How often can you take 600mg of ibuprofen. What are the different forms of ibuprofen available. How should you take ibuprofen tablets, capsules, granules, and liquid. What are the potential risks of taking too much ibuprofen. How to use ibuprofen gel, mousse, and spray safely.

Understanding Ibuprofen Dosage and Strength

Ibuprofen is a widely used over-the-counter pain reliever and anti-inflammatory medication. It comes in various forms and strengths, catering to different needs and preferences. Understanding the correct dosage is crucial for effective and safe use.

Available Forms and Strengths

• Tablets and capsules: 200mg, 400mg, or 600mg
• Slow-release tablets and capsules: 200mg, 300mg, or 800mg
• Granules: 600mg per sachet
• Liquid: 200mg or 400mg per 10ml

Always check the label to ensure you’re taking the correct strength. The variety of options allows for personalized pain management, but it’s essential to follow recommended dosages.

Recommended Dosage for Adults

The standard dosage for adults varies depending on the severity of pain and individual needs. Here’s a breakdown of the typical recommendations:

• Regular tablets or capsules: One or two 200mg tablets/capsules, 3 times a day
• Higher doses: Up to 600mg, 4 times a day (under doctor’s supervision)
• Granules: One sachet, 2 to 3 times a day (some may need it 4 times a day)

Is there a minimum time gap between doses? Yes, it’s crucial to space out your ibuprofen intake. If taking it 3 times a day, leave at least 6 hours between doses. For 4 times a day, maintain a minimum 4-hour gap.

Slow-Release Formulations

For chronic pain management, doctors may recommend slow-release ibuprofen. These are typically taken once daily in the evening or twice a day with a 10 to 12-hour gap between doses.

Proper Administration of Ibuprofen

Taking ibuprofen correctly ensures maximum efficacy and minimizes potential side effects. Here’s how to administer different forms:

Tablets and Capsules

Swallow whole with water, milk, or juice. Avoid chewing, breaking, crushing, or sucking to prevent mouth or throat irritation.

Melt-in-Mouth Tablets

Place on the tongue, allow to dissolve, then swallow. No water is necessary.

Granules

Empty the sachet into a glass of water, stir to create an orange-flavored fizzy drink, and consume immediately.

Liquid Form

Use the provided plastic syringe or spoon for accurate measurement. Don’t use kitchen spoons as they’re imprecise.

Should you take ibuprofen with food? It’s advisable to take ibuprofen with a meal, snack, or milk to reduce the risk of stomach upset. However, taking it after food may delay its onset of action.

Duration of Ibuprofen Use

The length of ibuprofen treatment depends on the underlying condition:

• Short-term pain (e.g., toothache, menstrual cramps): 1-2 days may suffice
• Chronic conditions (e.g., rheumatoid arthritis): Long-term use under medical supervision

For extended use beyond 6 months, doctors may prescribe additional medication to protect the stomach from potential side effects.

Managing Missed Doses and Avoiding Overdose

Consistency is key in pain management, but mistakes can happen. Here’s how to handle missed doses:

• Take the missed dose as soon as you remember, unless it’s almost time for the next one
• Skip the missed dose if it’s close to the next scheduled intake
• Never double up on doses to compensate for a missed one

How can you remember to take your medication regularly? Consider setting alarms or using pill organizers. Your pharmacist can offer additional strategies to improve medication adherence.

Recognizing Ibuprofen Overdose

Taking excessive ibuprofen can lead to serious health risks. Be aware of these potential overdose symptoms:

• Nausea and vomiting
• Stomach pain
• Fatigue or drowsiness
• Black stools or blood in vomit (indicating stomach bleeding)
• Tinnitus (ringing in the ears)
• Breathing difficulties
• Irregular heart rate

If you suspect an overdose, seek immediate medical attention. Contact emergency services or go to the nearest emergency room, especially if experiencing slowed or rapid heart rate or breathing problems.

Topical Ibuprofen: Gels, Mousses, and Sprays

Ibuprofen isn’t limited to oral forms. Topical applications offer targeted relief for localized pain.

