Association Between Prescribed Ibuprofen and Severe COVID‐19 Infection: A Nationwide Register‐Based Cohort Study – Kragholm – 2020 – Clinical and Translational Science

The coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has led to substantial changes in healthcare utilization, morbidity, intensive care resources, and mortality.^1-7 The entry point for this novel coronavirus for its further pathogenesis in humans is thought to be through an angiotensin-converting enzyme 2 receptor found in the lungs, arteries, heart, kidneys, and intestines.⁸ Nonsteroidal anti-inflammatory drugs (NSAIDs) might facilitate and aggravate infection with COVID-19.^{9, 10} The mechanisms may include upregulation of the angiotensin-converting enzyme 2 enzyme expression and delayed diagnostics by masking inflammation and fever.^{9, 10} Initially, the World Health Organization (WHO) and national health boards issued a warning against the use of NSAIDs in patients with COVID-19 and that paracetamol or acetaminophen should be administered instead. However, later and current WHO and European Medicine Agency recommendations do not call for avoidance of ibuprofen to treat COVID-19 symptoms, based on the lack of evidence to support the initially recommended warning.¹⁰ The US Food and Drug Administration (FDA) has stated their awareness of reports of potential worsening of COVID-19 infection based on NSAID use, but the agency also stresses that there is currently insufficient evidence to support that NSAID should worsen the clinical course of COVID-19 infection. Therefore, given the current uncertainty about whether NSAID should be avoided in patients with COVID-19, we performed a nationwide register-based study to evaluate the risk of severe COVID-19 infection with recent ibuprofen prescription claims. Because very few patients were prescribed other NSAIDs, we only studied the association between ibuprofen prescription claims and outcome.

METHODS

Study setting and population

In Denmark, all citizens hold a unique civil registration number used in all healthcare and social contacts and recorded in national administrative registries. From the Danish National Patient Registry, we identified patients positive with COVID-19 between the end of February 2020 and May 16, 2020, through the use of International Classification of Disease-10th edition diagnosis codes DB342, DB342A, and DB972 for unspecific COVID-19 infection and DB972A for COVID-19 infection with severe acute respiratory syndrome.¹¹ Patients below 30 years of age, as well as patients with heart failure, in whom ibuprofen is not recommended, were excluded. Finally, only 57 patients were prescribed other NSAIDs, and these patients were excluded.

Exposure

From the Danish National Prescription Registry, data on prescription medication was available until April 30, 2020. We assessed ibuprofen prescription claims between January 1, 2020, and April 30, 2020, and the latest filled prescription before COVID-19 diagnosis or April 30, 2020, was used. Ibuprofen prescription claims were further divided into > 14 days before COVID-19 diagnosis vs. ≤ 14 days before COVID-19 diagnosis. Finally, because we do not have exact data on doses available from the Danish National Prescription Registry, we defined strengths of the latest package of 200–400 mg vs. 600–800 mg, respectively, as low-medium vs. high dosage. These 2 groups may be viewed as proxies for daily doses of 600–1,200 mg and 1,800–2,400 mg, respectively. Indications for ibuprofen and concomitant prescription for paracetamol were also assessed.

Covariates

We included information on patient age and sex from the Danish Civil Registration System. We assessed the following comorbidities: hypertension, diabetes, prior myocardial infarction, chronic obstructive pulmonary disease, hypertension, any malignancy, and rheumatic disease. Hypertension was defined as a redemption of at least 2 antihypertensive drugs in 2 consecutive 100-day periods prior to the COVID-19 diagnosis, as done previously.¹² All other comorbid conditions were identified from the Danish National Patient Registry up to 5 years prior to COVID-19 diagnosis.

Outcome

The study outcome was a 30-day composite of severe COVID-19 diagnosis (International Classification of Disease-10th edition: DB972A), admission to an intensive care unit (ICU), or death. The Danish National Patient Registry was used to identify the first two components of the composite end point, whereas vital status was identified from the Danish Civil Registration System. Patients admitted to an ICU 3 days before the COVID-19 diagnosis up to 30 days after the COVID-19 diagnosis were defined as admitted to an ICU and incorporated into the composite end point. For cases where the ICU admission was ahead of the COVID-19 diagnosis, risk time began at the time of COVID-19 diagnosis.

Statistics

Continuous variables are reported using median and 25–75 percentiles. Categorical variables are reported using counts and percentages. Thirty-day absolute risks and average risk ratios (treatment effects) for the ibuprofen vs. non-ibuprofen COVID-19 patient groups standardized to the age, sex, and comorbidity distribution of all patients were derived from multivariable Cox regression.¹³ The models included the following covariates: age (in groups 30–50, > 50–60, > 60–70, > 70–80, and > 80 years), sex, diabetes, prior myocardial infarction, chronic obstructive pulmonary disease, hypertension, cancer, and rheumatic disease. Data management and analyses were performed using SAS, version 9.4 (Cary, NC) and R version 3.6.1.¹⁴

Ethics

According to Danish legislation, register-based studies do not require ethical committee approval or patient consent. In accordance with the General Data Protection Regulation, the data responsible institute in the Capital Region of Denmark has approved the use of the data sources for research purposes (approval number P-2019-191). Data are accessed on secure servers under Statistics Denmark and cannot be shared according to Danish legislation.

RESULTS

Patients

Of a total of 4,842 patients with COVID-19 infection between the end of February and May 16, 2020, 4,002 patients formed the study population. A total of 264 patients (6.6%) filled an ibuprofen prescription claim prior to COVID-19 diagnosis. Patients with pre-existing heart failure (n = 208), < 30 years of age (n = 575), or who filled a prescription for other nonsteroidal anti-inflammatory drugs (n = 57) were excluded.

Characteristics

Characteristics of age, sex, and comorbidities were generally comparable between the two study groups (Table 1). Patients with ibuprofen prescription claims tended to be older and more likely to have hypertension, although insignificant, as well as the prevalence of diabetes, myocardial infarction, chronic obstructive pulmonary disease, and cancer were numerically higher for patients with ibuprofen prescription claims. Characteristics between patients with ibuprofen prescription claims > 14 days before COVID-19 vs. ≤ 14 days before COVID-19 were also comparable (Table 2). Indications for ibuprofen prescription were available for 220 patients of 264 patients who were prescribed ibuprofen: 13 patients (5.9%) were prescribed ibuprofen due to rheumatic disease/inflammation and the remaining 207 patients (94.1%) due to pain. Of these 220 patients, 156 (70.9%) were also prescribed paracetamol.

Table 1.
Characteristics of patients with COVID-19 with vs. without an ibuprofen prescription claim prior to COVID-19

Variable	Ibuprofen prescription claim (n = 264)	No ibuprofen prescription claim (n = 3,738)	P value
Age, median [25%–75%]	58 [46–68]	57 [45–73]	0. 67
Age ≤ 50 years, n (%)	87 (33.0)	1,359 (36.4)
Age > 50–60 years, n (%)	62 (23.5)	769 (20.6)
Age > 60–70 years, n (%)	56 (21.2)	528 (14.1)
Age > 70–80 years, n (%)	31 (11. 7)	575 (15.4)
Age > 80 years, n (%)	28 (10.6)	507 (13.6)	0.007
Male sex, n (%)	118 (44.7)	1,773 (47.4)	0.43
Diabetes, n (%)	35 (13.3)	414 (11.1)	0. 32
Prior MI, n (%)	7 (2.7)	94 (2.5)	0.99
COPD, n (%)	17 (6.4)	197 (5.3)	0.50
Hypertension, n (%)	64 (24.2)	815 (21.8)	0.40
Cancer, n (%)	19 (7.2)	362 (9. 7)	0.22
Rheumatic disease, n (%)	13 (4.9)	171 (4.6)	0.91

• COPD, chronic obstructive pulmonary disease; COVID-19, coronavirus disease 2019; MI, myocardial infarction.

Table 2.
Characteristics of patients with COVID-19 with an ibuprofen prescription claim ≤ 14 days before COVID-19 vs. > 14 days before COVID-19

Variable	Ibuprofen prescription claim	Ibuprofen prescription claim	P value
	≤ 14 days before COVID-19 (n = 64)	> 14 days before COVID-19 (n = 200)
Age, median [25% MI, 75% MI]	58. 5 [47.0, 74.2]	57 [46, 68]	0.50
Age ≤ 50 years, n (%)	19 (29.7)	68 (34.0)
Age > 50–60 years, n (%)	16 (25.0)	46 (23.0)
Age > 60–70 years, n (%)	12 (18.8)	44 (22.0)
Age > 70–80 years, n (%)	11 (17.2)	20 (10.0)
Age > 80 years, n (%)	6 (9.4)	22 (11.0)	0.58
Male sex, n (%)	35 (54.7)	83 (41.5)	0.089
Diabetes, n (%)	10 (15.6)	25 (12.5)	0.67
Prior MI, n (%)	4 (6.2)	3 (1.5)	0.11
COPD, n (%)	5 (7.8)	12 (6.0)	0.82
Hypertension, n (%)	18 (28.1)	46 (23.0)	0.51
Cancer, n (%)	6 (9.4)	13 (6.5)	0.62
Rheumatic disease, n (%)	NA	11 (5.5)	0.67

• COPD, chronic obstructive pulmonary disease; COVID-19, coronavirus disease 2019; MI, myocardial infarction; NA, not available (according to Statistics Denmark legislation, cells with number of patients below three cannot be reported).

