Ibuprofen

Ibuprofen Brand Names

Advil | Advil Children’s | Advil Children’s Fever | Advil Infants’ | Advil Junior Strength

What is Ibuprofen

Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) of the propionic acid chemical class.

Ibuprofen is a racemic mixture of 2 isomers; however, only the l-isomer of ibuprofen has been shown to have clinical activity.

Although d-isomer is considered inactive, it is slowly and incompletely converted to the l-isomer in adults and probably children and may serve as a circulating reservoir for the active drug.

All NSAIDs carry an increased risk of serious gastrointestinal adverse effects including bleeding, ulceration, and perforation of the stomach or intestines and may cause an increased risk of serious cardiovascular (CV) thrombotic events, myocardial infarction, and stroke.

FDA approved labeling of both the OTC and prescription products stress dosing at the lowest effective ibuprofen dose for the shortest possible duration, as the risk for adverse effects may increase with increased use.

A retrospective review by FDA Advisory Committees of short-term efficacy trials of a related non-prescription strength NSAID indicated that an increase in CV events was not apparent during the studies.

However, it is important to note that CV risk was not the focus of the studies, and further information is needed to determine if a cause and effect relationship exists between non-prescription strength NSAID use and adverse cardiovascular outcomes.

Specific populations are at an increased risk of NSAID-induced adverse events.

The American Geriatrics Society recommends that NSAIDs (nonselective and COX-2 inhibitors) not be used to treat persistent pain in elderly patients except rarely, then only in patients who have failed other therapies and have a favorable benefits vs risks assessment; extreme caution, continued therapy evaluation, and concurrent PPI or misoprostol is advised with ibuprofen use in this population. Ibuprofen is indicated for the treatment of rheumatoid arthritis, osteoarthritis, and dysmenorrhea.

It also is used for its antipyretic effects and for the alleviation of mild to moderate pain. In addition, clinical studies have demonstrated its effectiveness in the treatment of ankylosing spondylitis, gout, and psoriatic arthritis.

Topical use has been studied in minor muscle pain treatment. See separate ibuprofen lysine monograph for discussion of NeoProfen, the intravenous formulation indicated to close a clinically significant patent ductus arteriosus in premature infants.

Oral ibuprofen was approved by the FDA in 1974. In June 2009, the FDA approved an injectable ibuprofen (Caldolor) for pain and fever in hospitalized adults who are unable to take oral medications; in November 2015, intravenous use was approved in pediatric patients as young as 6 months.

Indications

  1. ankylosing spondylitis
  2. cystic fibrosis
  3. dysmenorrhea
  4. fever
  5. gouty arthritis
  6. headache
  7. juvenile rheumatoid arthritis (JRA)/juvenile idiopathic arthritis (JIA)
  8. migraine
  9. mild pain
  10. moderate pain
  11. osteoarthritis
  12. psoriatic arthritis
  13. rheumatoid arthritis
  14. severe pain

For the treatment of rheumatoid arthritis (RA) and juvenile rheumatoid arthritis (JRA)/juvenile idiopathic arthritis (JIA)

