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Ibuprofen

Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) widely marketed under various trademarks including Act-3, Advil, Brufen, Motrin, Nuprin, and Nurofen; a standing joke about some athletes' regular use has produced "Vitamin I" as a slang term for it. It is used for relief of symptoms of arthritis, primary dysmenorrhoea, and fever; and as an analgesic, especially where there is an inflammatory component. Ibuprofen was developed by the research arm of Boots Group. more...

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Clinical use

Low doses of ibuprofen (200 mg, and sometimes 400 mg) are available over the counter (OTC) in most countries. Ibuprofen has a dose-dependent duration of action of approximately 4–8 hours, which is longer than suggested by its short half-life. The recommended dose varies with body mass and indication. Generally, the oral dose is 200–400 mg (5–10 mg/kg in children) every 4–6 hours, up to a usual maximum daily dose of 800–1200 mg. Under medical direction, a maximum daily dose of 3200 mg may sometimes be used.

Indications

Approved clinical indications for ibuprofen include:

Rheumatoid arthritis (DMARDs should also be considered)
Osteoarthritis, ibuprofen can reduce pain and, if present, joint inflammation
Juvenile rheumatoid arthritis, alone or with corticosteroids
Morbus Bechterew (spondylitis ankylosans) together with corticosteroids
Rheumatic fever, together with antibiotic therapy
Acute gout attack, ibuprofen is not useful for chronic treatment
Primary dysmenorrhoea (ibuprofen proved superior to placebo and propoxyphen, and at least as effective as aspirin)
Fever
Pericarditis, chiefly after myocardial infarction, to reduce pain, fever and inflammation
Minor aches and pains such as toothache, backache, fever and pain associated with common flu, symptomatic relief of influenza, shingles, and postoperative pain
Sporting injuries and pain after mild to moderate trauma
Headache including mild to moderate migraine attack

Off-Label and investigational use

As with other NSAIDs, ibuprofen may be useful in the treatment of severe orthostatic hypotension (PMID 7041104)
In some studies, ibuprofen showed superior results compared to placebo in the prophylaxis of Alzheimer's disease, when given in low doses over a long time (PMID 16195368). Further studies are needed to confirm the results, before ibuprofen can be recommended for this indication.
Ibuprofen has been associated with a lower risk of Parkinson's disease, and may delay or prevent Parkinson's disease. Aspirin, other NSAIDs, and acetaminophen had no effect on the risk for Parkinson's (PMID 16240369). Further research is warranted before recommending ibuprofen for this use.

Ibuprofen lysine

In Europe and Australia, ibuprofen lysine (ibuprofenlysinat, the lysine salt of ibuprofen) is licensed for treatment of the same conditions as ibuprofen. Ibuprofen lysine is said to have a more rapid onset of action compared to base ibuprofen.

Mechanism of action

Ibuprofen is an NSAID which is believed to work through inhibition of cyclooxygenase (COX); thus inhibiting prostaglandin synthesis. As with other NSAIDs, ibuprofen inhibits platelet aggregation, but is not used therapeutically for this action since it is a minor and reversible effect.

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Which is better for the management of postpartum perineal pain: ibuprofen or acetaminophen with codeine? - Patient-Oriented Evidence that Matters
From Journal of Family Practice, 3/1/02 by Hikmat Maaliki

Porter EA, Janssen PA, Grange CS, Douglas MJ. Ibuprofen versus acetaminophen with codeine for the relief of perineal pain after childbirth: a randomized controlled trial. CMAJ 2001; 165:1203-9.

* BACKGROUND Pain that occurs from perineal laceration or episiotomy during childbirth can be severe and is often undertreated. This randomized double-blind controlled trial was designed to compare the effectiveness and side effects related to 2 common analgesics used in this setting: ibuprofen and acetaminophen with codeine.

* POPULATION STUDIED The study looked at 237 women who delivered vaginally and who had either a third- or fourth-degree perineal laceration or an episiotomy. The trial took place between August 1995 and November 1996 at a tertiary-care teaching and referral center for obstetric care in Vancouver, BC, Canada. Approximately 35% of the women enrolled spoke Cantonese or Mandarin; these women were supplied with consent forms in Chinese script translated by a bilingual nurse. Women were excluded for allergy to either of the study drugs, history of drug dependence, regular use of analgesic drugs, or any medical condition known to be potentially exacerbated by opioids or nonsteroidal anti-inflammatory drugs. Women were also excluded if any major postpartum complication, including postpartum hemorrhage, had occurred. The 2 groups of women did not differ significantly in sociodemographic characteristics or in gravidity and parity. All but 4 of the 237 women enrolled completed the study. The 2 treatment groups did not differ significantly except that the ibuprofen group contained more women who had had forceps delivery.

* STUDY DESIGN AND VALIDITY This study was a randomized, double-blind trial with no placebo control. Randomization was done in blocks of 20 and stratified on the use of forceps, which were postulated to contribute significantly to postpartum pain. Women were randomized within 1 hour after delivery to receive either 400 mg ibuprofen or 600 mg acetaminophen with 60 mg codeine and 30 mg caffeine every 4 hours for 24 hours after birth. The pharmacy allocated the patients to the treatment groups. Women and their nurses were blinded. Women who did not request analgesia were not enrolled.

* OUTCOMES MEASURED The primary outcome measured was severity of pain rated on a 10-cm visual analog scale. Other outcomes evaluated were the number of doses of medication, dosing intervals, treatment failures, side effects, overall level of satisfaction, cost of treatment, and nursing time required for medication administration.

* RESULTS Both groups had similar pain ratings before taking the first dose of analgesic (rating of 3.4 for ibuprofen vs 3.3 for acetaminophen plus codeine plus caffeine) as well as number of medication doses in 24 hours (3.4 vs 3.3) and treatment failures (13.8% vs 16%). Among treatment failures, 78% occurred in women who had had forceps delivery. Subjects receiving ibuprofen experienced fewer side effects (52.4% vs 71.7%, P = .006, number needed to harm = 5.2). Overall satisfaction between the groups did not differ. Ibuprofen ($0.02/table) was less expensive than acetaminophen with codeine ($0.05/tablet). Because of the need for additional inventory control, the administration of each dose of the codeine combination took an average of 10 minutes, more time than the administration of ibuprofen.

RECOMMENDATIONS FOR CLINICAL PRACTICE

Ibuprofen and acetaminophen with codeine were similarly effective for the management of postpartum perineal pain caused by significant maternal trauma. Women with forceps-assisted deliveries had significantly more pain and were more likely to fail treatment with either medication. Patients receiving acetaminophen with codeine experienced more side effects, most notably nausea, stomach pain, and disorientation. Ibuprofen should be used as a standard first-line medication for the treatment of perineal pain in this setting. It is less expensive, can be self-administered by patients from the bedside, and has fewer side effects while maintaining the same effectiveness for analgesia. Acetaminophen with codeine should be reserved for women who do not tolerate ibuprofen.

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