Absolute risks

A total of 688 patients met the 30-day composite end point, 42 patients (15.9%) in the ibuprofen group, and 646 patients (17.3%) in the non-ibuprofen group (Table 3). Absolute risks for the composite end point for patients with vs. without an ibuprofen prescription claim standardized to the age, sex, and comorbidity distribution of all patients were 16.3% (95% CI 12.1–20.6) vs. 17.0% (95% CI 16.0–18.1), P = 0.74. Corresponding risks for an ibuprofen prescription claim > 14 days before COVID-19 diagnosis vs. ≤ 14 days before diagnosis of COVID-19 were 16.0% (95% CI 11.9–20.9) vs. 14.4% (95% CI 6.7–23.0), P = 0.70 (Table 4).

Table 3.
Absolute risks and average risk ratio of the 30-day composite outcome for patients with COVID-19 with vs. without recent ibuprofen prescription claims prior to COVID-19

• The 30-day composite outcome consisted of severe COVID-19 diagnosis, intensive care unit admission, or death. The average risk ratio was standardized to the age, sex, and comorbidity distribution of all patients.
• CI, confidence interval; COVID-19, coronavirus disease 2019; Ref, reference.

Table 4.
Absolute risks and average risk ratio of the 30-day composite end point for patients with ibuprofen prescription claims > 14 days vs. ≤ 14 days before COVID-19 diagnosis

• The composite outcome consisted of severe COVID-19 diagnosis, intensive care unit admission, or death.
• The average risk ratio was standardized to the age, sex, and comorbidity distribution of all patients.
• CI, confidence interval; COVID-19, coronavirus disease 2019; Ref, reference.

Average risk ratios

The average risk ratio for patients with vs. without a recent ibuprofen prescription claim prior to COVID-19 diagnosis standardized to the age, sex, and comorbidity distribution of all patients was 0.96 (95% CI 0.72–1.23). The corresponding average risk ratio for ibuprofen prescription claims ≤ 14 days before the COVID-19 diagnosis vs. > 14 days before COVID-19 diagnosis (reference) was 0.90 (95% CI 0.39–1.57).

Other analyses

The dosage of ibuprofen was not directly available from the Danish National Prescription Registry. In analyses applying the strength of the ibuprofen, 215 patients were prescribed 200–400 mg ibuprofen pills and 49 patients were prescribed 600–800 mg ibuprofen pills. The absolute risk of the 30-day composite outcome standardized to the age, sex, and comorbidity distribution of all patients was 15.2% (95% CI 10.7–20.1) for the 200–400 mg ibuprofen group vs. 17.2% (95% CI 6.5–27.3) for the 600–800 mg ibuprofen group. The average risk ratio standardized to the age, sex, and comorbidity distribution of all patients for the 600–800 mg ibuprofen group vs. 200–400 mg ibuprofen group (reference) was 1.13 (95% CI 0.42–1.98).

DISCUSSION

In this nationwide study on the association between ibuprofen prescription claims and severe COVID-19 infection, defined as a COVID-19 diagnosis with severe acute respiratory syndrome, ICU admission, or fatal trajectory, we found no significant association between recent ibuprofen prescription claims and the composite end point.

Respiratory, septic, and cardiovascular complications and prolonged recovery have been linked to NSAID use in COVID-19 infectious disease.^{9, 15} In addition to the changing recommendations regarding ibuprofen and other NSAID use in the context of COVID-19 from the WHO and several national health boards, several experts have advocated against the use of these drugs in patients infected with COVID-19 and suggested paracetamol or acetaminophen as alternative treatments.¹⁵ Currently, the WHO do not call for avoidance of ibuprofen to treat COVID-19 symptoms. The European Medicine Agency as well as the FDA also do not advocate against the use of ibuprofen, and the FDA calls for more evidence to support the drug safety of NSAIDs, including ibuprofen. Our results do not provide sufficient evidence to change the current recommendations. Reassuringly, the overall results were consistent with results in which ibuprofen prescription claims were divided into > 14 days before COVID-19 diagnosis vs. ≤ 14 days before COVID-19 diagnosis. Finally, although the dosage of ibuprofen was not directly available from the Danish National Prescription Registry, we used the strength of the ibuprofen package of 200–400 mg and 600–800 mg, respectively, to divide patients into low-medium vs. high dosage groups. In these analyses, we did not find any significant differences in severe COVID-19 outcome between the two dosage groups.

In our study, ibuprofen users were defined based on prescription fills and information on whether or how many ibuprofen pills the patients actually took is not available. However, the proxies for ibuprofen dosage mentioned above did not provide evidence to suggest a dose-response relationship between ibuprofen strength and severe COVID-19 outcome. In addition, patients on prescription ibuprofen are presumably more likely to actually use the medication on a more regular and even daily basis. As such, the lack of an association with outcome for patients who claimed a prescription for ibuprofen within 14 days of the COVID-19 diagnosis is likely to be valid. Because ibuprofen also can be purchased as an over-the-counter drug in Denmark, we cannot exclude potential misclassification of ibuprofen exposure, as patients in the non-ibuprofen group may have used over-the-counter ibuprofen. We did not have data on the medication used during hospitalization for COVID-19. As such, we do not have information on whether ibuprofen use was continued or discontinued, which may have had an impact on our results. Whether patients actually were using ibuprofen or they avoided it on the basis of physician advice and/or the public attention in March 2020 on the potential negative effect on COVID-19 infection severity remain unknown. In support of our study findings, a limited number of recent studies, including reviews, have also not found any evidence suggesting worsening of COVID-19 infection in relation to ibuprofen or NSAID use.^{10, 16-19} Follow-up data on outcome was limited to May 16, 2020, which may limit the registration of severe COVID-19 infection for patients diagnosed with COVID-19 at the end of the study period. However, the majority of patients hospitalized for COVID-19 were in the hospital in the beginning of April ensuring that the greater majority of the included patients had sufficient follow-up to allow the study of the 30-day outcome measure. Although we adjusted for several confounding factors, we cannot rule out residual or unmeasured confounding. Given the observational design, results, and associations, no conclusions concerning causality can be made. However, we applied average treatment effect analyses with standardization of the age, sex, and comorbidity distribution in an attempt to minimize confounding by indication issues and mimic a randomized controlled trial setting. For these reasons, patients of younger age and with heart failure, in whom ibuprofen was not used, were excluded per study design. In addition to a lack of laboratory data to confirm that each case had a positive swab test, our sample is based on hospital registries, including only cases evaluated for hospitalization needs and/or hospital-based staff. Although most COVID-19 infections in Denmark are located in the capital region and more densely populated areas, the use of nationwide data minimizes selection bias based on geographic differences.

CONCLUSIONS

In this nationwide study, we did not find recent ibuprofen drug prescription claims prior to COVID-19 diagnosis to be significantly associated with severe, including fatal trajectory of COVID-19 infection.

Funding

No funding was received for this work.

Conflict of Interest

The authors declared no competing interests for this work.

Author Contributions

K.K. wrote the manuscript. K.K., C.T.P., E.F., G.G., M.S., and L.K. designed the research. K.K., T.A.G., E.F., M.P.A., M.P., J.H.B., J.P., C.B., L.Ø., and C.T.P. performed the research. K.K., T.A.G., and C.T.P. analyzed the data.

(ibuprofen and famotidine) Tablets 800 mg/26.6 mg

What is DUEXIS

^® (ibuprofen and famotidine)?

DUEXIS contains two medicines: ibuprofen, a nonsteroidal anti‐inflammatory drug (NSAID), and famotidine, a histamine H₂–receptor blocker medicine.

DUEXIS is a prescription medicine used to:

• relieve the signs and symptoms of rheumatoid arthritis and osteoarthritis.
• decrease the risk of developing ulcers of the stomach and upper intestines (upper gastrointestinal ulcers) in people taking ibuprofen for rheumatoid arthritis and osteoarthritis.

It is not known if DUEXIS is safe and effective in children.

IMPORTANT SAFETY INFORMATION

What is the most important information I should know about DUEXIS?

• DUEXIS can cause an increased risk of a heart attack or stroke that can lead to death. This risk may occur early in treatment and may increase with longer use and with increasing doses of medicine containing NSAIDs.
• DUEXIS can cause an increased risk of bleeding, ulcers, and tears (perforation) of the esophagus, stomach and intestines. These events can occur at any time during use, without warning symptoms and may cause death. Elderly patients and patients with a history of ulcer disease or stomach or intestine bleeding are at greater risk for getting an ulcer or bleeding.
• You should take DUEXIS exactly as prescribed, at the lowest dose possible and for the shortest time needed.