Dosage and Application

The amount of ibuprofen in topical products varies. Always refer to the package leaflet for specific instructions. Generally:

• Apply gently to the affected area 3-4 times daily
• Maintain a minimum 4-hour gap between applications

Are there any precautions for using topical ibuprofen? Yes, avoid applying to broken or irritated skin. If symptoms persist or worsen after 7 days of use, consult a healthcare professional.

Special Considerations and Precautions

While ibuprofen is generally safe when used as directed, certain groups need to exercise caution:

Pregnancy and Breastfeeding

Consult a healthcare provider before using ibuprofen during pregnancy, especially in the third trimester. For breastfeeding mothers, occasional use is usually safe, but regular use should be discussed with a doctor.

Existing Health Conditions

Individuals with the following conditions should seek medical advice before using ibuprofen:

• Asthma or other respiratory conditions
• Heart disease or high blood pressure
• Liver or kidney problems
• Stomach ulcers or bleeding disorders

Interactions with Other Medications

Ibuprofen can interact with various medications, including:

• Aspirin and other NSAIDs
• Blood thinners (e.g., warfarin)
• Certain antidepressants
• Some high blood pressure medications

Always inform your healthcare provider about all medications you’re taking, including over-the-counter drugs and supplements.

Alternatives to Ibuprofen

While ibuprofen is effective for many, some individuals may need alternatives due to contraindications or personal preference. Consider these options:

Other Over-the-Counter Pain Relievers

• Acetaminophen (Tylenol): Effective for pain and fever, but lacks anti-inflammatory properties
• Naproxen: Another NSAID with a longer duration of action
• Aspirin: Suitable for adults but not recommended for children due to the risk of Reye’s syndrome

Non-Medicinal Alternatives

For mild pain or inflammation, consider these natural approaches:

• Cold or heat therapy
• Gentle exercise and stretching
• Massage
• Relaxation techniques (e.g., meditation, deep breathing)

Can dietary changes help manage inflammation? Yes, an anti-inflammatory diet rich in omega-3 fatty acids, fruits, vegetables, and whole grains may help reduce chronic inflammation.

Long-Term Ibuprofen Use: Risks and Monitoring

While ibuprofen is generally safe for short-term use, long-term or high-dose usage requires careful consideration and monitoring.

Potential Long-Term Risks

• Gastrointestinal issues: Increased risk of ulcers and bleeding
• Cardiovascular concerns: Slightly elevated risk of heart attack and stroke
• Kidney problems: Potential for reduced kidney function

Monitoring and Prevention

For individuals requiring long-term ibuprofen use:

• Regular check-ups with healthcare providers
• Periodic blood tests to assess kidney and liver function
• Consideration of gastroprotective medications
• Exploration of alternative pain management strategies

How often should you reassess your pain management plan? It’s advisable to review your treatment approach with a healthcare provider at least annually or more frequently if you experience changes in your condition or new side effects.

Ibuprofen in Special Populations

Different age groups and health conditions may require specific considerations when using ibuprofen.

Children and Adolescents

Ibuprofen is generally safe for children over 6 months old, but dosage is based on weight and age. Always use child-specific formulations and follow dosing instructions carefully.

Elderly Individuals

Older adults may be more susceptible to side effects and should typically start with lower doses. Regular monitoring is crucial, especially for those with multiple health conditions or medications.

Athletes and Active Individuals

While ibuprofen can help manage exercise-related pain, regular use to mask pain during intense physical activity is not recommended. It may increase the risk of injury and delay healing.

Are there specific guidelines for using ibuprofen before or after exercise? It’s generally advisable to avoid ibuprofen before strenuous exercise. If used post-exercise, it should be in moderation and not as a regular practice.

Understanding and Managing Side Effects

While ibuprofen is generally well-tolerated, being aware of potential side effects is crucial for safe use.

Common Side Effects

• Stomach discomfort or mild nausea
• Headache
• Dizziness
• Mild allergic reactions (e.g., skin rash)

Serious Side Effects Requiring Medical Attention

• Severe stomach pain or signs of gastrointestinal bleeding
• Difficulty breathing or wheezing
• Swelling of the face, throat, or extremities
• Unusual weight gain or fluid retention
• Changes in urination patterns

How can you minimize the risk of side effects? Taking ibuprofen with food, using the lowest effective dose for the shortest necessary duration, and staying hydrated can help reduce the risk of adverse effects.

