Ibuprofen

How it works

Ibuprofen reversibly inhibits cyclo-oxygenase enzymes, reducing prostaglandin synthesis and thereby producing analgesic, anti-inflammatory and antipyretic effects.

Prescribing in practice

• NSAIDs should be avoided in pregnancy, particularly from the second half onwards, because of the risk of premature closure of the fetal ductus arteriosus, oligohydramnios and impaired fetal renal function, with MHRA advice reinforcing avoidance from around the midpoint of pregnancy.
• Gastrointestinal ulceration and bleeding, and renal impairment, are class risks, especially in those who are dehydrated, older or on other nephrotoxic drugs.
• Only small amounts pass into breast milk, so it is generally considered suitable for postnatal pain in breastfeeding women.

Monitoring

Monitor for gastrointestinal and renal adverse effects, particularly with prolonged use or in those with risk factors.

Counselling the patient

• Do not take ibuprofen in pregnancy unless specifically advised, especially in later pregnancy.
• Take it with food and stop if you develop stomach pain, indigestion or black stools.
• It is considered compatible with breastfeeding for short-term pain relief.

Evidence & guidelines

MHRA and NICE advice support avoiding NSAIDs such as ibuprofen in pregnancy, particularly from around the midpoint, owing to fetal cardiovascular and renal risks.