DUEXIS can cause serious side effects. Stop taking DUEXIS and call your doctor or go to your emergency department right away if you get:

• Difficulty breathing, swelling of the face or throat. These could be signs of a serious allergic reaction.
• Chest pain, shortness of breath, weakness in one part or side of your body, or slurring of speech. These could be signs of a serious blood clotting event.
• Upper stomach pain, upset stomach, black, tarry stools, or vomiting of blood. These could be signs of an esophagus, stomach, or intestinal ulcer, bleed, or tear. Note: if you are also taking low‐dose aspirin, you are at increased risk for esophagus, stomach, or intestinal bleeding.
• Nausea, more tired or weaker than usual, itching, yellowing of the skin or eyes, right upper abdomen tenderness, and “flu‐like” symptoms. These could be signs of a liver problem.
• Shortness of breath, unexplained weight gain, or swelling of the arms, legs, hands or feet. These could be signs of a serious heart problem.
• Any type of rash. This could be a sign of a serious skin reaction.

These are not all of the possible side effects of DUEXIS. Please talk to your doctor if you experience any symptoms that bother you or that do not go away. If you take too much DUEXIS, call your poison control center at 1-800-222-1222.

Who should not use DUEXIS?

Do not take DUEXIS:

• if you are allergic to ibuprofen, famotidine, any other histamine H₂–receptor blocker, or any of the ingredients in DUEXIS. See the Medication Guide for a complete list of ingredients.
• if you have had an asthma attack, hives, or other allergic reaction with aspirin or any other NSAIDs.
• right before or after heart bypass surgery called coronary artery bypass graft.
• if you are in the 30th week of pregnancy until delivery

How should I take DUEXIS?

Take DUEXIS exactly as your health care provider tells you to take it. Do not change your dose or stop DUEXIS without first talking to your health care provider. Swallow DUEXIS tablets whole with liquid. Do not split, chew, crush, or dissolve the DUEXIS tablet. If you forget to take a dose of DUEXIS, take it as soon as you remember. If it is almost time for your next dose, do not take the missed dose. Take the next dose on time. Do not take 2 doses at one time to make up for a missed dose. You should not take an ibuprofen tablet and famotidine tablet together instead of taking a DUEXIS tablet, because they will not work in the same way.

What are the possible side effects of DUEXIS?

The most common side effects of DUEXIS include nausea, diarrhea, constipation, upper abdominal pain, and headache.

What other medications might interact with DUEXIS?

Do not use DUEXIS while taking other NSAIDs unless your health care provider says it is OK. NSAIDs may be present in over‐the‐counter medications for treatment of colds, fever, or insomnia; refer to the label of over‐the‐counter medications you are taking or ask your pharmacist. Do not use DUEXIS and low‐dose aspirin until you talk to your health care provider. Tell your health care provider about all of the medicines you take as some medicines can react with NSAIDs and cause serious side effects.

What should I tell my health care provider?

Before starting DUEXIS, tell your health care provider if you have a history of ulcer disease or esophagus, stomach, or intestine bleeding, liver or kidney problems, high blood pressure, heart problems, bleeding problems, asthma, or are pregnant, trying to become pregnant, or breast feeding. Taking DUEXIS at about 20 weeks of pregnancy or later may harm your unborn baby. If you need to take DUEXIS for more than 2 days when you are between 20 and 30 weeks of pregnancy, your healthcare provider may need to monitor the amount of fluid in your womb around your baby. You should not take DUEXIS after about 30 weeks of pregnancy. Also tell your health care provider about all of the medicines you take, including prescription or over-the-counter medicines, vitamins, or herbal supplements. Do not start taking new medicines without talking to your health care provider first.

Please see the Medication Guide and Prescribing Information, or visit Duexis.com for additional information.

How Much Ibuprofen Can I Take Safely?

Most people occasionally take ibuprofen at home for minor aches and pains such as headaches, toothaches, and fever. Ibuprofen is a non-steroidal anti-inflammatory drug (NSAID) that reduces pain and relieves inflammation. Familiar brand names for this medication include Motrin^® and Advil^®. Lower strengths of ibuprofen are available over the counter, and higher strengths can be obtained with a prescription.

Ibuprofen is available in various dosage strengths and formulations, including tablets, chewable tablets, caplets, liquid gels, and suspensions or oral drops. It is sometimes included in cold and allergy medicines for fever and pain relief.

When taken at the correct dose, ibuprofen is safe and effective for both children and adults. However, it is important to be aware of the maximum dosage of ibuprofen. At large doses, ibuprofen can cause serious adverse effects and may even be fatal. Notably, studies have shown that among all analgesic (pain-reliever) overdoses, nearly one-third included ibuprofen, making ibuprofen the most common NSAID involved in an overdose. 

Continue reading to learn more about the harmful effects caused by taking ibuprofen in excess amounts and find out why it is important to follow dosage instructions as directed on the label. This information will provide useful guidance when using ibuprofen to treat pain and fever in children and adults.

What is ibuprofen used to treat?

Ibuprofen is commonly used to treat mild to moderate aches and pains such as headache, toothache, period pain, and sports injuries like sprains and strains. Due to its anti-inflammatory properties, ibuprofen is also used to control pain and inflammation in the joints, bones, and muscles, for example, in conditions like osteoarthritis and rheumatoid arthritis. Ibuprofen may also be used to reduce fever during a flu-like illness or common cold. 

Why is it important to know the appropriate ibuprofen dosing?
You should know how much ibuprofen is safe because taking too much ibuprofen can be very harmful. Although higher strengths of ibuprofen require a prescription,  over-the-counter ibuprofen can be purchased and self-administered by patients at a higher than recommended maximum daily dose. 

Ibuprofen should be used with extreme caution in children and pregnant women as their metabolism rate of ibuprofen may be different than a healthy adult. Therefore, consulting a gynecologist and pediatrician is highly recommended for this patient population. Last but not least, since ibuprofen is a household name, it is very crucial to know when to avoid ibuprofen usage with certain medications. For example, ibuprofen should not be taken with other NSAIDs such as Aleve (naproxen), high doses of aspirin, or prescription NSAIDs such as ketorolac and celecoxib. Ibuprofen should also be avoided in patients who have a heart condition such as atrial fibrillation who are on blood-thinning agents such as warfarin, rivaroxaban, or apixaban, as ibuprofen or NSAIDs in general increase the risk of bleeding. Please consult your pharmacist or doctor before taking ibuprofen if you are already taking other medications to avoid drug interaction.  

What doses is ibuprofen available in?

As noted above, over-the-counter and prescription ibuprofen is available in various dosage forms like tablets and suspensions. The most commonly available formulations and dosage strengths of ibuprofen include tablets (100 mg, 200 mg, 400 mg, 600 mg, and 800 mg), capsules (200 mg), chewable tablets (100 mg), oral suspension, or liquid (100 mg per 5 mL), and concentrated oral suspension for infants (50 mg per 1.25 mL). Notably, the 400 mg, 600 mg, and 800 mg tablets of ibuprofen are available by prescription only. 

What is a safe dose of ibuprofen?

The recommended dose of ibuprofen is 200-400 mg by mouth every 4-6 hours as needed for pain or fever. The recommended maximum daily dose is 1200 mg for over-the-counter ibuprofen and 3200 mg for prescription-strength ibuprofen.

In children, safe dosage of ibuprofen depends on the child’s weight as well as the condition that is being treated. A doctor or pharmacist can help you determine the correct dosing for your child. It is not recommended to give ibuprofen to children under six months of age.

Can I take 3 tablets of ibuprofen at once?

It depends on the strength of the ibuprofen. If you are using 100 mg OTC ibuprofen tablets, it is safe to take 3 tablets at once to make up the total dose of 300 mg since the recommended dose is 200 to 400 mg orally every 4-6 hours as long as the maximum recommended daily dose of 1200 mg is not exceeded. However, if you are using prescription-strength ibuprofen such as the 800 mg tablet, then taking 3 of these tablets at once is not recommended because taking more than 800 mg of ibuprofen in a single dose can potentially cause both short-term and long-term side effects, even though the three of the 800 mg ibuprofen tablet make up a total dose of 2400 mg and it does not exceed the recommended total daily dose of 3200 mg. 

Can I take 3 tablets of ibuprofen 200 mg at once?

For over-the-counter ibuprofen, 200 mg to 400 mg is the dose that should be taken at one time. Therefore, it is not recommended to take 3 of the 200 mg ibuprofen tablets since that makes up a total of 600 mg which exceeds the maximum 400 mg per dose. 

Taking too much ibuprofen can result in side effects such as nausea, vomiting, stomach ache, gassiness, indigestion, dizziness, and headache.

How often can I take ibuprofen 800 mg?

