Products
Ibuprofen is commercially available in the form of film-coated tablets, oral suspension, soft capsules, and granules, among others. It is also used externally as ibuprofen cream. Ibuprofen was developed in the 1960s at the Boots Pure Drug Company under the direction of Stewart Adams in Nottingham, England. It went on sale in the United Kingdom in 1969. Brufen is the original. Ibuprofen is now one of the most widely used painkillers in the world.
Structure and properties
Ibuprofen (C13H18O2, Mr = 206.3 g/mol) belongs to the propionic acid derivative group. It is a racemate consisting of equal parts of the (+)- and (-)-enantiomers. The (+)-enantiomer dexibuprofen is mainly pharmacologically active and is also marketed. However, chiral inversion also occurs in the body. Ibuprofen is present in drugs as an acid, as ibuprofen lysinate, ibuprofen arginate, or ibuprofen sodium. The effect is much faster when ibuprofen is taken as a salt rather than as an acid because it dissolves better and is therefore absorbed more quickly.
Effects
Ibuprofen (ATC M01AE01) has analgesic, antipyretic, anti-inflammatory, and mild antiplatelet properties. The effects are due to inhibition of cyclooxygenase (COX-1 and COX-2) and inhibition of prostaglandin synthesis. Ibuprofen has a short half-life of only about 1 to 3 hours.
Indications
For the treatment of fever, inflammatory conditions, and pain. Indications include, for example:
- Headache, migraine
- Pain in the area of joints and ligaments
- Back pain
- Toothache
- Menstrual pain
- Pain after injuries and operations
- Fever with flu and colds
- Rheumatoid arthritis and other rheumatic diseases
- Arthroses
Ibuprofen is also approved in some countries for the treatment of hemodynamically active patent ductus arteriosus botalli in preterm infants before 34 weeks’ gestation (Pedea).
Dosage
According to the SmPC. In self-medication, the maximum daily dose for adults is 1200 mg, equivalent to 200 to 400 mg three times daily (dosing interval 4 to 6 hours). The drugs for self-medication are approved only for short-term treatment of a maximum of three days. On a doctor’s recommendation, maximum daily doses of up to 2400 mg can be prescribed (single dose 200 mg to 800 mg). Doses for children are lower and are based on body weight. In case of a sensitive stomach, it is recommended to take it with a meal. Because of the possible adverse effects, the dose should be kept as low as possible and the duration of therapy should be short.
Contraindications
Numerous precautions must be considered before use. Full details of precautions and drug interactions can be found in the Drug Information Leaflet.
Interactions
Ibuprofen is a substrate of CYP2C9. Drug-drug interactions include those with other NSAIDs, COX-2 inhibitors, alcohol, antihypertensives, glucocorticoids, vitamin K antagonists (anticoagulants), low-dose acetylsalicylic acid, SSRIs, antidiabetics, and organic anions such as methotrexate (selection).
Adverse effects
The most common possible adverse effects include:
- Gastrointestinal disorders: Indigestion, diarrhea, nausea, vomiting, constipation, abdominal pain, flatulence, tarry stools, vomiting blood, and bleeding in the digestive tract.
- Central nervous side effects: Limitation of reaction, headache, dizziness, fatigue.
- Skin rashes
Like other NSAIDs, ibuprofen can rarely cause serious side effects. These include gastric and intestinal ulcers, perforations, bleeding, cardiovascular disease, hypertension, hepatitis, life-threatening skin reactions and renal dysfunction and even kidney failure.