Side Effects

  1. abdominal pain
  2. agranulocytosis
  3. alopecia
  4. amblyopia
  5. anaphylactoid reactions
  6. anemia
  7. angioedema
  8. anxiety
  9. aplastic anemia
  10. apnea
  11. arrhythmia exacerbation
  12. aseptic meningitis
  13. asthenia
  14. azotemia
  15. blurred vision
  16. bradycardia
  17. bronchospasm
  18. bullous rash
  19. cataracts
  20. chest pain (unspecified)
  21. coma
  22. confusion
  23. conjunctivitis
  24. constipation
  25. cystitis
  26. depression
  27. diaphoresis
  28. diarrhea
  29. diplopia
  30. dizziness
  31. drowsiness
  32. dyspepsia
  33. dysphagia
  34. dyspnea
  35. dysuria
  36. ecchymosis
  37. edema
  38. elevated hepatic enzymes
  39. emotional lability
  40. eosinophilia
  41. epistaxis
  42. eructation
  43. erythema multiforme
  44. esophageal stricture
  45. esophageal ulceration
  46. esophagitis
  47. exfoliative dermatitis
  48. fever
  49. flatulence
  50. fluid retention
  51. gastritis
  52. GI bleeding
  53. GI perforation
  54. glomerulonephritis
  55. glossitis
  56. gynecomastia
  57. hallucinations
  58. headache
  59. hearing loss
  60. heart failure
  61. hematemesis
  62. hematuria
  63. hemolytic anemia
  64. hepatic failure
  65. hepatic necrosis
  66. hepatitis
  67. hyperglycemia
  68. hyperkalemia
  69. hypertension
  70. hyperuricemia
  71. hypoglycemia
  72. hyponatremia
  73. hypotension
  74. infection
  75. infertility
  76. injection site reaction
  77. insomnia
  78. interstitial nephritis
  79. jaundice
  80. leukopenia
  81. lymphadenopathy
  82. maculopapular rash
  83. malaise
  84. melena
  85. menorrhagia
  86. metabolic acidosis
  87. myocardial infarction
  88. nausea
  89. nephrotic syndrome
  90. neutropenia
  91. odynophagia
  92. oliguria
  93. optic neuritis
  94. palpitations
  95. pancreatitis
  96. pancytopenia
  97. paresthesias
  98. peptic ulcer
  99. peripheral edema
  100. photophobia
  101. photosensitivity
  102. platelet dysfunction
  103. polyuria
  104. prolonged bleeding time
  105. proteinuria
  106. pruritus
  107. pseudotumor cerebri
  108. purpura
  109. pyrosis (heartburn)
  110. rash
  111. renal failure (unspecified)
  112. renal papillary necrosis
  113. renal tubular necrosis
  114. respiratory depression
  115. rhinitis
  116. scotomata
  117. seizures
  118. serum sickness
  119. sinus tachycardia
  120. Stevens-Johnson syndrome
  121. stomatitis
  122. stroke
  123. syncope
  124. thrombocytopenia
  125. thromboembolism
  126. tinnitus
  127. toxic epidermal necrolysis
  128. tremor
  129. urticaria
  130. vasculitis
  131. vertigo
  132. visual impairment
  133. vomiting
  134. weight gain
  135. weight loss
  136. wheezing
  137. withdrawal
  138. xerophthalmia
  139. xerostomia

Monitoring Parameters

  • CBC
  • LFTs
  • serum creatinine/BUN
  • stool guaiac

Contraindications

  • acute bronchospasm
  • acute myocardial infarction
  • alcoholism
  • angina
  • anticoagulant therapy
  • asthma
  • bone marrow suppression
  • breast-feeding
  • cardiac arrhythmias
  • cardiac disease
  • cardiomyopathy
  • cerebrovascular disease
  • chemotherapy
  • coagulopathy
  • coronary artery bypass graft surgery (CABG)
  • coronary artery disease
  • corticosteroid therapy
  • Crohn’s disease
  • dehydration
  • diabetes mellitus
  • edema
  • geriatric
  • GI bleeding
  • GI disease
  • GI perforation
  • heart failure
  • hematological disease
  • hemophilia
  • hepatic disease
  • hypertension
  • hypovolemia
  • immunosuppression
  • infertility
  • labor
  • myocardial infarction
  • nasal polyps
  • neutropenia
  • NSAID hypersensitivity
  • obstetric delivery
  • peptic ulcer disease
  • peripheral vascular disease
  • pregnancy
  • renal disease
  • renal failure
  • renal impairment
  • reproductive risk
  • rheumatoid arthritis
  • salicylate hypersensitivity
  • stroke
  • surgery
  • systemic lupus erythematosus (SLE)
  • tachycardia
  • thrombocytopenia
  • thromboembolism
  • tobacco smoking
  • ulcerative colitis
  • urticaria

Interactions

  • Abciximab
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  • Glipizide; Metformin
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  • Gold
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