Ibuprofen 800 mg is a prescription-strength dosage. The total recommended dose is 3200 mg per day. Therefore, you can take ibuprofen 800 mg 4 times a day or every 6 hours. As mentioned above, even though the maximum daily dose of prescription ibuprofen is 3200 mg, it is potentially harmful to exceed 800 mg per dose. 

Can I take ibuprofen with other painkillers?

It is safe to take ibuprofen with paracetamol/acetaminophen (Tylenol^®) . However, taking ibuprofen with other NSAIDS like naproxen, ketorolac, or aspirin is not recommended unless it is indicated for certain medical conditions and your healthcare providers are aware of such combination. Taking ibuprofen with other NSAIDs can increase your risk of side effects such as stomach ulcers, increased risk of bleeding, acute kidney injury that can lead to chronic kidney disease.

What are the harmful effects of excess ibuprofen intake?

The maximum amount of ibuprofen in adults is 800 milligrams per dose or 3200 milligrams per day. You should keep these numbers in mind because a large ibuprofen overdose can lead to potentially life-threatening complications. Overdose symptoms can be mild to severe. Mild overdose symptoms include nausea, vomiting, diarrhea, and dizziness. Severe overdose symptoms are convulsions, hypotension (low blood pressure), little to no urine production, and even coma. Notably, a large ibuprofen overdose is extremely rare unless it is an intentional overdose in an adult or an accidental overdose in a child. 

Besides the risk of an overdose, taking ibuprofen over the recommended dose can lead to serious side effects. Side effects of ibuprofen include increased risk of cardiovascular adverse events such as heart failure, heart disease, and stroke, kidney injury that leads to kidney failure, and gastrointestinal complications such as ulceration, bleeding, stomach or intestinal perforation.

What if I forget to take an ibuprofen dose?

If you are using ibuprofen regularly long-term and have missed a dose, take it as soon as you remember. However, if it is nearly time for your next dose, do not double up to make up for the forgotten dose. Skip the missed dose and take the next dose as usual. 

What to do if I take too much ibuprofen?

If you have taken too much ibuprofen due to a mistake or misinformation, obtain medical advice from a healthcare professional as soon as possible. Stop taking the medicine and be vigilant for side effects like fatigue, sleepiness, stomach pain, nausea, vomiting, blood in the vomit, black stools, and tinnitus (ringing in the ears). If you experience any of these symptoms, please seek medical attention at the nearest emergency room without delay. Please call 911 or have someone drive you to the emergency department if the symptoms are severe and affecting your capability to operate a motor vehicle safely. 

The bottom line

In general, NSAIDs such as ibuprofen are well-tolerated and safe to use with a low risk of adverse events provided you take the medication as directed on the label or by your healthcare professional. Overall, ibuprofen can be safely used to treat pain, fever, and inflammation in both children and adults, as long as it is used as directed.

References:

1. https://www.ncbi.nlm.nih.gov/books/NBK526078/
2. https://www.nhs.uk/medicines/ibuprofen-for-adults/

Ibuprofen 800mg 100 Tablets

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In order to place an order for some of the items on CaliforniaPetPharmacy.com, you will be required to complete our online order form, which requires certain information and data. By placing an order, you agree that all information provided in the order form is true and accurate and that you will take the initiative to maintain and update this information as required in order to keep it current, complete, and accurate.

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Terms of Sale (“Agreement”) apply to your purchase of products, medications, and supplies sold to you by California Pet Pharmacy. You agree to these terms by placing your order. If you have already placed your order and no longer want to be bound to this Agreement then you must promptly cancel your order by calling 877.554.4797. Please act promptly and note that canceling an order may carry a cancellation fee, restocking fee, or other fees. If you have placed an order for a prescription drug without providing lawful veterinary medical information you will assessed a $10 order cancellation fee.

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When placing a prescription item order with California Pet Pharmacy you acknowledge the FDA and California Board of Pharmacy guideline for pharmacies on pharmaceutical returns. You waive your right to return a prescription item, seek reimbursement for a no longer needed prescription item, and waive your right to file a dispute with your credit card provider for reimbursement. If you have already placed your order and no longer want to be bound to this agreement then you must promptly cancel your order by calling 877.554.4797. Please act promptly and note that canceling an order may carry a cancellation fee, restocking fee, or other fees. Once a prescription order has shipped it is the property of the client and cannot be returned. If you are looking for a specific expiration date for a product, we advise you to call us before placing your order. In the event the item you ordered is a prescription you will not be able to return your order if the expiration date is not to your satisfaction.

An order for a prescription item must be canceled before shipping. We do not accept returns of prescription items. Please reference the following link to learn more. https://www.fda.gov/ICECI/ComplianceManuals/CompliancePolicyGuidanceManual/ucm074399.htm

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Orders are shipped without signature confirmation unless otherwise noted. By placing an order with California Pet Pharmacy you acknowledge this. The customer may add signature confirmation to the shipment at an additional fee. If signature confirmation is needed, please contact 877.554.4797 prior to your order shipping. If your order is above $300, it will automatically ship with a signature required for delivery.

All orders containing a controlled substance must be shipped with signature confirmation, and an adult must be present to sign for the package. There will be no exceptions made. The cost for the signature delivery is incorporated into the price of the product.

Inclement Weather

If you live in a region that exhibits extreme hot or cold temperatures we recommend you choose the express overnight shipping method. California Pet Pharmacy is not responsible if the content(s) of your package undergo inclement weather as this is out of our control. It is the client’s responsibility to consider current weather conditions when ordering medications. If arrangements need to be made on a particular shipping service or shipping method, it is the client’s responsibility to contact our customer service line at 877.554.4797 to discuss how we can help make arrangements. Additional charges may be applied at that time.

Please Note: Most prescription products require storage at room temperature unless otherwise stated.

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Over the counter orders are typically processed within 24-72 hours, given stock is available. Prescription orders require confirmation by your prescribing veterinarian. We generally contact vets within 24 business hours of the order being placed. We request that vets respond to the request within 24 hours, but sometimes the process can take longer, depending on the veterinarian. Once prescription authorization is received, the order will be processed and shipped within 24-72 business hours.

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Although California Pet Pharmacy reserves the right to correct any errors, omissions, or inaccuracies, we do not accept any responsibility for the accuracy, reliability or completeness of any information, content, materials, services, products, merchandise, functionality or other resources on the website, even typographical or imaging errors, including the substance, accuracy, of any product information listed on the website. Further, we do not represent that the website will operate without interruption or error, nor do we provide any assurances of the availability or usability of the online shopping services.

California Pet Pharmacy does not accept any liability for the consequences arising from the application, use, or misuse of any products contained on or made available through the website, including any injury and/or damage to any pet, person or property as a matter of product liability, negligence, or otherwise.

California Pet Pharmacy further disclaims any responsibility for the accuracy, reliability, currency, availability, or completeness of any information or advertising found on any third-party sites that link to or from the California Pet Pharmacy website. California Pet Pharmacy also does not accept any responsibility for product failures, interactions, side effects, and allergies. All cases for the aforementioned must be handled by the manufacture of the product and we encourage reporting to the FDA website.
https://www.accessdata.fda.gov/scripts/medwatch/index.cfm?action=reporting.home

Ibuprofen (Oral Route) Description and Brand Names

Description and Brand Names

Drug information provided by: IBM Micromedex

US Brand Name

1. Addaprin
2. Advil
3. A-G Profen
4. Bufen
5. Genpril
6. Haltran
7. Ibu
8. Ibu-2
9. Ibu-200
10. Ibu-4
11. Ibu-6
12. Ibu-8
13. Ibuprohm
14. Ibu-Tab
15. I-Prin
16. Midol
17. Motrin
18. Nuprin
19. Proprinal
20. Q-Profen

Canadian Brand Name

1. Actiprofen
2. Advil Childrens
3. Advil Pediatric
4. Childrens Motrin
5. Childrens Motrin Berry Flavor
6. Childrens Motrin Bubble Gum Flavor
7. Childrens Motrin Grape Flavor
8. Equate Childrens Ibuprofen – Berry
9. Equate Childrens Ibuprofen – Berry – Dye Free

Descriptions

Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) used to treat mild to moderate pain, and helps to relieve symptoms of arthritis (osteoarthritis, rheumatoid arthritis, or juvenile arthritis), such as inflammation, swelling, stiffness, and joint pain. This medicine does not cure arthritis and will help you only as long as you continue to take it .

In addition, ibuprofen can be used to treat fever, menstrual cramps, and other conditions as determined by your doctor .

This medicine is available both over-the-counter (OTC) and with your doctor’s prescription .

This product is available in the following dosage forms:

• Tablet, Chewable
• Tablet
• Suspension
• Capsule, Liquid Filled

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.

Americans are abusing over-the-counter drugs as well as opioids, study shows

Americans aren’t just abusing prescription opioid painkillers — they’re taking too much of the over-the-counter stuff as well.

