Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that is used to relieve pain, fever, and inflammation. This includes painful menstrual periods, migraines, and rheumatoid arthritis. It can be taken orally (by mouth) or intravenously (injected into a vein). It typically begins working within an hour. Common side effects include heartburn, nausea, indigestion, and abdominal pain. Potential side effects include gastrointestinal bleeding. Long-term use has been associated with kidney failure, and rarely liver failure, and it can exacerbate the condition of people with heart failure. At low doses, it does not appear to increase the risk of myocardial infarction (heart attack); however, at higher doses it may. Ibuprofen can also worsen asthma. While its safety in early pregnancy is unclear, it appears to be harmful in later pregnancy, so it is not recommended during that period. It works by inhibiting the production of prostaglandins by decreasing the activity of the enzyme cyclooxygenase (COX). Ibuprofen is a weaker anti-inflammatory agent than other NSAIDs. Ibuprofen was discovered in 1961 in Nottingham by Stewart Adams and John Nicholson while working at Boots the Chemists, and initially sold as Brufen. It is available under a number of brand names including Advil, Brufen, Motrin, and Nurofen. Ibuprofen was first sold in 1969 in the United Kingdom and in 1974 in the United States. It is on the World Health Organization's List of Essential Medicines. It is available as a generic medication. In 2023, it was the 32nd most commonly prescribed medication in the United States, with more than 17 million prescriptions.
Medical uses
Ibuprofen is used primarily to treat fever (including post-vaccination fever), mild to moderate pain (including pain relief after surgery), painful menstruation, osteoarthritis, dental pain, headaches, and pain from kidney stones. About 60% of people respond to any NSAID; those who do not respond well to a particular one may respond to another. A Cochrane medical review of 51 trials of NSAIDs for the treatment of lower back pain found that "NSAIDs are effective for short-term symptomatic relief in patients with acute low back pain". It is used for inflammatory diseases such as juvenile idiopathic arthritis and rheumatoid arthritis. It is also used for pericarditis and to close a patent ductus arteriosus in a premature baby.
Ibuprofen lysine In some countries, ibuprofen lysine (the lysine salt of ibuprofen, sometimes called "ibuprofen lysinate") is licensed for treatment of the same conditions as ibuprofen; the lysine salt is used because it is more water-soluble. However, subsequent studies have shown no statistical differences between the lysine salt and standalone ibuprofen. In 2006, ibuprofen lysine was approved in the United States by the Food and Drug Administration (FDA) for closure of patent ductus arteriosus in premature infants weighing between 500 and 1,500 g (1 and 3 lb), who are no more than 32 weeks gestational age when usual medical management (such as fluid restriction, diuretics, and respiratory support) is not effective.
Adverse effects Adverse effects include nausea, heartburn, indigestion, diarrhea, constipation, gastrointestinal ulceration, headache, dizziness, rash, salt and fluid retention, and high blood pressure. Infrequent adverse effects include esophageal ulceration, heart failure, high blood levels of potassium, kidney impairment, confusion, and bronchospasm. Ibuprofen can exacerbate asthma, sometimes fatally. Allergic reactions, including anaphylaxis, may occur. Ibuprofen may be quantified in blood, plasma, or serum to demonstrate the presence of the drug in a person having experienced an anaphylactic reaction, confirm a diagnosis of poisoning in people who are hospitalized, or assist in a medicolegal death investigation. A monograph relating ibuprofen plasma concentration, time since ingestion, and risk of developing renal toxicity in people who have overdosed has been published. In October 2020, the US Food and Drug Administration (FDA) required the prescribing information to be updated for all NSAID medications to describe the risk of kidney problems in unborn babies that result in low amniotic fluid.
Cardiovascular risk Along with several other NSAIDs, chronic ibuprofen use is correlated with the risk of progression to hypertension in women, though less than for paracetamol (acetaminophen), and myocardial infarction (heart attack), particularly among those chronically using higher doses. On 9 July 2015, the FDA toughened warnings of increased heart attack and stroke risk associated with ibuprofen and related NSAIDs; the NSAID aspirin is not included in this warning. The European Medicines Agency (EMA) issued similar warnings in 2015.
Skin Along with other NSAIDs, ibuprofen has been associated with the onset of bullous pemphigoid or pemphigoid-like blistering. As with other NSAIDs, ibuprofen has been reported to be a photosensitizing agent, but it is considered a weak photosensitizing agent compared to other members of the 2-arylpropionic acid class. Like other NSAIDs, ibuprofen is an extremely rare cause of the autoimmune diseases Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis.
Pregnancy The National Health Service recommends against the use of ibuprofen for more than 3 days in pregnancy as it can affect the fetus's kidneys and circulatory system. Paracetamol is considered a safer alternative. A 2012 Canadian study of pregnant women suggested that those taking any type or amount of NSAIDs (including ibuprofen, diclofenac, and naproxen) were 2.4 times more likely to miscarry than those not taking the medications. However, a 2014 Israeli study found no increased risk of miscarriage in the group of mothers using NSAIDs and noted that two previous studies, including the 2012 Canadian study, "did not adjust for important known risk factors" which may have exposed those results to residual confounding.
Interactions
Alcohol Drinking alcohol when taking ibuprofen may increase the risk of stomach bleeding.
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