Ibuprofen Storage and Disposal

Proper storage and disposal of ibuprofen ensure its effectiveness and safety.

Storage Guidelines

• Keep at room temperature, away from heat and moisture
• Store out of reach of children and pets
• Keep in original packaging to protect from light

Safe Disposal

To dispose of unused or expired ibuprofen:

• Check for local medication take-back programs
• If unavailable, mix with unpalatable substance (e.g., used coffee grounds) and dispose in household trash
• Remove or obscure personal information on packaging before disposal

Is it safe to flush ibuprofen down the toilet? Generally, this is not recommended due to potential environmental impact. Always check local guidelines for proper medication disposal methods.

Future Developments in Pain Management

As medical research progresses, new approaches to pain management are emerging that may complement or replace traditional NSAIDs like ibuprofen.

Targeted Therapies

Researchers are developing more specific COX-2 inhibitors and exploring novel anti-inflammatory pathways to provide pain relief with fewer side effects.

Non-Pharmacological Approaches

Advancements in fields such as neurostimulation, biofeedback, and virtual reality therapy show promise in managing various types of pain without relying solely on medications.

Personalized Medicine

Genetic testing and biomarker analysis may soon allow for more tailored pain management strategies, optimizing efficacy while minimizing risks for individual patients.

How might these developments change the way we use ibuprofen in the future? While ibuprofen will likely remain a valuable tool in pain management, these advancements may lead to more targeted and personalized approaches, potentially reducing reliance on NSAIDs for certain conditions.

Understanding the proper use of ibuprofen, from dosage to administration and potential risks, is crucial for safe and effective pain management. While it’s a valuable medication for many, it’s essential to use it judiciously and under appropriate guidance. Always consult with healthcare professionals for personalized advice, especially for long-term use or in the presence of other health conditions. As pain management strategies continue to evolve, staying informed about both current best practices and emerging therapies will help ensure optimal care and well-being.

How and when to take or use ibuprofen

Dosage and strength for tablets, capsules, granules and liquid

Each ibuprofen tablet or capsule contains 200mg, 400mg or 600mg of ibuprofen. Slow-release tablets and capsules contain 200mg, 300mg or 800mg of ibuprofen.

Each sachet of granules contains 600mg of ibuprofen.

If you’re taking ibuprofen as a liquid, 10ml contains either 200mg or 400mg. Always check the label.

The usual dose for adults is one or two 200mg tablets or capsules 3 times a day. In some cases, your doctor may prescribe a higher dose of up to 600mg to take 4 times a day if needed. This should only happen under supervision of a doctor.

If you’re taking granules, the usual dose for adults is one sachet 2 or 3 times a day. Some people might need to take it 4 times a day.

If you take ibuprofen 3 times a day, leave at least 6 hours between doses. If you take it 4 times a day, leave at least 4 hours between doses.

If you have pain all the time, your doctor may recommend slow-release ibuprofen tablets or capsules. You’ll usually take these once a day in the evening or twice a day. Leave a gap of 10 to 12 hours between doses if you’re taking ibuprofen twice a day.

How to take tablets, capsules, granules and liquid

Swallow ibuprofen tablets or capsules whole with a drink of water, milk or juice. Do not chew, break, crush or suck them as this could irritate your mouth or throat.

For people who find it difficult to swallow tablets or capsules, ibuprofen is available as a tablet that melts in your mouth, granules that you mix with a glass of water to make a drink, and as a liquid.

If you’re taking the tablet that melts in your mouth, put it on your tongue, let it dissolve and then swallow. You do not need to drink any water.

Take ibuprofen granules by emptying the contents of the sachet into a glass full of water to make an orange flavoured fizzy drink, stir and drink straight away.

If you’re taking liquid, it will come with a plastic syringe or spoon to measure your dose. If you do not have a syringe or spoon, ask your pharmacist for one. Do not use a kitchen spoon, as it will not measure the right amount.

Take ibuprofen tablets, capsules, granules or liquid with a meal or snack, or with a drink of milk. It will be less likely to upset your stomach. If you take it just after food, ibuprofen may take longer to start working.