Nearly one in five users of popular headache remedies like Advil or Aleve admitted exceeding the recommended daily maximum dose during a one-week period, according to a new study led by a Boston University School of Health researcher.

And while people who pop too many non-steroidal anti-inflammatory drugs (NSAIDs) like these aren’t likely to move on to heroin the way patients who get hooked on opioids have, they raise their risk for serious health problems.

“These drugs can have serious side effects, including gastrointestinal bleeding and heart attacks, and are often taken without medical oversight,” lead researcher Dr. David Kaufman, a professor of epidemiology at BU’s School of Public Health, told NBC News in an email.

Advil.Scott Olson / Getty Images file

“The attitude that users can choose their own dose regardless of label directions, along with poor knowledge of dosing limits, is associated with exceeding the daily limit,” he said.

Kaufman reached his conclusion by having 1,326 adults keep drug diaries for a week between 2015 and 2016. The average age of the participants was 45, three quarters of them were white, and some 60 percent were women, according to the study.

Some 87 percent took an ibuprofen like Advil or Motrin. But 37 percent also took other NSAIDs like aspirin or naproxens like Aleve.

The result? Over 15 percent of the participants took too many pills on one or more of the days during the week. And participants who were in the worst shape — particularly those who suffer from chronic pain — were more likely to exceed the dosage limit.

Asked if the non-prescription pill abusers could be trying to avoid getting hooked on highly addictive opioids, which have been ravaging the nation, Kaufman said he didn’t think so.

“My guess is that while avoidance of opioids may influence prescribing decisions by doctors, it may not affect consumer behavior very much,” he told the Chicago Tribune.

Dr. David Katz, who heads the Yale University Prevent Research Clinic and wasn’t involved in Kaufman’s study, agreed that Advil or Aleve abusers aren’t going to graduate to fentanyl. But there is a link.

“My point is that there is a lot of chronic pain in our culture, much of it poorly managed,” he wrote in an email to NBC News. “Opioids are one response to that, but not the only one.”

In an earlier interview, Katz called the opioid crisis “a window to a less-publicized crisis of chronic, inadequately managed pain.”

“When narcotics are not being used to manage such pain, NSAIDs often are,” Katz said. “That a substantial subset of those relying on NSAIDs are using them ill-advisedly or excessively is rather to be expected under these circumstances.”

Earlier this week, Florida nurse Katherine Locker lectured patients about over-the-counter remedies and the flu in a video that went viral — and which appears to lay out the correct dosages for patients.

“Treat your fever with Tylenol or Motrin,” she said. “If you are an adult, you can take more than 200 milligrams of Motrin. You can actually take four to six hundred. And if you’re a big dude in pain, you can take maybe 800, just depends on your weight.”

Locker went on to say that four to six hundred milligrams of ibuprofen is a “perfectly appropriate dose” for a “regular size adult” and a “big person” can take anywhere from 650 to 1,000 milligrams of Tylenol.

Tylenol recommends a maximum daily dosage of 3,000 milligrams per day (one regular strength pill is 325 mg, extra strength is 500 mg). The recommended maximum dosage for Motrin is 800 milligrams per dose (four 200 mg tablets) or 3,200 milligrams per day.

Some doctors, however, believe ibuprofens like Advil or Motrin, in particular, should require prescriptions because patients don’t read instructions — and take them for the wrong reasons.

“In my opinion NSAIDs should not be available as an over-the-counter drug, because of all their deleterious effects,” Dr. Liffert Vogt of the Academic Medical Center at the University of Amsterdam in the Netherlands, wrote in an email to Reuters.

Acetaminophen’s like Tylenol are “a much safer option and very efficacious as a pain killer,” Vogt wrote. “But we know that many people use NSAIDs for indications other than pain, such as flu, allergies, fever — and there is no medical base that indicates that NSAIDs or acetaminophen are of any use under these circumstances.”

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90,000 Toothache pills list of quick and effective

Almost everyone had to deal with a toothache, one way or another. This symptom is a signal that there are inflammatory processes in the oral cavity that require the intervention of a professional dentist. However, when a toothache occurs, it is not always possible to immediately consult a specialist.Therefore, the first-aid kit should always contain funds that will help relieve pain before visiting the dentist’s office. After all, such can appear very suddenly, and getting rid of them without analgesics is not easy.

Fast and effective remedies

Pharmaceuticals have developed very extensively in recent years. There is a huge selection of medicines in pharmacies. It is not easy to decide which of them will really have the desired effect and will do it in the shortest possible time.When a toothache occurs, there is no time to hesitate, because it worsens the state of health so much that those suffering from unpleasant sensations are pursued by one desire: to get rid of it as soon as possible.

In order not to be lost in guessing which pain reliever is better to give preference in case of toothache, study the list below of drugs available in pharmacies that have proven their effectiveness and fast action.

So, with severe pain, it is worth giving preference to one of such drugs as:

• Nise;
• Ketarol;
• Ibuprofen.

To cope with moderate to mild discomfort, drugs such as:

• Ketans;
• I took it.

You can also use anti-inflammatory drugs that will not only relieve pain, but also help fight the source of it. These drugs include:

• Ketonal;
• Actasulide;
• Nurofen;
• Instant.

Let’s consider the features and characteristic properties of each drug in more detail.

1. Nise. This drug is classified as potent. Produced in India, it is supplied to the shelves of Russian pharmacies almost without interruption. Nise, just a couple of minutes after its application, relieves even acute and severe toothache. The effect lasts from 6 to 8 hours. If pain occurs, it is recommended to take one tablet.It is enough to relieve pain. In large quantities, this type of medicine can cause a skin rash, nausea, pain in the stomach. Nise is not recommended for pregnant women.

2. Ketarol. Also belongs to the category of potent drugs. It can only be taken in limited quantities – up to three tablets a day. The drug has an analgesic effect very quickly, but subject to the simultaneous intake of a large amount of liquid.Therefore, Ketarol is washed down with a whole glass of water. Pregnant women should not take this drug in order to avoid the negative effect of potent substances on the fetus.

3. Ibuprofen. Another remedy from the category of potent. This drug can be used during pregnancy as it is less toxic than the previous drugs on the list. It is recommended to take one ibuprofen tablet if toothache occurs. If the desired effect has not come, then after four hours you can drink another one.

4. Ketans. This drug is recognized as one of the best in the fight against toothache. The analgesic effect is caused by ketorolac, which is part of the drug. However, taking this remedy also needs to be done with caution. Pregnant women, children under 16 years old, as well as those who suffer from bronchial asthma, should refrain from using this drug. Among the side effects of Ketanov are nausea, drowsiness, dry mouth, dizziness.

5. Took.This drug does not work well with other drugs, but it does a good job of moderate to mild pain. Its reception is allowed in an amount of up to 6 tablets per day. As a side effect, allergies, chills, heart palpitations, a decrease in blood pressure and heart rate may occur.

6. Ketonal. Belongs to the category of anti-inflammatory drugs. Works quickly to reduce fever and pain. Children under 15 years old should not take it. A number of side effects are also noted with its use: nausea, loose stools, vomiting, fatigue and nervousness.

7. Actasulide. An effective anti-inflammatory agent that requires caution when taken. Actasulide is not recommended for children under 12 years old, pregnant and lactating women, as well as those who suffer from renal, hepatic and heart failure, stomach or intestinal ulcers, diabetes mellitus.

8. Nurofen. A very effective and popular remedy. Nurofen relieves pain symptoms, as well as inflammation of the soft tissues of the gums. This effect is achieved due to the content of codeine in tablets.Not recommended for hypertension, Crohn’s disease and liver and kidney defects.

9. Instant. A popular drug with anti-inflammatory and analgesic effects. Instantly relieves pain, fever. It can be taken ½ tablet three times a day. You can use the Mig in this mode for no more than 7 days. This medicine is contraindicated in pregnant women and people with diseases of the optic nerve, blood.

In addition to the drugs listed above, drugs with the so-called freezing effect can also be purchased in pharmacies.They relieve pain quickly and effectively. These include drugs such as Kamistad, Dentol, Metrogyl.

If a pregnant woman has a toothache, then it is best to use traditional medicine to relieve it. In the event that they did not have the proper effect, it is possible to take Ibuprofen, as well as drugs such as No-shpa, Spazmalgon, Baralgin, Analgin.

OTC drugs

All of the medicines listed above are available in pharmacies in the public domain.You can buy them without a doctor’s prescription. It should be understood that analgesics and anti-inflammatory drugs have a very strong effect on the body. They are usually very toxic, which means that in order to avoid unpleasant consequences, you must strictly follow the rules of the instructions for use.

Before taking such drugs, you must carefully read the attached annotation, study the list of contraindications and side effects.If, due to the state of health, the drug is not recommended for you by the manufacturer, then it is better to follow the advice in order to avoid a serious deterioration in well-being and any complications.

