Ibuprofen

Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) with pain-relieving, anti-inflammatory, and fever-reducing effects. At low doses (up to 400 mg), it is available without a prescription; higher doses (600 mg, 800 mg) are prescription-only.

Well-known brand names include Ibuflam® and Ibu-ratiopharm®. Ibuprofen has been used since the 1960s.

It is suitable for mild to moderately severe pain and inflammatory conditions of the musculoskeletal system.

Ibuprofen inhibits the enzymes cyclooxygenase-1 and -2 (COX-1 and COX-2):

Mechanism of action:

• Blocks prostaglandin synthesis
• Prostaglandins sensitize pain receptors and promote inflammation
• This inhibition raises the pain threshold and dampens the inflammatory response

Effect profile:

• Pain relief: Onset of action after 30–60 minutes
• Anti-inflammatory effect: Full effect after several days of regular use
• Fever reduction: Rapid effect when body temperature is elevated
• Duration of action: 4–6 hours

Tolerability: Gastrointestinal bleeding, ulcers or perforations, including fatal cases, have been reported with all NSAIDs. Particularly at high doses (2400 mg per day), ibuprofen may be associated with a slightly increased risk of arterial thrombotic events such as heart attack or stroke.

Ibuprofen is suitable for:

• Mild to moderately severe pain
• Headaches and toothaches
• Menstrual pain
• Muscle and joint pain
• Back pain
• Rheumatoid arthritis, osteoarthritis
• Fever and cold symptoms
• Postoperative and post-traumatic pain

Not suitable:

• With active stomach ulcers
• With severe heart, liver, or kidney failure
• During the last trimester of pregnancy
• With known NSAID intolerance

Prescription-only doses:

• 600 mg tablets
• 800 mg tablets (extended-release)

Usual daily dose (adults):

• 1200–2400 mg, divided into 3 single doses
• Maximum daily dose: 2400 mg

Non-prescription doses (for information):

• 200 mg, 400 mg

Recommendation: The lowest effective dose for the shortest necessary duration.

How to take:

• Swallow the tablets whole with a glass of water
• With or after a meal (better stomach tolerability)
• Space doses at even intervals

Dosing schedule (prescription-only):

• 600 mg: 1 tablet 2–3 times daily
• 800 mg extended-release: 1 tablet 2 times daily

Important notes:

• Do not take together with ASA (aspirin) – ibuprofen can weaken the blood-thinning effect of low-dose ASA
• Do not take on an empty stomach
• Consider stomach protection for long-term use

Ibuprofen must not be taken in cases of:

• Hypersensitivity to ibuprofen or other NSAIDs
• Active stomach or intestinal ulcers
• Severe heart failure
• Severe kidney or liver failure
• The last trimester of pregnancy
• Unexplained disorders of blood formation

Use with caution in:

• Elderly patients
• High blood pressure
• Asthma (ASA intolerance)
• Use of blood thinners
• Chronic inflammatory bowel diseases (Crohn's disease, ulcerative colitis)

Pregnancy: In the 1st and 2nd trimesters, only if strictly indicated. Contraindicated in the 3rd trimester.

Common (1–10%):

• Stomach pain, heartburn
• Nausea, diarrhea
• Headache, dizziness

Uncommon (0.1–1%):

• Stomach ulcers
• Gastrointestinal bleeding
• Skin rash
• Edema

Rare:

• Severe allergic reactions
• Kidney function disorders
• Liver damage
• Changes in blood count

Note: The risk of gastrointestinal side effects increases with the dose and the duration of use.

Do not combine with:

• ASA (can weaken the inhibition of platelet aggregation)
• Other NSAIDs (increased risk of side effects)

Increased risk of bleeding with:

• Anticoagulants (Marcumar, DOACs)
• SSRI antidepressants
• Corticosteroids

Reduced effect of:

• ACE inhibitors, sartans
• Diuretics

Increased toxicity of:

• Methotrexate
• Lithium
• Digoxin