • Tacrolimus
  • Desipramine
  • Salsalate
  • Desirudin
  • Sulindac
  • Desvenlafaxine
  • Sulfasalazine
  • Dexamethasone
  • Sibutramine
  • Dexibuprofen
  • Sertraline
  • Dexketoprofen
  • Spironolactone
  • Diflunisal
  • Sodium Salicylate
  • Diazoxide
  • Ticlopidine
  • Dibenzepin
  • Tirofiban
  • Diclofenac
  • Tinzaparin
  • Digoxin
  • Tolfenamic Acid
  • Dipyridamole
  • Tolmetin
  • Dipyrone
  • Torsemide
  • Dothiepin
  • Triamterene
  • Doxepin
  • Valdecoxib
  • Droxicam
  • Trolamine Salicylate
  • Duloxetine
  • Treprostinil
  • Edoxaban
  • Trimipramine
  • Flurbiprofen
  • Reviparin
  • Fluvoxamine
  • Reboxetine
  • Fondaparinux
  • Protriptyline
  • Furosemide
  • Rivaroxaban
  • Ginkgo
  • Salicylamide
  • Gossypol
  • Tenoxicam
  • Heparin
  • Rofecoxib
  • Hydrochlorothiazide
  • Prednisolone
  • Hydrocortisone
  • Piroxicam
  • Hydroflumethiazide
  • Proglumetacin
  • Loxoprofen
  • Prednisone
  • Lornoxicam
  • Piketoprofen
  • Lumiracoxib
  • Polythiazide
  • Magnesium Salicylate
  • Pralatrexate
  • Meadowsweet
  • Prasugrel
  • Meclofenamate
  • Tianeptine
  • Mefenamic Acid
  • Protein C
  • Melitracen
  • Xipamide
  • Meloxicam
  • Vortioxetine
  • Mesalamine
  • Ticagrelor
  • Methotrexate
  • Tiaprofenic Acid
  • Methyclothiazide
  • Vilazodone
  • Methylprednisolone
  • Proquazone
  • Opipramol
  • Venlafaxine
  • Propyphenazone
  • Oxaprozin
  • Metolazone
  • Paroxetine
  • Oxyphenbutazone
  • Vorapaxar
  • Parnaparin
  • Nortriptyline
  • Parecoxib
  • Warfarin
  • Paramethasone
  • Olsalazine

Although patients should not usually take Ibuprofen in conjunction with any of the above medications, doctors may feel it is necessary in some situations. If so, the patient's physician may modify their dose to try and prevent an interaction occurring.

When taking Ibuprofen, there are some medications which can increase the risk of side effects occurring. Although Ibuprofen may still be prescribed alongside these medicines, patients should be aware that they may be more prone to side effects. These medicines include:

  • Acebutolol
  • Metipranolol
  • Alacepril
  • Metoprolol
  • Amikacin
  • Levobunolol
  • Atenolol
  • Lisinopril
  • Azilsartan
  • Labetalol
  • Azilsartan Medoxomil
  • Fosinopril
  • Benazepril
  • Losartan
  • Betaxolol
  • Imidapril
  • Bisoprolol
  • Irbesartan
  • Candesartan
  • Nebivolol
  • Captopril
  • Oxprenolol
  • Carteolol
  • Esmolol
  • Carvedilol
  • Pentopril
  • Celiprolol
  • Olmesartan
  • Cilazapril
  • Penbutolol
  • Delapril
  • Practolol
  • Spirapril
  • Enalapril
  • Ramipril
  • Trandolapril
  • Enalaprilat
  • Telmisartan
  • Quinapril
  • Eprosartan
  • Temocapril
  • Moexipril
  • Sotalol
  • Nadolol
  • Timolol
  • Perindopril
  • Valsartan
  • Pindolol
  • Zofenopril
  • Propranolol

Warnings

Before taking Ibuprofen, patients should obtain advice from their pharmacist or physician. There are some conditions which may affect the suitability of treatment with Ibuprofen and these include:

  • Bleeding problems
  • Asthma
  • Blood clots
  • Anemia
  • Heart disease
  • Body swelling or fluid retention (Edema)
  • Heart attack
  • Liver disease
  • Kidney disease
  • High blood pressure
  • Stroke
  • Intestinal or stomach ulcers
  • Intestinal or stomach bleeding
  • Diabetes
  • Aspirin sensitivity
  • Heart surgery

Although the patient's current medical conditions can affect their use of Ibuprofen, any previous conditions can affect the safety of treatment with Ibuprofen as well. If patients have a history of strokes, for example, they may not be able to use Ibuprofen, even if they have not suffered a stroke recently. Due to this, patients should disclose their medical history to their physician before using Ibuprofen.

Pediatric patients may be given Ibuprofen but their dose must be calculated carefully. As studies have not been carried out on the effects of Ibuprofen on patients under the age of six months, this medicine should not be used to treat patients who are under this age.

If geriatric patients are using Ibuprofen, their dose may need to be modified. Older patients are more likely to have age-related heart, liver or kidney problems and these can result in medications building up in their systems. Geriatric patients may need to take a lower dose of Ibuprofen or take the medication less often in order to avoid complications occurring.

In some cases, patients may be prescribed Ibuprofen on a long-term basis. This is usually when patients are suffering from chronic conditions, such as arthritis. In such instances, it may take some time for the medication to take effect and patients may not notice a reduction in their symptoms until they have been taking Ibuprofen for a number of weeks.

If patients are taking Ibuprofen on a long-term basis, they will need to have regular consultations with their physician. They will also need to undergo regular urine and blood tests to ensure that the medication isn't having any harmful effects.

However, patients should not use Ibuprofen for long periods of time, unless their doctor has advised them to. If patients are taking over-the-counter Ibuprofen, they should only use the medication for approximately 48-72 hours before seeking further medical advice.

Taking Ibuprofen can increase the patient's risk of having a stroke and/or a heart attack. This is more likely in patients who take the medicine for long periods of time or in patients who have heart disease.

Ibuprofen can cause bleeding in the intestines and/or stomach. If so, these problems often arise suddenly and without warning. This may be more likely to occur in patients who smoke, are over the age of 60 years, are in poor health, consume alcohol regularly, have had a stomach ulcer in the past or who are taking additional medications, such as blood thinners or steroids. If patients think they may be experiencing bleeding, they should obtain immediate medical help.

When taking Ibuprofen, patients can experience serious skin reactions. If patients notice the following side effects occurring whilst they are taking this medicine, they should seek immediate medical help:

  • Loosening, blistering or peeling of the skin
  • Diarrhea
  • Cough
  • Fever
  • Chills
  • Muscle or joint pain
  • Itching
  • Ulcers
  • Sores
  • Red skin lesions
  • Sore throat
  • Unusual weakness or tiredness
  • White spots on the lips or in the mouth

If patients are experiencing serious side effects when taking Ibuprofen, they may exhibit some warning signs. These may include:

  • Slurred speech
  • Unusual warmth or flushing of the skin
  • Irregular or fast heartbeat
  • Weakness
  • Chest pain or tightness
  • Unusual weight gain
  • Rash on the skin
  • Bruising or bleeding
  • Decreased urination
  • Yellowing of the skin or eyes
  • Vomiting material which looks like coffee grounds
  • Vomiting blood
  • Severe stomach pain
  • Swelling of the fingers, feet, face and/or lower legs
  • Tarry, black stools

If patients experience any of the above side effects whilst using Ibuprofen, it may indicate a serious complication, such as a heart problem. Patients should stop taking the medication and seek immediate medical help.

When using Ibuprofen, some patients have experienced symptoms associated with meningitis. If patients have any of the following symptoms, they should obtain urgent medical treatment:

  • Stiff back or neck
  • Nausea
  • Fever
  • Vomiting
  • Headache

When taking Ibuprofen, patients may experience visual side effects. These can include difficulty reading, blurred vision or a change in vision. If patients notice these side effects occurring, they should seek advice from their physician. Patients may be referred to an ophthalmologist so that a more thorough assessment of their eyes can be carried out.