When to take pain pills

Drugs dispensed in pharmacies that have analgesic and anti-inflammatory effects can relieve the symptom, but not eliminate the cause of the toothache that has arisen. It should be borne in mind that this kind of sensation is a clear and reliable signal that a disease is developing in the oral cavity, which requires the urgent help of a specialist.

The cause of pain in the teeth can be one – inflammation of the dental nerve. But among the problems that led to this, there is a whole list of dental diseases. These include the following.

1. Caries.
2. Pulpitis.
3. Periodontitis.
4. Root cyst.
5. Granuloma and others.

The neglect of such pathologies can lead to further damage to the soft and hard tissues of the oral cavity.As a result – the development of serious complications, up to the complete loss of even healthy teeth.

That is why, in the event of an acute, throbbing or aching toothache of varying severity, you should immediately contact your dentist. Moreover, if such attacks are not one-time. Pills against toothache can only be used to eliminate discomfort if they caught you by surprise at night, far from the city and in other circumstances, when there is no possibility of visiting a dental office.

Ibuprofen CAPS – analgesic and antipyretic agent

Adverse effects can be minimized by using a low effective dose for the short time needed to control symptoms.

The drug is prescribed with caution to elderly patients, since they are more likely to develop adverse adverse reactions to NSAIDs, mainly gastrointestinal bleeding and perforation, which can lead to a sharp deterioration in the condition.

Respiratory system:

Caution should be exercised when using the drug in patients with bronchial asthma and other obstructive pulmonary diseases due to the risk of bronchospasm.

Other NSAIDs:

The simultaneous use of ibuprofen CAPS and other NSAIDs, including selective cyclooxygenase-2 inhibitors, should be avoided.

Systemic lupus erythematosus and mixed connective tissue diseases increase the risk of aseptic meningitis.

Kidneys:

The drug is used with caution in renal failure, because renal function may deteriorate.

Liver:

The drug is used with caution in case of liver dysfunction.

Cardiovascular and cerebrovascular effects:

The drug is prescribed with caution to patients with heart failure, arterial hypertension, and blood clotting disorders.

Clinical trials and epidemiological data suggest that with the use of ibuprofen, especially in high doses (2400 mg per day) and with long-term treatment, there may be a slight increase in the risk of arterial thrombotic complications (for example, myocardial infarction or stroke). In general, epidemiological studies do not suggest that low doses of ibuprofen (eg, ≤1200 mg daily) are associated with an increased risk of myocardial infarction.

Impaired female fertility:

There is limited evidence that drugs that inhibit cyclooxygenase / prostaglandin synthesis can impair female fertility by affecting ovulation.This phenomenon is reversible when the drug is discontinued.

Gastrointestinal tract:

Patients with diseases of the gastrointestinal tract (ulcerative colitis, Crohn’s disease) should be prescribed with caution NSAIDs in connection with the possible exacerbation of these diseases.

Patients with a history of gastrointestinal toxicity, especially elderly patients, should be informed of any unusual abdominal symptom (especially gastrointestinal bleeding), especially if the symptom is observed at the initial stage of taking the drug.

If patients develop gastrointestinal bleeding while taking the drug, the drug should be stopped immediately.

Caution should be observed in patients receiving concomitant medications that may increase the risk of ulceration or bleeding, such as oral corticosteroids, anticoagulants such as warfarin, selective serotonin reuptake inhibitors, or antiplatelet agents such as aspirin.

Dermatological:

Serious skin reactions, some fatal, including exfoliative dermatitis, Stevens-Johnson syndrome, and toxic epidermal necrolysis, have been reported very rarely in association with the use of NSAIDs.Ibuprofen CAPS should be discontinued at the first appearance of a skin rash, mucosal lesions, or any other sign of hypersensitivity.

How to be treated at home and when to worry

The peak incidence of COVID-19 in Ukraine is approaching. The next few weeks will be critical for the autumn wave, says chief sanitary doctor Igor Kuzin. Coronavirus tsunami overwhelming
most Ukrainians meet unvaccinated. Many still have not acquired a family doctor, and the diagnosis of COVID-19, as at the dawn of the pandemic, still causes panic.Ill, do not need to immediately
run to CT, but endure the temperature at 40 ° C for a week, drink raspberry tea and paracetamol is also not worth it. How not to miss alarm calls?

COVID-19? Pay attention to red flags

The doctor’s job is to make the patient feel safe and secure, but anxious doctors are dangerous to the patient. Panic can be reduced if the family doctor explains to the patient what to do in certain
situations.

“It’s important for a person to have a plan.If the patient has an algorithm, he is less nervous, and the doctor also reduces the burden on himself, “says the family doctor, board member of the PA Academy of Family Medicine
Ukraine “ Igor Zastavny .

Experience shows that few family doctors follow this rule. But there are those who, in addition to periodic follow-up examinations, monitor the condition of covid patients using standard
daily questionnaires, even more advanced – they create chat bots for this.

So, what can the patient himself or his loved ones do? Arm yourself with a device for measuring saturation – a pulse oximeter (how to use it correctly, read below), learn how to measure
respiratory rate and familiarize yourself with the so-called red flags (markers indicating a possible aggravation of the disease).

Saturation (an indicator of blood oxygen saturation) is all right if the pulse oximeter shows 95% or more. However, you need to use the device correctly. Keep your hands warm and clean.
If there is varnish on the nails, it is better to remove it. You need to measure the saturation at rest. If before that you walked around the room, against the background of a coronavirus infection, the indicator may be lower than usual. That’s why
sit down, catch your breath and measure after 10-15 minutes.

According to doctors, a very common mistake is to use a pulse oximeter while lying on your back.The fact is that the posterior parts of the lungs are most often affected, so in this position the readings decrease.
It is not forbidden to measure saturation while lying down, but only on the stomach or side.

Pulse oximeters are of different quality and can “lie”. It’s good if it is a licensed device. Also, patients often confuse the readings of saturation and pulse (saturation is indicated by SpO2). Yet
one important caveat: the oxygen saturation indicators need to be read in the first 5-10 seconds after putting the pulse oximeter on your finger.If you hold the device longer, the “clothespin” can transmit the capillaries, which
will affect the performance. Remember: as soon as the batteries start to run out, the readings can also be erroneous.

How to measure breathing rate? You need to sit for 10 minutes, then put your hand on your chest or stomach and count the number of breaths per minute (the norm is up to 20).

How is the mild course of the disease characterized? Many are afraid of fever. An elevated body temperature (above 37.2 ° C) with coronavirus infection is normal if it
controlled, that is, knocked down by paracetamol or ibuprofen.You may experience a runny nose, nasal congestion, headache, and sore throat. Patients complain of myalgia (muscle pain). Cough
(no signs of respiratory distress such as shortness of breath, increased respiratory rate, hemoptysis). Gastrointestinal manifestations (nausea, vomiting, diarrhea) without
signs of dehydration. With COVID-19, smell and taste are often distorted, or even completely lost. With a mild course, there are no changes in the mental state (impaired consciousness, lethargy).

The list of symptoms is not exhaustive, because the coronavirus mutates, changing the symptoms. Are you sick with a coronavirus infection or ARVI, testing will help to answer. Referral to free
the test must be issued by your family doctor. If you did not get one or for some reason he did not provide directions for testing, call the hotline 0 800 60 20 19,
advise in the Ministry of Health.

Important: the symptomatology of a mild course of the disease does not mean that the patient’s condition will not worsen.Therefore, in addition to measuring saturation, respiratory rate, watch for red flags.

Red flags (danger signs)

• Temperature above 39 ° C, which is not knocked down by either paracetamol or ibuprofen.
• Dry cough all day incessantly. (“It’s not a cough when a person coughs for three minutes and then doesn’t cough for an hour,” notes family doctor Igor Zastavny).
• Dizziness when sitting or lying down. (When you change your position, you may feel dizzy.This is fine. It is about dizziness even when lying down).
• Confusion (How to understand this? Supposedly you were awakened from a deep sleep and you do not fully know where you are).
• Watery diarrhea (now more common).
• Inability to get out of bed (if a person cannot even walk to the toilet due to weakness).
• Shortness of breath (respiratory rate over 25).

If there are red flags or a drop in oxygen saturation (below 92, also remember the correct measurement), you must inform your family doctor or call the clinic’s reception.The night follows
call an ambulance.

Complications from the respiratory system with COVID-19 usually develop in the second week of the disease, so patients should be actively monitored during this period.

Rules for treating covid at home

The only thing that fights the virus is our own immunity. Until he becomes too aggressive (if
critical current). In order for the immune system to work well, you need a lot of rest, sleep and drink water.The family doctor should monitor the patient’s condition. This step uses
symptomatic treatment (eg, paracetamol, ibuprofen).

“We usually advise patients to spend 60-70% of the day in bed and lie on their stomach for 30-50% of this time. This reduces the risk of serious pneumonia. Avoid overloading. People who are on their feet
they endure covid, they risk getting to the hospital more, ”advises Igor Zastavny.

