Editing Ibuprofen (section)

==Adverse effects==

Adverse effects include [[nausea]], [[heartburn]], [[indigestion]], [[diarrhea]], [[constipation]], [[gastrointestinal ulceration]], [[headache]], [[dizziness]], rash, salt and fluid retention, and [[hypertension|high blood pressure]].<ref name="AHFS2016" /><ref name="AMH"/><ref>{{cite journal | vauthors = Castellsague J, Riera-Guardia N, Calingaert B, Varas-Lorenzo C, Fourrier-Reglat A, Nicotra F, Sturkenboom M, Perez-Gutthann S | title = Individual NSAIDs and upper gastrointestinal complications: a systematic review and meta-analysis of observational studies (the SOS project) | journal = Drug Safety | volume = 35 | issue = 12 | pages = 1127–46 | date = December 2012 | pmid = 23137151 | pmc = 3714137 | doi = 10.1007/BF03261999 }}</ref>

Infrequent adverse effects include esophageal ulceration, [[Congestive heart failure|heart failure]], [[hyperkalemia|high blood levels of potassium]], [[Renal failure|kidney impairment]], confusion, and [[bronchospasm]].<ref name="AMH"/> Ibuprofen can exacerbate asthma, sometimes fatally.<ref name="Lancet1987-Ayres">{{cite journal | vauthors = Ayres JG, Fleming DM, Whittington RM | title = Asthma death due to ibuprofen | journal = Lancet | volume = 1 | issue = 8541 | pages = 1082 | date = May 1987 | pmid = 2883408 | doi = 10.1016/S0140-6736(87)90499-5 | s2cid = 38589434 }}</ref>

Allergic reactions, including [[anaphylaxis]], may occur.<ref>{{cite journal | vauthors = Shaikhain TA, Al-Husayni F, Elder K | title = Ibuprofen-induced Anaphylactic Shock in Adult Saudi Patient | journal = Cureus | volume = 11 | issue = 12 | pages = e6425 | date = December 2019 | pmid = 31993263 | pmc = 6970456 | doi = 10.7759/cureus.6425 | doi-access = free }}</ref> 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.<ref name=Baselt>{{cite book| vauthors = Baselt R |title=Disposition of Toxic Drugs and Chemicals in Man|edition=8th|publisher=Biomedical Publications|location=[[Foster City]], USA|year=2008|pages=758–761}}</ref>

In October 2020, the U.S. FDA required the [[Drug labelling|drug label]] to be updated for all NSAID medications to describe the risk of kidney problems in unborn babies that result in low amniotic fluid.<ref name="FDA PR 20201015">{{cite press release | title=FDA Warns that Using a Type of Pain and Fever Medication in Second Half of Pregnancy Could Lead to Complications | website=U.S. [[Food and Drug Administration]] (FDA) | date=15 October 2020 | url=https://www.fda.gov/news-events/press-announcements/fda-warns-using-type-pain-and-fever-medication-second-half-pregnancy-could-lead-complications | access-date=15 October 2020 | archive-date=16 October 2020 | archive-url=https://web.archive.org/web/20201016180003/https://www.fda.gov/news-events/press-announcements/fda-warns-using-type-pain-and-fever-medication-second-half-pregnancy-could-lead-complications | url-status=live }} {{PD-notice}}</ref><ref name="FDA safety 20201015">{{cite web | title=NSAIDs may cause rare kidney problems in unborn babies | website=U.S. [[Food and Drug Administration]] (FDA) | date=21 July 2017 | url=https://www.fda.gov/drugs/drug-safety-and-availability/fda-recommends-avoiding-use-nsaids-pregnancy-20-weeks-or-later-because-they-can-result-low-amniotic | access-date=15 October 2020 | archive-date=17 October 2020 | archive-url=https://web.archive.org/web/20201017014419/https://www.fda.gov/drugs/drug-safety-and-availability/fda-recommends-avoiding-use-nsaids-pregnancy-20-weeks-or-later-because-they-can-result-low-amniotic | url-status=live }} {{PD-notice}}</ref>