If patients are due to undergo medical tests, dental work, surgical procedures or operations, they must tell the relevant healthcare practitioner that they are using Ibuprofen in advance. Often, patients will need to stop using it some time in advance of their test, operation or procedure.

Taking or using Ibuprofen when pregnant can cause harm to an unborn baby. Patients who are pregnant should not, therefore, take Ibuprofen for any reason. If patients become pregnant when using Ibuprofen, they should contact their physician for advice.

Patients should not breastfeed when taking or using Ibuprofen. If the medication is transferred to the infant, it could cause them harm. Due to this, patients are generally advised not to breastfeed when using this medicine or for some time afterwards.

Before using Ibuprofen, patients should tell their doctor if they have any allergies. In rare cases, Ibuprofen can cause patients to experience a severe allergic reaction, involving anaphylaxis. Although this is more likely to occur in patients who have previously exhibited an allergic reaction to other nonsteroidal anti-inflammatory drugs or aspirin, any patient could be affected.

If a patient experiences an allergic reaction, it is a life-threatening situation and urgent medical treatment must be sought. The symptoms of an allergic reaction may include:

  • Difficulty breathing
  • Irregular or very fast breathing
  • Wheezing
  • Fainting
  • Changes in skin color of the face
  • Gasping for breath
  • Hive-like swellings on the skin
  • Irregular and/or very fast pulse or heartbeat
  • Swelling or puffiness around the eyes or of the eyelids
  • Difficulty swallowing
  • Itching
  • Swelling of the face, lips, throat, tongue, mouth and/or hands

Storage

When patients purchase or are prescribed Ibuprofen, they should ensure that it is kept in a safe location. When storing medication at home, for example, using a locked cabinet or secure medicine box can help to ensure that no-one else can gain access to it. It is particularly important that children and/or pets cannot access Ibuprofen or other medications which may be kept in the home.

Patients should follow the manufacturer's instructions when storing Ibuprofen but, in most cases, this medicine can be kept at room temperature. However, Ibuprofen should be kept away from moisture, heat and/or direct light. Due to this, Ibuprofen should not be kept in a kitchen or bathroom environment.

If patients are taking Ibuprofen in tablet or capsule form, the medication should remain in the packaging until the patient is ready to take their next dose. Capsules or tablets should not be removed from their blister packs until the patient is ready to take them. If the patient is taking Ibuprofen in liquid form, the bottle of medicine should be secured with a child-proof cap at all times.

If patients are advised to stop using Ibuprofen or if the medication reaches its use-by date, patients will need to dispose of it. Medications which are not in use should not typically be stored in the home. However, it is not safe to dispose of medicines along with normal household waste as they may cause harm to other people.

In order to dispose of Ibuprofen responsibly, patients should contact their physician's office or pharmacist and make use of a specialist medicine disposal service.

Summary

Although Ibuprofen can sometimes be used on a long-term basis to treat chronic conditions, this medicine is more commonly used to treat short-term ailments. The pain associated with headaches, migraines, menstrual cramps and acute injuries can often be relieved completely when the patient takes Ibuprofen, for example.

Before using this medicine, however, patients must ensure that it is safe for them do to so. There are certain contra-indicators which prevent patients from using Ibuprofen and it's important that patients are aware of them. Failure to adhere to these guidelines and restrictions can have negative consequences and patients may experience serious and permanent health complications as a result.

Once patients have confirmed that it's safe for them to use this medicine, Ibuprofen can be used to treat a variety of conditions. As well as being used to manage the symptoms of illness, such as reducing a fever, Ibuprofen can be used on an ad hoc basis to minimize pain and inflammation caused by numerous conditions, including, arthritis, migraine, headache, joint pain, sprains, strains and menstrual cramps.