According to the family doctor, antibiotics, hormones, anti-thrombotic drugs should be avoided when not indicated.Antibiotics and hormones reduce immunity, and as a result, the infection accelerates faster.
Often, doctors literally from the first days of illness prescribe antibiotics from the category of “heavy artillery”. When such patients, God forbid, end up in intensive care, doctors have no money left
to fight bacterial infection. You should be careful with antithrombotic agents, there are many people with concomitant diseases and a high risk of bleeding.

What tests can the doctor prescribe?

CBC (complete blood count) is usually prescribed for risk factors or red flags.Or to reduce the patient’s anxiety.

CRP (C-reactive protein). “When you do it, it’s an indicator to tell you about those who have received bacterial infection,” – respect Igor Zastavny. – In the Netherlands, there was a pre-release, de SRB
until 30 do not tell about the acceptance. In the last few years – 60. We have taken the bar from 30. Yaksho SRB is more than 30, so you can see the antibiotics sign. ”

D-dimer (prescribed for risk factors, for example, oral contraception, thrombosis, age, diabetes mellitus, atrial fibrillation, etc.)

CT is not routinely prescribed. “It doesn’t change anything in the treatment. There is a very limited range of indications when a doctor directs for a CT scan, the family doctor says. – I urge doctors to refuse this,
after all, there will be big problems later, in particular with the growth of oncological diseases. ”But pulse oximetry is performed routinely – this is important. Many of the patients today have pulse oximeters, but it is necessary
teach them how to use them correctly.

Respiratory failure. Or maybe a panic attack?

The coronavirus also affects our mental health.This is especially true for those who have already had experience of anxiety disorders, panic attacks. During covid, things escalate. Panic attack
can be confused with respiratory failure – the heartbeat also accelerates, it is difficult for a person to inhale. Breathing exercises can help with a panic attack. The simplest: put your hand on
belly, imagine that there is a ball. Your task is to inflate it with your nose, and blow it out with your mouth. That is, breathe in with your nose, inflate your stomach (try to breathe with your stomach), then completely deflate with your mouth.Doctors advise doing this exercise three to four times a day. First of all, it promotes adequate ventilation of the lungs, and secondly, to relieve anxiety.

Relaxation techniques also help keep you afloat. For example, exercise in a safe place. Close your eyes and imagine a place where you are comfortable, then fill it with details. As if you
paint a picture, for example, there is a bird, there is a sun, a tree, etc. When a person is in a panic mood, they can close their eyes and go to their pre-filled safe place.
details.

Hospitalization – When You May Need

Coronavirus disease COVID-19 can proceed in different ways: mild, moderate and severe. Now patients of moderate severity and seriously ill patients are hospitalized for inpatient treatment.

You may need hospitalization for the following symptoms:

• chest pain;
• severity of breathing, shortness of breath at rest, signs of respiratory failure;
• Saturation with blood oxygen levels less than 92%;
• impaired consciousness;
• Other life-threatening signs that indicate a critical condition of the patient.

It is important that the patient is consulted by the family doctor. It is he who can provide recommendations and determine whether the patient has enough outpatient treatment.

And yes, there is still time to be vaccinated against the hateful coronavirus, reducing the risks of getting into intensive care and death at times.

Vitamin E – description, benefits and where it is contained

Contents of article

International name – tocol, tocopherol, tocotrienol, alpha-tocopherol, beta-tocopherol,
gamma-tocopherol, delta-tocopherol, alpha-tocotrienol, beta-tocotrienol, gamma-tocotrienol, delta-tocotrienol.

Chemical formula

C ₂₉ H ₅₀ O ₂

Brief characteristic

Vitamin E – a powerful antioxidant,
which prevents the proliferation of reactive oxygen species and promotes
improving overall health. In addition, it suspends
the functioning of free radicals, and as a regulator of enzymatic
activity plays a role in proper muscle development.Affects expression
genes, supports the health of the eyes and nervous system. One of the main
functions of vitamin E – maintenance
heart health by keeping cholesterol levels balanced. Improves
blood circulation to the scalp, accelerates the healing process, and
protects the skin from drying out. Vitamin E protects our body from
exposure to harmful external factors and preserves our youth.

Discovery history

Vitamin E was first discovered in 1922 by scientists Evans and Bishop,
as an unknown component in plant
oils necessary for reproduction in female rats. This observation
was immediately published, and initially the substance was named
“ factor X ” and “ factor against infertility “, and later
Evans offered to officially accept the letter designation for him
E – next to the newly discovered vitamin
D.

The active compound of vitamin E was isolated in 1936 from oil
wheat germ. Since this substance allowed animals to have
offspring, the research team decided to name him
alpha-tocopherol – from the Greek “ tocos ” (which means
birth of a child) and “ ferein ” (to grow). To indicate
for the presence of an OH group in the molecule, “ol” was added to the end.Its correct structure was given in 1938 and the substance was
first synthesized by P. Carrer, also in 1938. In the 1940s
a team of Canadian doctors discovered that vitamin E can protect
people from ischemic
heart diseases. The demand for vitamin E has increased rapidly. Along with
with market demand, the number of types of products available has increased
for the pharmaceutical, food, feed and cosmetic industries.1968 Councils on Nutrition and Nutrition of the National Academy of Sciences
officially recognized as vitamin E as a primary nutrient
substances ^[3] .

Foods rich in vitamin E

Indicated availability in 100 g of product:

Daily requirement for vitamin E

As we can see, vegetable oils are the main sources of
vitamin E. Also, a large amount of vitamin can be obtained from
nuts. Vitamin
E is very important for our body, therefore it is necessary to provide
intake of a sufficient amount of it with food.According to official
data, the daily intake of vitamin E is:

Scientists believe there is credible evidence
that a daily intake of at least 200 IU (134 mg)
alpha-tocopherol may protect adults from certain chronic diseases,
such as heart problems, stroke,
neurodegenerative diseases and certain types of cancer.

The main problem in making vitamin E recommendations is
dependence on the consumption of polyunsaturated
fatty acid (PUFA). There are big differences across Europe
in the consumption of PUFA. Based on the proportional relationship between
the need for vitamin E and PUFA, recommendations should be taken into account
different consumption of acid in different population groups. Taking
taking into account the difficulty of reaching recommendations with optimal impact
on human metabolism, the norm for daily intake of vitamin E
for adults, expressed in milligrams of alpha-tocopherol equivalents
(mg alpha-TEQ), differs in European countries:

• in Belgium – 10 mg per day;
• in France – 12 mg per day;
• in Austria, Germany, Switzerland – 15 mg per day;
• in Italy – more than 8 mg per day;
• in Spain – 12 mg per day;
• in the Netherlands – 9.3 mg per day for women, 11.8 mg per day for men;
• in the Nordic countries – women 8 mg per day, men 10 mg per day;
• in the UK – women over 3 mg per day, men over 4 mg per day ^[5.6] .

Generally we can get enough vitamin E
from food products. In some cases, the need for it may
increase, for example, in severe chronic diseases:

These diseases interfere with the absorption of vitamin E in the intestine ^[7] .

Chemical and physical properties

Vitamin E refers to all tocopherols and tocotrienols that exhibit
alpha-tocopherol activity.Due to phenolic hydrogen at the core
2H-1-benzopyran-6-ol, these compounds exhibit varying degrees of
antioxidant activity depending on the place and amount of methyl
groups and type of isoprenoids. Vitamin E is stable when heated to
temperatures from 150 to 175 ° C. It is less stable in acidic and alkaline
environment. α-Tocopherol has the consistency of a clear, viscous oil.
It can degrade with some types of food processing. At
temperatures below 0 ° C, it loses activity.Its activity is unfavorable
affects iron, chlorine and mineral oil. Insoluble in
water, freely soluble in ethanol, miscible in ether. Colour
– from slightly yellow to amber, almost odorless, oxidizes and
dims on exposure to air or light ^[8.9] .

The term vitamin E combines eight related fat-soluble compounds,
naturally occurring: four tocopherols (alpha, beta, gamma
and delta) and four tocotrienols (alpha, beta, gamma and delta).In humans, only alpha-tocopherol is selected and synthesized in the liver,
therefore, it is most abundant in the body. The form
alpha-tocopherol found in plants is RRR-alpha-tocopherol
(also called natural or d-alpha-tocopherol). Vitamin form
E, mainly used in fortified foods and food
supplements are all-rac-alpha-tocopherol (synthetic or dl-alpha-tocopherol).
It contains RRR-alpha-tocopherol and seven very similar forms of alpha-tocopherol.All-rac-alpha-tocopherol is defined as slightly less bioavailable
more active than RRR-alpha-tocopherol, although currently this
definition under revision ^[10] .

