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Using Ibuprofen for pain relief, fever and swelling

Posted by Gerhard Fourie on

Written on the 17 September 2013 by The Compounding Team

Using Ibuprofen for pain relief, fever and swelling

Ibuprofen is the active ingredient of medications such as Advil, Bugesic, Herron Blue, Nurofen and Panafen. Ibuprofen may also be one of multiple active ingredients in similar acting medications.

General information
Ibuprofen is a non-steroidal anti-inflammatory medication, also known as a NSAID. It is an effective pain reliever and is prescribed to treat inflammation, swelling, stiffness and muscle injury. In addition, it is used to provide pain relief from menstrual, dental pain and post-operative pain. It is also prescribed for the treatment of arthritic conditions such rheumatoid- and osteoarthritis, and acute attacks of gout. It has been suggested Ibuprofen shows promising results in the prevention of Alzheimer's disease, when given in low doses over a long time.

In Europe, Australia, and New Zealand, Ibuprofen lysine (sometimes called "Ibuprofen lysinate"), is licensed for treatment of the same conditions as Ibuprofen. The lysine salt has increased water solubility, allowing intravenous use, and is indicated for a certain congenital heart disorder in premature infants.

At moderate doses - not exceeding 1.2g a day - Ibuprofen appear to have fewer gastrointestinal side-effects than aspirin and many other non-steroidal anti-inflammatory drugs. It may however, still cause gastrointestinal irritation, and should be used with caution if you have a stomach ulcer or related disease. Unlike aspirin, which breaks down in solution, Ibuprofen is stable, thus it can be made available in a topical gel form.

Ibuprofen compounded into a topical gel is absorbed through the skin, and can thus be used for sports injuries with consequent less risk of digestive problems.

How does Ibuprofen work?
Ibuprofen does not cure the underlying condition responsible for pain, fever or inflammation, but keeps the symptoms under control.

Ibuprofen blocks the production of certain chemicals in the body that are responsible for pain, fever, swelling and inflammation. Nonsteroidal anti-inflammatory medications such as Ibuprofen work by inhibiting the enzyme cyclooxygenase (COX), which converts arachidonic acid to prostaglandin [H2 (PGH2). PGH2]. This in turn is converted by other enzymes to several other prostaglandins (which are the mediators of pain, inflammation, and fever).

More information about Ibuprofen
It is available as tablets, film-coated tablets, capsules, slow-release capsules, oral suspension, and as a gel.
The overdose and dependence risks are low
Onset of the effect is usually within 30 minutes and the duration of action is up to 8 hours.
Unless your doctor has prescribed Ibuprofen for long-term use, it can be safely stopped when no longer needed.

Precautions
Ibuprofen should be taken with a meal to minimise gastrointestinal irritation. This risk increases the longer you take this medication, or if you are also taking corticosteroid medications such as prednisone, anticoagulants (blood thinning medication), such as warfarin, if you smoke or if you consume alcohol while being treated with Ibuprofen. The likelihood of adverse effects increases with prolonged use. Your doctor may perform periodic liver and kidney function tests, while also examining you for possible gastrointestinal damage.

• Use during Pregnancy should be avoided. A potential risk to the foetus has been reported. Consult your doctor before use, or if you are planning to fall pregnant
• This medication is safe to use during Breastfeeding. You should however, first discuss this with your doctor.
• The medication is reported to safe to use by those that are afflicted with Porphyria.
• The safety and efficacy has not been established for Children under the age of 2.
• Caution is advised when used by the Elderly, as side-effects may be more likely. The dose may need to be adjusted.
• Caution is advised during Driving and Hazardous Work, as use of this medication may lead to dizziness, light-headedness and/or sedation. Avoid such activities until you know how it affects you.
• Avoid concomitant use of Alcohol as it may worsen stomach irritation. Drinking alcohol when taking Ibuprofen may increase risk of stomach bleeding.

Special precautions
Alert your doctor before using this drug if:
• You have asthma,
• You have a stomach ulcer,
• You have a bleeding disorder,
• You are taking blood-thinning medication,
• You are allergic to aspirin or any other medication, or
• You are taking other medication.

Disease interactions
Consult your doctor before using this drug if you have asthma, a stomach ulcer, bleeding disorder, you are taking blood-thinning medication, or if you are allergic to aspirin or any other medication.

Other Interactions
According to the US Food and Drug Administration, "Ibuprofen can interfere with the antiplatelet effect of low-dose aspirin (81 mg per day), potentially rendering aspirin less effective when used for cardioprotection and stroke prevention." Allowing sufficient time between doses of Ibuprofen and immediate-release (IR)aspirin can avoid this problem.

The recommended elapsed time between a 400-mg dose of Ibuprofen and a dose of aspirin depends on which is taken first. It would be 30 minutes or more for Ibuprofen taken after IR aspirin, and 8 hours or more for Ibuprofen taken before IR aspirin. However, this timing cannot be recommended for enteric-coated aspirin.

If Ibuprofen is taken only occasionally without the recommended timing, the reduction of the cardioprotection and stroke prevention of a daily aspirin regimen is minimal.

Overdose
A small overdose is no cause for concern. In case of intentional large overdose, seek emergency medical attention immediately.

Recommended dosage
Adults: 600-1200mg/day in divided doses. Maximum daily dose is 2400mg.
Children: 20mg/kg/day in divided doses (maximum 40mg/kg/day)

REFERENCES and suggested Further Reading
1. Geisslinger, G.; Dietzel, K.; Bezler, H.; Nuernberg, B.; Brune, K. (1989). "Therapeutically relevant differences in the pharmacokinetical and pharmaceutical behavior of Ibuprofen lysinate as compared to Ibuprofen acid". International journal of clinical pharmacology, therapy, and toxicology 27 (7): 324–328. PMID 2777420.
2. "Neoprofen (Ibuprofen lysine) injection. Package insert". Ovation Pharmaceuticals.
3. Su, P. H.; Chen, J. Y.; Su, C. M.; Huang, T. C.; Lee, H. S. (2003). "Comparison of Ibuprofen and indomethacin therapy for patent ductus arteriosus in preterm infants". Pediatrics international : official journal of the Japan Pediatric Society 45 (6): 665–670. PMID 14651538.
4. "Topical NSAIDs: plasma and tissue concentrations". Bandolier.
5. http://en.wikipedia.org/wiki/Ibuprofen#cite_ref-topical_13-0
6. "Ibuprofen". Drugs.com.
7. "Information for Healthcare Professionals: Concomitant Use of Ibuprofen and Aspirin". U.S. Food and Drug Administration (FDA). 2006-09. Retrieved 2010-11-22.
8. Kakuta, H.; Zheng, X.; Oda, H.; Harada, S.; Sugimoto, Y.; Sasaki, K.; Tai, A. (2008). "Cyclooxygenase-1-Selective Inhibitors Are Attractive Candidates for Analgesics That Do Not Cause Gastric Damage. Design and in Vitro/in Vivo Evaluation of a Benzamide-Type Cyclooxygenase-1 Selective Inhibitor". Journal of Medicinal Chemistry 51 (8): 2400–2411. doi:10.1021/jm701191z. PMID 18363350.

Important:
Always read the label on any medication and use only as directed. Vitamin and other supplements should not replace a balanced diet, unless so instructed by your medical practitioner. If symptoms persist, seek further health advice. The information presented above is not intended to replace the advice of your medical practitioner, but is for informational purposes only.


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