Ibuprofen

Along with diclofenac  and  acetylsalicylic acid , ibuprofen is   one of the most commonly used so-called “acidic” painkillers. Thanks to its acidic nature, ibuprofen, in contrast to substances such as  paracetamol  or metamizole, is not only effective against pain, but also against inflammation, because these active ingredients do not penetrate so well into the inflamed and thus acidified tissue.

effects of ibuprofen

Ibuprofen is used to relieve mild to moderate pain and to stop inflammation – for example in rheumatic diseases, which are manifested by painful joint inflammation. In addition, ibuprofen has an antipyretic effect, but is rarely used therapeutically for this purpose.

Ibuprofen belongs to the class of non-steroidal anti-inflammatory drugs (NSAIDs), in contrast to  cortisone , for example . The active ingredient ibuprofen is also a representative of the non-opioid analgesics, and thus belongs to the group of (unlike opioids) non-addictive cyclooxygenase inhibitors that are frequently used worldwide.

Ibuprofen works by inhibiting cyclooxygenase. Therefore, the so-called prostaglandins, which promote inflammation, cause pain and increase fever, are only reproduced to a reduced extent.

Areas of application of ibuprofen

Ibuprofen is often used in the following cases:

  • Ibuprofen was particularly often used and originally developed for the treatment of rheumatic joint diseases. It reduces the inflammation, swelling and pain associated with osteoarthritis, rheumatoid arthritis and  gout .
  • In lower doses, ibuprofen is also good for headaches and  migraines  , as well as for toothache or  menstrual pain .
  • Ibuprofen is also used for muscle pain and sports injuries such as  strains  and torn ligaments, alternatively diclofenac helps here.
  • Other areas of application are pain relief in acute otitis media, tonsillitis or sunburn.

Ibuprofen: dosage

Ibuprofen is sold in a variety of dosage forms. It is available as a tablet, capsule, suppository, juice, granules or ointment. The drug is commercially available in different dosages, the low dosages are freely available in pharmacies. Ibuprofen in  doses over 400 mg require a prescription.

The spectrum of effects of ibuprofen depends on the dose: Lower doses of between 200 and 800 mg in adults primarily have an  analgesic and antipyretic effect. The anti-inflammatory effect  only comes into play at higher doses of up to 2,400 mg daily   .

The drugs taken remain in the same concentration in the blood for about two to three hours, after which the effect decreases. Most of the degradation products are excreted via the kidneys, partly also via the liver.

Ibuprofen: side effects

Side effects such as stomach pain , nausea and  diarrhea often occur with ibuprofen  . Rarely, dizziness, headache, and reversible loss of visual acuity occur.

As with the related cyclooxygenase inhibitors acetylsalicylic acid and diclofenac, frequent use of ibuprofen can also lead to stomach bleeding and even gastric perforation. Because the inhibition of cyclooxygenase not only reduces the production of unwanted pro-inflammatory prostaglandins. The prostaglandins that normally protect the stomach are also lost, which makes the stomach very sensitive to the digestive enzymes it contains and its own stomach acid.

Because of this, prolonged ibuprofen therapy should only be carried out in  combination with gastric  protection. Drugs that reduce the production of gastric acid are recommended, for example proton pump inhibitors such as  omeprazole  or  pantoprazole . It also helps to protect the stomach if you do  not take these drugs on an empty stomach  .

Ibuprofen: Interactions

Parallel therapy with steroid painkillers such as cortisone is not recommended because this would further increase the risk of bleeding.

In addition, ibuprofen has an inhibitory effect on platelet aggregation, similar to the effect of acetylsalicylic acid. Therefore there is an  increased risk of bleeding.  The simultaneous intake of other anticoagulants such as Marcumar® can therefore be questionable.

Paradoxically, however, the effect of other blood platelet inhibitors such as acetylsalicylic acid when taken at the same time is reduced due to competition at the same receptor. This can lead to increased thrombi and embolism. Because the effect on your own blood clotting is difficult to assess, you should definitely inform the doctor treating you about the previous use of painkillers before any surgical intervention.

Ibuprofen in pregnancy

There have also been reports of problems with unintentionally prolonging a pregnancy as part of prostaglandin intake: some prostaglandins have a labor-promoting effect. If these are reduced, the contractions will start later.

According to scholarly opinion, the treatment of rheumatoid arthritis appears to be safe at low doses of up to 600 mg daily, even during pregnancy and breastfeeding. Other doctors see pregnancy as a clear contraindication to ibuprofen therapy. In each individual case, it is therefore urgently recommended to consult the doctor treating you again.

ibuprofen in children

In contrast to the related acetylsalicylic acid, ibuprofen can also be used in children  after consultation with a doctor  . A reason for treatment is, for example, in the case of premature babies. In order to support their still immature heart, the often persisting ductus arteriosus Botalli, a connection between the venous and arterial system, is helped to close with the help of ibuprofen.

Ibuprofen: contraindications

Caution is advised in patients with known inflammatory gastrointestinal diseases such as  ulcerative colitis  or  Crohn’s disease , as taking ibuprofen can trigger an acute flare-up of these diseases.

Rarely, asthmatics develop what is known as “aspirin asthma”, which can also occur when taking the painkillers ibuprofen and diclofenac. Because less prostaglandins are formed, the body converts the starting substance into leukotrienes. These trigger coughing and constrict the lungs.

Patients who have a  strained kidney  must also be careful when taking ibuprofen and other cyclooxygenase inhibitors, since the kidney vessels also narrow when fewer prostaglandins are formed. This can further reduce an already low kidney function and, in the worst case, lead to dialysis being required. The intake of ibuprofen in the case of existing kidney disease must therefore be carefully monitored.

The same applies to  liver diseases,  since part of the drug is metabolized via the liver. It is therefore not advisable to consume alcohol during treatment, as this puts additional strain on the liver. Regular checks of the kidney and liver values ​​are therefore important when taking ibuprofen for a long time.

In the case of concomitant lithium therapy, the plasma level of this antidepressant must be monitored particularly carefully, since the excretion of lithium in the kidneys is reduced by the ibuprofen intake. The same applies to therapy with the antiepileptic drug phenytoin, which is broken down more slowly in the presence of ibuprofen.

 

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