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Ibuprofen Review Article

 

Ibuprofen, initially launched as Brufen, a non-steroidal anti-inflammatory drug (NSAID), is now widely opened into the market under various trademarks, Nurofen, Advil and Mortin. Now invalid nomenclature, Ibuprofen was an iso-butyl-propanoic-phenolic acid. It is applied as an aid for arthritis, primary dysmenorrhoea and common fever. With the presence of an inflammatory element, this drug also acts as a painkiller. Ibuprofen also has proven to have an antiplatelet effect. But when contrasted with that of aspirin and other popular antiplatelet medicines, it is comparatively mild and short-termed. Measured as one of the core drugs in the "Essential Drugs List" of the World Health Organization, Ibuprofen plays a vital part of the minimum medical needs for a basic health care system.

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The FDA approved ibuprofen in 1974.

PREPARATIONS:
Tablets of 200, 400, 600, and 800 mg; Chewable tablets of 50 and 100 mg; Capsules of 200 mg; Suspension of 100 mg/2.5 ml and 100 mg/5 ml; Oral drops of 40 mg/ml.

STORAGE:
Ibuprofen should be stored at room temperature, between 15-30C (59-86F).

PRESCRIBED FOR:
Ibuprofen is used for the treatment of mild to moderate pain, inflammation and fever caused by many and diverse diseases.

DOSING:
For minor aches, mild to moderate pain, menstrual cramps, and fever, the usual adult dose is 200 or 400 mg every 4 to 6 hours.
Arthritis is treated with 300 to 800 mg 3 or 4 times daily.
When under the care of a physician, the maximum dose of ibuprofen is 3.2 g daily. Otherwise, the maximum dose is 1.2 g daily. Individuals should not use ibuprofen for more than 10 days for the treatment of pain or more than 3 days for the treatment of a fever unless directed by a physician.

Children 6 months to 12 years of age usually are given 5-10 mg/kg of ibuprofen every 6-8 hours for the treatment of fever and pain. The maximum dose is 40 mg/kg daily.

Juvenile arthritis is treated with 20 to 40 mg/kg/day in 3-4 divided doses.

Ibuprofen should be taken with meals to prevent stomach upset.

DRUG INTERACTIONS:
Ibuprofen is associated with several suspected or probable interactions that can affect the action of other drugs. Ibuprofen may increase the blood levels of lithium (Eskalith) by reducing the excretion of lithium by the kidneys. Increased levels of lithium may lead to lithium toxicity. Ibuprofen may reduce the blood pressure-lowering effects of drugs that are given to reduce blood pressure. This may occur because prostaglandins play a role in the regulation of blood pressure. When ibuprofen is used in combination with aminoglycosides [for example, gentamicin (Garamycin)] the blood levels of the aminoglycoside may increase, presumably because the elimination of aminoglycosides from the body is reduced. This may lead to aminoglycoside-related side effects. Individuals taking oral blood thinners or anticoagulants [for example, warfarin (Coumadin)] should avoid ibuprofen because ibuprofen also thins the blood, and excessive blood thinning may lead to bleeding.

PREGNANCY:
There are no adequate studies of ibuprofen in pregnant women. Therefore, ibuprofen is not recommended during pregnancy. Ibuprofen should be avoided in late pregnancy due to the risk of premature closure of the ductus arteriosus in the fetal heart..

NURSING MOTHERS:
Ibuprofen is not excreted in breast milk. Use of ibuprofen while breastfeeding, poses little risk to the infant.

SIDE EFFECTS:
The most common side effects from ibuprofen are rash, ringing in the ears, headaches, dizziness, drowsiness, abdominal pain, nausea, diarrhea, constipation and heartburn. NSAIDs reduce the ability of blood to clot and therefore increase bleeding after an injury. Ibuprofen may cause ulceration of the stomach or intestine, and the ulcers may bleed. Sometimes, ulceration can occur without abdominal pain, and black, tarry stools, weakness, and dizziness upon standing (orthostatic hypotension) due to bleeding may be the only signs of an ulcer. NSAIDs reduce the flow of blood to the kidneys and impair function of the kidneys. The impairment is most likely to occur in patients who already have impaired function of the kidney or congestive heart failure, and use of NSAIDs in these patients should be cautious. People who are allergic to other NSAIDs, including aspirin, should not use ibuprofen. Individuals with asthma are more likely to experience allergic reactions to ibuprofen and other NSAIDs. Fluid retention (edema), blood clots, heart attacks, hypertension and heart failure have also been associated with the use of NSAIDs.