How long to take it for

If you’re taking ibuprofen for a short-lived pain like toothache or period pain, you may only need to take it for a day or two.

You may need to take ibuprofen for longer if you have a long-term health problem, such as rheumatoid arthritis.

If you need to take ibuprofen for more than 6 months, your doctor may prescribe a medicine to protect your stomach from any side effects.

If you forget to take ibuprofen tablets, capsules, granules or liquid

If you are prescribed ibuprofen as a regular medicine and forget to take a dose, take the missed dose as soon as you remember, unless it’s almost time for your next dose. In this case, skip the missed dose and take your next dose at the usual time.

Never take a double dose to make up for a forgotten one.

If you often forget doses, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to help you remember to take your medicine.

If you take too much ibuprofen tablets, capsules, granules or liquid

Taking too much ibuprofen by mouth can be dangerous. It can cause side effects such as:

• feeling and being sick (nausea and vomiting)
• stomach pain
• feeling tired or sleepy
• black poo and blood in your vomit – a sign of bleeding in your stomach
• ringing in your ears (tinnitus)
• difficulty breathing or changes in your heart rate (slower or faster)

Urgent advice: Contact 111 for advice now if:

• you’ve taken more than it says on the packet of ibuprofen tablets, capsules, granules or liquid

Go to 111.nhs.uk or call 111

Immediate action required: Go to A&E now if:

you’ve taken more than it says on the packet of ibuprofen tablets, capsules, granules or liquid and:

• your heart rate (pulse) has slowed down or got faster
• you’re having difficulty breathing

If you go to A&E, do not drive yourself. Get someone else to drive you or call for an ambulance.

Take the ibuprofen packet, or the leaflet inside it, plus any remaining medicine with you.

Dosage for ibuprofen gel, mousse or spray

The amount of ibuprofen you put on your skin depends on the product you’re using. Check the package leaflet carefully for how much to use.

How to use ibuprofen gel, mousse or spray

Gently massage the ibuprofen into the painful area 3 or 4 times a day. Leave at least 4 hours between applications.

Most products must not be used more than 4 times in 24 hours. Check the instructions that come with the medicine to see how many times a day you can use it.

Never use ibuprofen gel, mousse or spray on your eyes, mouth, lips, nose or genital area. It may make them sore. Do not put it on sore or broken skin.

Do not put plasters or dressings over skin you’ve applied ibuprofen to.

Wash your hands after using it, unless you are treating your hands.

Do not smoke or go near naked flames as clothes that have been in contact with ibuprofen gel, mousse or spray burn more easily, even if they have been washed.

If you forget to put it on

Do not worry if you occasionally forget to use ibuprofen gel, mousse or spray, just carry on using it when you remember.

If you put on too much ibuprofen gel, mousse or spray

Putting too much ibuprofen on your skin is unlikely to cause problems.

If you swallow the gel, mousse or spray

If you swallow ibuprofen gel, mousse or spray, you may get symptoms including:

• headaches
• being sick (vomiting)
• feeling sleepy or dizzy

Urgent advice: Contact 111 for advice now if:

• you swallow ibuprofen gel, mousse or spray and you feel unwell

Go to 111. nhs.uk or call 111

How much ibuprofen can I take and how often?

Medically reviewed by Carmen Pope, BPharm. Last updated on Sep 6, 2022.

What is the maximum amount you can take?

Adults can take one or two ibuprofen 200mg tablets (200mg to 400mg) three or four times daily if they need to. You should only take ibuprofen every 4 to 6 hours.

You should not take more than 6 tablets (1200mg) in total in one day if you have bought them over the counter, from a supermarket or drug store. You should always try and take the smallest dose needed that gives you relief.

If your doctor has prescribed them for you on prescription, usually as a higher strength tablet, then you can take a maximum of 3200mg in one day.

How much ibuprofen is in a single dose?

A single dose of ibuprofen contains 200mg if it has been bought over the counter from a supermarket or a drug store. Extra strength tablets usually contain 400mg. Some prescription strengths of ibuprofen contain an even higher dose, such as 600mg or 800mg. Always check the label on the packet to make sure you know what dosage your ibuprofen tablets contain.

How often can you take Ibuprofen?