===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),<ref>{{cite journal | vauthors = Forman JP, Stampfer MJ, Curhan GC | title = Non-narcotic analgesic dose and risk of incident hypertension in US women | journal = Hypertension | volume = 46 | issue = 3 | pages = 500–7 | date = September 2005 | pmid = 16103274 | doi = 10.1161/01.HYP.0000177437.07240.70 | doi-access = free | title-link = doi }}</ref> and [[myocardial infarction]] (heart attack),<ref>{{cite journal | vauthors = Hippisley-Cox J, Coupland C | title = Risk of myocardial infarction in patients taking cyclo-oxygenase-2 inhibitors or conventional non-steroidal anti-inflammatory drugs: population based nested case-control analysis | journal = BMJ | volume = 330 | issue = 7504 | pages = 1366 | date = June 2005 | pmid = 15947398 | pmc = 558288 | doi = 10.1136/bmj.330.7504.1366 }}</ref> particularly among those chronically using higher doses. On 9 July 2015, the U.S. 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.<ref name="FDA-20150709">{{cite web|title=FDA Drug Safety Communication: FDA strengthens warning that non-aspirin nonsteroidal anti-inflammatory drugs (NSAIDs) can cause heart attacks or strokes |url=https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-fda-strengthens-warning-non-aspirin-nonsteroidal-anti-inflammatory |date=9 July 2015 |work=U.S. [[Food and Drug Administration]] (FDA) |access-date=9 July 2015 |url-status=live |archive-url=https://web.archive.org/web/20191028180713/https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-fda-strengthens-warning-non-aspirin-nonsteroidal-anti-inflammatory |archive-date=28 October 2019 }}</ref> The [[European Medicines Agency]] (EMA) issued similar warnings in 2015.<ref>{{cite web | title=Ibuprofen- and dexibuprofen-containing medicines | website=[[European Medicines Agency]] (EMA) | date=22 May 2015 | url=https://www.ema.europa.eu/en/medicines/human/referrals/ibuprofen-dexibuprofen-containing-medicines | archive-url=https://web.archive.org/web/20191028181523/https://www.ema.europa.eu/en/medicines/human/referrals/ibuprofen-dexibuprofen-containing-medicines | archive-date=28 October 2019 | url-status=live | access-date=28 October 2019 | id=EMA/325007/2015 }}</ref><ref>{{cite web | title=High-dose ibuprofen (≥2400mg/day): small increase in cardiovascular risk | website=[[Medicines and Healthcare products Regulatory Agency]] (MHRA) | date=26 June 2015 | url=https://www.gov.uk/drug-safety-update/high-dose-ibuprofen-2400mg-day-small-increase-in-cardiovascular-risk | archive-url=https://web.archive.org/web/20191028182113/https://www.gov.uk/drug-safety-update/high-dose-ibuprofen-2400mg-day-small-increase-in-cardiovascular-risk | archive-date=28 October 2019 | url-status=live | access-date=28 October 2019}}</ref>

=== Skin ===
Along with other NSAIDs, ibuprofen has been associated with the onset of [[bullous pemphigoid]] or pemphigoid-like blistering.<ref name="Chan">{{cite web| vauthors = Chan LS |title=Bullous Pemphigoid Clinical Presentation|work=[[eMedicine|Medscape Reference]]|publisher=[[WebMD]]|location=[[United States]]| veditors = Hall R, Vinson RP, Nunley JR, Gelfand JM, Elston DM |date=12 June 2014|url=http://emedicine.medscape.com/article/1062391-clinical#showall|url-status=live|archive-url=https://web.archive.org/web/20111110071913/http://emedicine.medscape.com/article/1062391-clinical#showall|archive-date=10 November 2011}}</ref> As with other NSAIDs, ibuprofen has been reported to be a [[photosensitivity|photosensitizing]] agent,<ref>{{cite journal | vauthors = Bergner T, Przybilla B | title = Photosensitization caused by ibuprofen | journal = Journal of the American Academy of Dermatology | volume = 26 | issue = 1 | pages = 114–6 | date = January 1992 | pmid = 1531054 | doi = 10.1016/0190-9622(92)70018-b }}</ref> 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 disease|autoimmune diseases]] [[Stevens–Johnson syndrome]] (SJS) and [[toxic epidermal necrolysis]].<ref>{{cite journal |vauthors=Raksha MP, Marfatia YS |year=2008 |title=Clinical study of cutaneous drug eruptions in 200 patients |journal=Indian Journal of Dermatology, Venereology and Leprology |volume=74 |issue=1 |pages=80 |doi=10.4103/0378-6323.38431 |pmid=18193504 |doi-access=free |hdl-access=free |title-link=doi |hdl=1807/48058}}</ref><ref>{{cite journal |vauthors=Ward KE, Archambault R, Mersfelder TL |date=February 2010 |title=Severe adverse skin reactions to nonsteroidal antiinflammatory drugs: A review of the literature |journal=American Journal of Health-System Pharmacy |volume=67 |issue=3 |pages=206–13 |doi=10.2146/ajhp080603 |pmid=20101062}}</ref><ref name="Rainsford" />