Ibuprofen notes:

Belonging to the class of drugs called non-steroidal anti-inflammatory drugs or NSAIDs, Ibuprofen is prescribed to reduce fever, mild to moderate pain and inflammation. It is also prescribed for uncontrollable menstrual cramps. Pain, inflammation and fever are usually brought about by the discharge of the body of chemicals called prostaglandins. Ibuprofen works by blocking the enzyme that creates prostaglandins (cyclooxygenase) that results in lower levels of prostaglandins. As a result, reduction of inflammation, pain and fever occurs.

Approved by the FDA, the product manufacturer of Ibuprofen is Hexal. These drugs are available in the form of chewable drugs and are prescribed in doses 200 mg, 400 mg, 600 mg, and 800 mg according to the severity of the pain or inflammation. 50 mg and 100 mg of chewable tablets are also available. You can also get oral drops of 40 mg/ml and suspension of 100 mg/2.5 ml and 100 mg/5 ml. 300 to 800 mg of Ibuprofen is prescribed for patients suffering from arthritis. 20 to 40 mg/kg/day of ibuprofen are given to treat Juvenile arthritis. Children are also prescribed with ibuprofen to treat pain and fever, but the maximum dose should be limited to 40 mg/kg daily.

There are several drug interactions suspected with using this drug in combination with other drugs. It is found that Ibuprofen reduces the blood pressure-lowering effects of drugs that help in reducing blood pressure. This drug also increases the blood levels of lithium (Eskalith). Using ibuprofen with aminoglycosides leads to aminoglycoside-related complications. Using warfarin with this drug causes excessive blood thinning.

Ibuprofen should be avoided during pregnancy and by nursing mothers. Some common side effects that can be caused due to the use of ibuprofen include skin rashes, headaches, ringing in the ears, dizziness, nausea, drowsiness, abdominal pain, heartburn, constipation etc.


Ibuprofen provides significant effects against oesophageal burning.

In a recent development, a study was carried out at Department Of Paediatric Surgery, Faculty of Medicine, Turkey to demonstrate the efficiency of ibuprofen on the healing process of oesophagus and its proficiency of restricting the structure development after caustic injuries by oesophageal. The study was carried out on rats divided into three groups.

One group consists of rats with oesophageal burn injury; the second group consists of rats with injury having treatment of ibuprofen and third was mock group. In two groups of rats having injury and passing through treatment of ibuprofen, an oesophageal burn injury was created by administering 10% of NaOH solution to oesophagus of about 3 cm. The rats in the mock group were given isotonic solution instead of NaOH. Ibuprofen at a dose of 90 mg/kg per day was given to the rats of second group via oral route. Normal saline was given to the first and third group of rats. The routine was continued for 28 days and after that all the living rats were killed. The distal oesophageal fragments of all rats were detached and were divided into two equal parts for biochemical inspection. Researchers studied the biochemically hydroxyproline, histopathological content and stricture symptoms for efficiency of treatment.

The result showed that the hydroxyproline levels was 4.82+/-0.60 mug/mg in first group, 3.28+/-0.27 mug/mg in second group and about 1.54 +/-0.08 in third group. Researchers found that hydroxyproline level increases in first group as compared to third group and it decreases significantly in group two as compared to group first because of the treatment through ibuprofen. The content of collagen which is a group of naturally occurring proteins in group two was 1.50+/-0.26 which was lower than first group having score of 2.62+/-0.37. Researchers also studied the stenosis index which was 0.84+/-0.02 in first group, 0.67+/-0.03 in second group and 0.37+/-0.02 in the third group. This indicates that the stenosis index in group one was higher than second and third group. The index in group two was found to be much lower than that of first group due to the treatment of ibuprofen. Thus the researchers concluded that treatment with ibuprofen in oesophageal burning injury has more beneficial effects on healing it and also helps in decreasing stricture development. Based on the results it is clear that ibuprofen can be used in treatment of acute phase of oesophageal burning.


 

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