You can take ibuprofen every four to six hours.

How much ibuprofen can you take in a day?

You should not take more than 6 tablets (1200mg) in total in one day if you have bought them over the counter, from a supermarket or drug store.

If your doctor has prescribed them for you on prescription, usually as a higher strength tablet, then you can take a maximum of 3200mg in one day.

You should always try and take the smallest dose needed that gives you relief.

How much ibuprofen is too much?

More than 3200mg of ibuprofen in one day is too much.

What happens if you take too much ibuprofen?

If you take too much ibuprofen you may develop stomach problems, such as heartburn, indigestion, or a stomach ulcer. You may experience bleeding from your gastrointestinal tract or from anywhere in your body and you may feel dizzy.

Occasionally people who have overdosed on ibuprofen have developed kidney failure or seizures. Metabolic acidosis (a build-up of acidic by-products in the blood) has been reported and an increase in the time it takes for blood to clot can occur.

If you suspect a person has overdosed on ibuprofen, seek medical attention immediately. Usually, doctors can reverse the effects of an ibuprofen overdose if the person is seen quickly.

References

• Ibuprofen. Updated 01/2021. Drugs.com https://www.drugs.com/ibuprofen.html
• Ibuprofen (oral route). Mayo Clinic. https://www.mayoclinic.org/drugs-supplements/ibuprofen-oral-route/proper-use/drg-20070602

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Interactions Ibuprofen – what it is combined with, the effect of the use with other drugs

Ibuprofen: instruction, price, analogues | Compendium – Drug Guide

Ibuprofen – NSAID

Ibuprofen is a widely prescribed NSAID, is considered one of the safest drugs in this group and is generally well tolerated, but, nevertheless, may rarely cause clinically significant and severe acute liver injury. Ibuprofen has anti-inflammatory, analgesic and antipyretic effects.

The drug is prescribed for the symptomatic treatment of various types of pain, including headache, toothache, dysmenorrhea, neuralgia, back pain, joint pain, muscle pain, rheumatic pain, as well as signs of SARS and influenza. Ibuprofen is prescribed alone or in combination with other analgesics, antihistamines, or anticholinergics, usually at doses of 200, 400, 600, or 800 mg. Pediatric formulations of this drug are also available from pharmacies. Ibuprofen is part of many combined drugs for the symptomatic treatment of dysmenorrhea, headache, allergies, and acute respiratory viral infections.

Ibuprofen. FDA Approved Indications

Ibuprofen is indicated and FDA approved for the symptomatic treatment of inflammatory diseases and rheumatoid arthritis. Ibuprofen was discovered in the search for an alternative non-corticosteroid treatment for rheumatoid arthritis. This disease was the impetus for the creation of the substance that eventually became known as ibuprofen. Patented as 2-(4-isobutylphenyl)propionic acid (ibuprofen) by Dr. Stuart Adams and John Nicholson, it has become and remains one of the most widely used NSAIDs in the world (Halford G.M. et al., 2012). Today, ibuprofen is used as a monotherapy for the symptomatic treatment of pain in rheumatoid arthritis and inflammatory diseases, with some research being conducted into the introduction of new treatments or dosage forms. One of these studies includes the creation of complex drugs based on NSAIDs and a carbonic anhydrase inhibitor for the symptomatic treatment of pain in rheumatoid arthritis (Akgul O. et al., 2018).

Ibuprofen is FDA approved for symptomatic use in mild to moderate pain. As an over-the-counter drug, it is used as a symptomatic treatment for muscle strain, joint pain, migraine, sore throat, SARS / influenza. Postoperative pain is one type of pain. One randomized, double-blind study demonstrated the therapeutic efficacy of i.v. ibuprofen, with i.v. acetaminophen being the comparator. The effectiveness of drugs was compared in the treatment of postoperative pain in patients undergoing laparoscopic cholecystectomy. As a result of the study, in the first 24 hours after the procedure, it was found that with intravenous ibuprofen therapy, the severity of pain decreases and thus it is possible to reduce the dose of opioids (Ekinci M. et al., 2019). Ibuprofen is widely used as an effective drug for the symptomatic treatment of pain, but research is constantly aimed at improving the effectiveness of its clinical use.