=== Pregnancy ===
The [[National Health Service]] recommends against the use of ibuprofen for more than 3 days in pregnancy as it can affect the fetus' kidneys and circulatory system. Paracetamol is considered a safer alternative.<ref>{{cite web |title=Pregnancy, breastfeeding and fertility while taking or using ibuprofen |url=https://www.nhs.uk/medicines/ibuprofen-for-adults/pregnancy-breastfeeding-and-fertility-while-taking-ibuprofen/ |website=National Health Service |access-date=9 April 2025 |date=18 November 2021}}</ref>

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 [[miscarriage|miscarry]] than those not taking the medications.<ref>{{cite journal | vauthors = Verma P, Clark CA, Spitzer KA, Laskin CA, Ray J, Koren G | title = Use of non-aspirin NSAIDs during pregnancy may increase the risk of spontaneous abortion | journal = Evidence-Based Nursing | volume = 15 | issue = 3 | pages = 76–77 | date = July 2012 | pmid = 22411163 | doi = 10.1136/ebnurs-2011-100439 | s2cid = 28521248 }}</ref> 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]].<ref>{{cite journal | vauthors = Daniel S, Koren G, Lunenfeld E, Bilenko N, Ratzon R, Levy A | title = Fetal exposure to nonsteroidal anti-inflammatory drugs and spontaneous abortions | journal = CMAJ | volume = 186 | issue = 5 | pages = E177–E182 | date = March 2014 | pmid = 24491470 | pmc = 3956584 | doi = 10.1503/cmaj.130605 }}</ref>

=== Interactions ===

==== Alcohol ====
Drinking [[alcohol (drug)|alcohol]] when taking ibuprofen may increase the risk of [[stomach bleeding]].<ref name="drugs">{{cite web|url=https://www.drugs.com/ibuprofen.html|title=Ibuprofen|publisher=Drugs.com|url-status=live|archive-url=https://web.archive.org/web/20110806064653/http://www.drugs.com/ibuprofen.html|archive-date=6 August 2011}}</ref>

==== Aspirin ====
According to the FDA, "ibuprofen can interfere with the [[antiplatelet]] effect of low-dose [[aspirin]], 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 dose of ibuprofen and a dose of aspirin depends on which is taken first. It would be 30&nbsp;minutes or more for ibuprofen taken after IR aspirin, and 8&nbsp;hours or more for ibuprofen taken before IR aspirin. However, this timing cannot be recommended for [[Enteric coating|enteric-coated]] aspirin. If ibuprofen is taken only occasionally without the recommended timing, though, the reduction of the cardioprotection and stroke prevention of a daily aspirin regimen is minimal.<ref name='FDA2006'>{{cite web |url=https://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm125222.htm |title=Information for Healthcare Professionals: Concomitant Use of Ibuprofen and Aspirin |access-date=22 November 2010 |date=September 2006 |publisher=U.S. [[Food and Drug Administration]] (FDA) |url-status=dead |archive-url=https://web.archive.org/web/20101113035657/https://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm125222.htm |archive-date=13 November 2010 }}
*{{lay source |template= cite web|url = https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/information-about-taking-ibuprofen-and-aspirin-together|title = Information about Taking Ibuprofen and Aspirin Together|date = 9 September 2019 |website = U.S. [[Food and Drug Administration]] (FDA) }}</ref>

==== Paracetamol (acetaminophen) ====
Ibuprofen combined with [[paracetamol]] is considered generally safe in children for short-term usage.<ref>{{cite journal | vauthors = Kanabar DJ | title = A clinical and safety review of paracetamol and ibuprofen in children | journal = Inflammopharmacology | volume = 25 | issue = 1 | pages = 1–9 | date = February 2017 | pmid = 28063133 | pmc = 5306275 | doi = 10.1007/s10787-016-0302-3 }}</ref>

