Ibuprofen

How it works

Ibuprofen non-selectively inhibits cyclo-oxygenase (COX-1 and COX-2), reducing prostaglandin synthesis and thereby pain, inflammation and fever.

Prescribing in practice

• Use the lowest effective dose for the shortest time; gastrointestinal, renal and cardiovascular risks rise with dose and duration.
• Avoid or use caution in peptic ulcer disease, significant renal impairment, heart failure, and uncontrolled hypertension; consider gastroprotection in at-risk patients.
• It reduces the renal clearance of several drugs and adds to bleeding risk with anticoagulants/antiplatelets; the combination with an ACE inhibitor or ARB plus a diuretic is a particular renal risk.

Monitoring

Short courses in healthy adults need no routine monitoring; with longer use or in at-risk patients monitor renal function and blood pressure and review GI symptoms.

Counselling the patient

• Take it with or after food.
• Report indigestion, black stools, or reduced urine output.
• Avoid combining it with other NSAIDs.

Evidence & guidelines

NSAIDs are effective for inflammatory and musculoskeletal pain but are used at the lowest effective dose for the shortest duration because of GI, renal and cardiovascular risk.