Ibuprofen is also FDA-approved as an antipyretic drug used to reduce body temperature in both adults and children. NSAIDs are much more commonly used in the treatment of fever in children, and much current research is focused on making ibuprofen more effective for this purpose.

Dysmenorrhea is a disease characterized by pain during menstruation, which can vary. Dysmenorrhea can be either primary, which is usually mediated by prostaglandin production during ovulation, or secondary to another disease such as endometriosis or pelvic inflammatory disease (Durain D. , 2004). NSAIDs are often the therapeutic choice and are FDA approved for the treatment of primary dysmenorrhea. Transdermal drug delivery has been a topic of research in the context of the use of ibuprofen for the symptomatic treatment of primary dysmenorrhea. One study examined the use of essential oils as penetration enhancers for the transdermal delivery of ibuprofen in patients with dysmenorrhea. As a result of the study, one of the essential oils (Chuanxiong oil) was found to have a positive effect on the permeability and relief of pain symptoms when administered with ibuprofen hydrogel (Chen J. et al., 2015).

Ibuprofen and other NSAIDs are also FDA approved for the treatment of osteoarthritis. The results of a comparative study of celecoxib (a group of coxibs) and ibuprofen demonstrated the same tolerability and efficacy in the treatment of patients with osteoarthritis of the knee (Gordo A.C. et al., 2015).

Ibuprofen has been studied for the symptomatic treatment of gout attacks. In 1978, a study by Schweitz et al. reported rapid improvement and reduction in pain in 10 patients with acute gouty arthritis (patients were treated with ibuprofen 2400 mg) (Schweitz M.C. et al., 1978). Ibuprofen is usually used as monotherapy for mild attacks and colchicine as therapy for moderate to severe gout attacks.

NSAIDs and colchicine are also often used in combination in the treatment of pericarditis due to the anti-inflammatory and analgesic properties of NSAIDs. Since 2011, ibuprofen has been one of the most widely used NSAIDs in the treatment of pericarditis. Its efficacy has been demonstrated in the CORP and CORP-2 trials in the treatment and prevention of multiple relapses of idiopathic pericarditis compared to acetylsalicylic acid. The study found no significant difference between the two drugs in the treatment or prevention of idiopathic pericarditis (Schwier N. et al., 2017). In a 2014 review, colchicine was shown to be effective in reducing the incidence of recurrent pericarditis when used as add-on therapy to NSAIDs such as ibuprofen, acetylsalicylic acid, or indomethacin, but with limited study numbers (Bayes-Genis A. et al. , 2017).

Intravenous ibuprofen has been approved by the FDA for the treatment of patent ductus arteriosus in preterm infants. As a result of studies, a similar efficacy of ibuprofen with indomethacin was recorded in this pathology. Differences exist in the incidence of systemic vasoconstriction and renal toxicity; probably due to the lower selectivity for COX-1, ibuprofen was found to have reduced rates of both outcomes (Ferguson J.M., 2019).

Since 2007, USPSTF guidelines recommend the use of acetylsalicylic acid and NSAIDs for the prevention of colorectal cancer in certain populations. In 2016, they updated these recommendations, as well as recommendations from 2009 on the use of acetylsalicylic acid and NSAIDs in the prevention of cardiovascular diseases (Bibbins-Domingo K. et al., 2016). Although these recommendations do not apply specifically to ibuprofen, they do provide a solid basis for research that confirms the potentially great role of NSAIDs in the treatment and prevention of cancer. The results of a study on the effectiveness of NSAIDs in the treatment of cancer, as well as some studies on the effectiveness of ibuprofen, have shown promising results. A review by Hil’ovska et al documented the potential use of NSAIDs in reducing the growth, morphology, and invasion of cancer cells; in the induction of cancer cell death and in the use of a lower dose of cytotoxic drugs (Hiľovská L. et al., 2015). The reviewed studies were mainly devoted to COX-2 inhibitors. With regard to ibuprofen specifically, some studies have suggested that it has a stronger antitumor effect compared to acetylsalicylic acid, namely in studies conducted in the treatment of breast and lung cancer (Harris R.E. et al., 2005). Also, when using ibuprofen or acetylsalicylic acid, the risk of developing breast cancer is reduced (Cuzick J. et al., 2009).