===Overdose===
Ibuprofen overdose has become common since it was licensed for [[Over-the-counter drug|over-the-counter]] (OTC) use. Many overdose experiences are reported in the [[Medical journal|medical literature]], although the frequency of life-threatening complications from ibuprofen overdose is low.<ref>{{cite journal | vauthors = McElwee NE, Veltri JC, Bradford DC, Rollins DE | title = A prospective, population-based study of acute ibuprofen overdose: complications are rare and routine serum levels not warranted | journal = Annals of Emergency Medicine | volume = 19 | issue = 6 | pages = 657–662 | date = June 1990 | pmid = 2188537 | doi = 10.1016/S0196-0644(05)82471-0 }}</ref> Human responses in cases of overdose range from an absence of symptoms to a fatal outcome despite intensive-care treatment. Most symptoms are an excess of the pharmacological action of ibuprofen and include abdominal pain, nausea, [[vomiting]], drowsiness, dizziness, headache, [[tinnitus|ear ringing]], and [[pathologic nystagmus|nystagmus]]. Rarely, more severe symptoms such as [[gastrointestinal bleeding]], [[seizures]], [[metabolic acidosis]], [[hyperkalemia]], [[hypotension|low blood pressure]], [[bradycardia|slow heart rate]], [[tachycardia|fast heart rate]], [[atrial fibrillation]], [[coma]], liver dysfunction, [[acute kidney failure]], [[cyanosis]], [[Hypoventilation|respiratory depression]], and [[cardiac arrest]] have been reported.<ref>{{cite journal | vauthors = Vale JA, Meredith TJ | title = Acute poisoning due to non-steroidal anti-inflammatory drugs. Clinical features and management | journal = Medical Toxicology | volume = 1 | issue = 1 | pages = 12–31 | date = January 1986 | pmid = 3537613 | doi = 10.1007/BF03259825 | s2cid = 25223555 }}</ref> The severity of symptoms varies with the ingested dose and the time elapsed; however, individual sensitivity also plays an important role. Generally, the symptoms observed with an overdose of ibuprofen are similar to the symptoms caused by overdoses of other NSAIDs.

The correlation between the severity of symptoms and measured ibuprofen plasma levels is weak. Toxic effects are unlikely at doses below 100{{nbsp}}mg/kg, but can be severe above 400{{nbsp}}mg/kg (around 150 tablets of 200{{nbsp}}mg units for an average adult male);<ref name = Clinicalmedicine2003-Volans>{{cite journal | vauthors = Volans G, Hartley V, McCrea S, Monaghan J | title = Non-opioid analgesic poisoning | journal = Clinical Medicine | volume = 3 | issue = 2 | pages = 119–123 | date = March–April 2003 | pmid = 12737366 | pmc = 4952728 | doi = 10.7861/clinmedicine.3-2-119 }}</ref> however, large doses do not indicate the clinical course is likely to be lethal.<ref>{{cite journal | vauthors = Seifert SA, Bronstein AC, McGuire T | title = Massive ibuprofen ingestion with survival | journal = Journal of Toxicology. Clinical Toxicology | volume = 38 | issue = 1 | pages = 55–57 | date = 2000 | pmid = 10696926 | doi = 10.1081/clt-100100917 | s2cid = 38588541 }}</ref> A precise [[lethal dose]] is difficult to determine, as it may vary with age, weight, and concomitant conditions of the person.

Treatment to address an ibuprofen overdose is based on how the symptoms present. In cases presenting early, decontamination of the stomach is recommended. This is achieved using [[activated charcoal]]; charcoal absorbs the drug before it can enter the [[systemic circulation|bloodstream]]. [[Gastric lavage]] is now rarely used, but can be considered if the amount ingested is potentially life-threatening, and it can be performed within 60&nbsp;minutes of ingestion. Purposeful vomiting is not recommended.<ref>{{cite journal | title = Position paper: Ipecac syrup | journal = Journal of Toxicology. Clinical Toxicology | volume = 42 | issue = 2 | pages = 133–143 | date = 2004 | pmid = 15214617 | doi = 10.1081/CLT-120037421 | last1 = American Academy Of Clinical Toxico | s2cid = 218865551 }}</ref> Most ibuprofen ingestions produce only mild effects, and the management of overdose is straightforward. Standard measures to maintain normal urine output should be instituted and [[kidney function]] monitored.<ref name="Clinicalmedicine2003-Volans"/> Since ibuprofen has acidic properties and is also excreted in the urine, [[forced diuresis|forced alkaline diuresis]] is theoretically beneficial. However, because ibuprofen is highly protein-bound in the blood, the kidneys' excretion of the unchanged drug is minimal. Forced alkaline diuresis is, therefore, of limited benefit.<ref>{{cite journal | vauthors = Hall AH, Smolinske SC, Conrad FL, Wruk KM, Kulig KW, Dwelle TL, Rumack BH | title = Ibuprofen overdose: 126 cases | journal = Annals of Emergency Medicine | volume = 15 | issue = 11 | pages = 1308–1313 | date = November 1986 | pmid = 3777588 | doi = 10.1016/S0196-0644(86)80617-5 }}</ref>