Similar to previous authors, Wawro et al. in their studies demonstrated potential indications for the use of NSAIDs, especially acetylsalicylic acid and ibuprofen, in cancer therapy in patients with colorectal cancer treated with vincristine monotherapy. The proposed role of NSAIDs is primarily to prevent chemoresistance by inhibiting the proliferation of cancer-associated fibroblast formation. Vincristine stimulates the growth of cancer-associated fibroblasts through the secretion of tumor growth factors beta (TGF-β) and IL-6; when using acetylsalicylic acid and ibuprofen, scientists recorded an inhibitory effect of the drug on this pathological process. Their studies were based on the assumption that the probable mechanism of this inhibitory effect is associated with NSAIDs that affect the rate of regulation of microtubule polymerization dynamics (Wawro M.E. et al., 2019).

Ibuprofen. Pain in the pediatric population

Pain is a common symptom in children. For more than 30 years, the use of ibuprofen in the pediatric population has been the subject of research. The scientific literature has reviewed information on childhood illnesses over the past 20 years, drawing conclusions about the efficacy and side effects associated with the use of ibuprofen as an analgesic. Ibuprofen has been effective in several pain conditions in children such as musculoskeletal pain, ear pain and acute otitis media, toothache and inflammatory diseases of the mouth and throat. The drug is a reasonable and effective alternative for postoperative pain, including tonsillectomy and adenoidectomy. It also remains the choice in the symptomatic treatment of pain in chronic inflammatory diseases such as arthritis. Side effects associated with ibuprofen are minor. It has the lowest gastrointestinal toxicity among NSAIDs, although some cases of GI toxicity (gastrointestinal toxicity) may occur. Adverse reactions from the kidneys are minimal, but dehydration plays an important role in the occurrence of kidney damage, so ibuprofen should not be prescribed to patients with vomiting and diarrhea. Ibuprofen therapy has demonstrated a good safety profile and evidence of efficacy in the symptomatic treatment of mild to moderate pain in children of various backgrounds. The analgesic effect of NSAIDs such as ibuprofen is mainly to inhibit the biosynthesis of prostaglandins. A decrease in the synthesis of prostaglandins leads to a decrease in the production of glutathione and renal perfusion.

Advantage of ibuprofen and acetaminophen combined/alternating

Benefits of using NSAIDs and acetaminophen simultaneously or alternately have been suggested due to their potential synergy of antinociceptive effects, as well as the convenience of using an additional analgesic drug for pain that is not amenable to monotherapy at any dose of age. In acetaminophen, C _max in plasma is reached after 30 minutes compared to 60 minutes for ibuprofen. In studies of antipyretic effects, acetaminophen maximally reduces high body temperature after 2 hours, and ibuprofen after 3 hours. The recommended dosing intervals are every 6 and 8 hours for acetaminophen and ibuprofen, respectively; thus, theoretically, they can be rotated every 3 hours. Short-term use of an alternating dosing regimen may be considered for the symptomatic treatment of pain that is not relieved by monotherapy (Massimo Barbagallo et al. , 2019)

There are several randomized controlled trials of symptomatic treatment of headache in children. They concluded that only ibuprofen and sumatriptan were significantly more effective than placebo in reducing headache severity.

One Cochrane review included 27 pediatric randomized controlled trials of NSAIDs. Each of them compared the therapeutic efficacy of one of the drugs in this group with placebo. Efficacy was evaluated 2 hours after administration of the study drug. Based on a systematic review, ibuprofen appeared to be more effective, making it the drug of choice for the symptomatic treatment of headache. If migraine is suspected, NSAIDs and triptans should be considered. In case of nausea and vomiting, antiemetics and IV rehydration should be used (Raucci U., 2019).

Conclusions. Ibuprofen – safety profile among NSAIDs

Ibuprofen first appeared on the market about 50 years ago and quickly became a popular drug. In April 2019, the National Agency for the Safety of Medicines and Health Products (ANSM) of France issued a warning against the use of NSAIDs in patients with infectious diseases, based on an analysis of 20 years of real data on the safety of ibuprofen and ketoprofen.