Useful properties and its effect on the body

Metabolism in the body

Vitamin E is a fat-soluble vitamin that breaks down and is stored
in the body fat. It acts as an antioxidant,
destroying free radicals that damage cells.Free
radicals are molecules that have an unpaired electron that
makes them very reactive. They feed on healthy cells during
time of a number of biochemical processes. Some free radicals
are natural by-products of digestion, others
come from cigarette smoke, grill carcinogens and other sources.
Healthy cells damaged by free radicals can cause
to the development of chronic diseases such as heart disease
and cancer.Having enough vitamin E in your diet can serve as a
a preventive measure to protect the body from these diseases.
Optimal absorption is achieved with ingestion of the vitamin
E into the body with food ^[11] .

Vitamin E is absorbed into the intestines and enters the bloodstream through
the lymphatic system. It is absorbed along with lipids, gets into
into chylomicrons and with their help is transported to the liver.This process
is similar for all forms of vitamin E. Only after passing
through the liver, α-tocopherol appears in plasma. Most of the consumed
β-, γ- and δ-tocopherols are secreted in bile or not absorbed,
and is excreted from the body. The reason for this is the presence in the liver
a special substance – a protein that exclusively transports
α-tocopherol, TTPA.

The introduction of RRR-α-tocopherol into plasma is a saturating process.Plasma levels with vitamin E supplementation stop rising at
~ 80 μM, even though the dose is increased to 800 mg. Research
show that limiting the concentration of α-tocopherol in plasma,
appears to be the result of a rapid replacement of the circulating
newly absorbed α-tocopherol. These data are consistent with
kinetic analyzes demonstrating that all plasma
the α-tocopherol composition is updated daily ^[12] .

Interaction with other elements

Vitamin E has an antioxidant effect in combination with other
antioxidants including beta-carotene, vitamin
C and selenium.
Vitamin C can restore oxidized vitamin E to its natural
antioxidant form. Megadoses of vitamin C may increase the need
in vitamin E. Vitamin E may also protect against certain effects
excessive amounts of vitamin
And also regulate the level of this vitamin.Vitamin E is essential
for the action of vitamin A, and a high intake of vitamin A can
reduce absorption of vitamin E.

Vitamin E may be required for the conversion of vitamin
B12 in its active form and may reduce some symptoms
zinc deficiency.
Large doses of vitamin E may interfere with the anticoagulant effect
vitamin K and may reduce intestinal absorption of the vitamin
TO.

Vitamin E increases the absorption of vitamin A in the intestine at medium
and high concentrations, up to 40%. A and E together lead to an increase
antioxidant properties, protect against certain forms of cancer
and support gut health. They work synergistically to
preventing
obesity, hearing loss, metabolic syndrome, inflammation,
immune response, maintaining brain health.

Selenium deficiency exacerbates the effects of vitamin E deficiency, which
in turn can prevent selenium toxicity. Combined
deficiency of selenium and vitamin E has a greater effect on the body,
than a lack of only one of the nutrients. General action
vitamin E and selenium can help prevent cancer by stimulating
apoptosis in abnormal cells.

Inorganic iron affects the absorption of the vitamin
E and can destroy it.Vitamin E deficiency exacerbates excess
iron, but extra vitamin E prevents it. Better to take
these additives at different times ^[13.14] .

Digestibility

Vitamins are most beneficial when combined correctly.
For the best effect, we recommend using the following combinations ^[15.16] :

• tomato and avocado;
• fresh carrots and nut butters;
• greens and salad with olive oil;
• sweet potatoes and walnuts;
• bell peppers and guacamole.

A combination of spinach will be useful (moreover,
processing, it will have great nutritional value) and vegetable
oils.

Natural Vitamin E is a family of 8 different
compounds – 4 tocopherols and 4 tocotrienols. It means that
if you consume certain healthy foods, you will receive
all these 8 connections. In turn, synthetic vitamin E
contains only one of these 8 components ( alpha-tocopherol ).Thus, a pill containing vitamin E is not always
a good idea. Synthetic medicines cannot give you
what natural sources of the vitamin can do. Exists
a small amount of medicinal vitamins that also have
in the composition of vitamin E acetate and vitamin E succinate. Although it is known
that they can prevent heart disease, we still
We recommend that you get vitamin E from food ^[1] .

Application in official medicine

Vitamin E has the following functions in the body:

• Maintaining healthy cholesterol levels in the body;
• fight against free radicals and prevention of disease;
• restoration of damaged skin;
• maintenance of hair density;
• balance of the level of hormones in the blood;
• relief of symptoms of premenstrual syndrome;
• improvement of vision;
• slowing down the dementia process in Alzheimer’s disease and other neurodegenerative diseases;
• Potential reduction in the risk of cancer;
• Increased endurance and muscle strength;
• of great importance in pregnancy, growth and development.

Taking vitamin E in the form of a medicinal product is effective in treating:

• ataxia – a motility disorder associated with a lack of vitamin E in the body;
• vitamin E deficiency.In this case, as a rule, they prescribe
  60-75 International Units of Vitamin E per day.

Most often the effectiveness of the vitamin
E in such cases is manifested in combination with other drugs.Before taking it, be sure to consult with your doctor
doctor ^[17] .

In pharmacology, vitamin E is found in the form of soft capsules according to
0.1 g, 0.2 g and 0.4 g, as well as a solution of tocopherol acetate in oil
in vials and ampoules, fat-soluble vitamins, powder for
making tablets and capsules containing 50% vitamin E. It is
the most common forms of the vitamin. To translate
amount of substance from International Units in mg, you need 1
IU equate to 0.67 mg (when it comes to the natural form of the vitamin)
or to 0.45 mg (synthetic).1 mg alpha-tocopherol
is equal to 1.49 IU in natural form or 2.22 of a synthetic substance.
It is best to take the vitamin dosage form before or during
food ^[6] .

Application in traditional medicine

Traditional and alternative medicine values ​​vitamin E first of all
for its nourishing, regenerative and moisturizing properties. Oils,
as the main source of vitamin, very often found in folk
recipes for various diseases and skin problems.For example, olive
oil is considered an effective remedy for
psoriasis – it moisturizes, soothes the skin and relieves inflammation.
It is recommended to apply the oil to the scalp, elbows and other affected
plots.

For the treatment of various types of dermatitis
use jojoba oil, coconut oil, wheat germ oil, grape
bones. All of them help to cleanse the skin, soothe the inflamed
areas and saturate the skin with useful substances.

Comfrey ointment containing vitamin E is recommended
apply at
arthritis. To do this, first mix the leaves or roots of the comfrey
(1: 1, usually a glass of oil to 1 glass of the plant), then make
from the resulting mixture, a decoction (cook for 30 minutes). After that,
filter the broth and add a quarter cup of beeswax
and some pharmacy vitamin E.A compress is made from such an ointment,
kept on painful areas day ^[18] .

Ivy is another of the many plants that contain vitamin E.
For treatment, the roots, leaves and branches of the plant are used, which
used as an antiseptic, anti-inflammatory effect,
has expectorant, diuretic and antispasmodic effects. Decoction
used for rheumatism, gout, purulent wounds, amenorrhea and tuberculosis.It is necessary to use ivy preparations with caution, since the plant
itself is poisonous and contraindicated in pregnancy, hepatitis
and children ^[19] .

Traditional medicine often uses walnut
nut as a remedy for many ailments. Like all nuts, he is
a storehouse of vitamin E. Moreover, both mature and immature are used
fruits, leaves, seeds, shells and seed oil.For example, a decoction
from walnut leaves are used in the form of compresses to accelerate healing
wounds. A decoction of unripe fruits is recommended to be drunk as tea three times
per day for stomach diseases, parasites, scrofula, hypovitaminosis,
scurvy and diabetes. Alcoholic infusion is used for dysentery,
pain in the organs of the urinary system. Tincture of golden leaves
mustache, walnut kernels, honey and water are taken as a remedy for
bronchitis.Unripe nuts are considered potent in folk medicine
a remedy for parasites. Nut peel jam helps with
inflammation of the kidneys and fibroma.

In addition, vitamin E is traditionally considered a vitamin of fertility,
it is used for ovarian wasting syndrome, male and female
infertility. For example, a mixture of evening oil is considered effective.
primrose and pharmacy vitamin E (1 tablespoon of oil and 1 capsule
vitamin, taken for a month three times a day before meals).

A universal remedy is sunflower-based ointment
oil, beeswax and honey.
This ointment is advised to be applied externally (for the treatment of various skin
damage from mastopathy)
and internally (in the form of tampons for a runny nose, ear inflammation, diseases
reproductive organs, as well as ingestion when
constipation and peptic ulcers).

Vitamin E in scientific research

• A new study identified genes that control
  the amount of vitamin E in corn
  grains, which can stimulate further improvement in nutritional
  and nutritional qualities of the product. Scientists have conducted several types
  analysis to identify 14 genes synthesizing vitamins
  E. Recently, six genes were discovered that encode a protein and respond
  for the synthesis of vitamin E.Breeders are working to increase
  the amount of provitamin A in corn, while increasing
  the composition of vitamin E. They are biochemically related, and tochromanols
  essential for seed vitality. They prevent subsidence
  oils in seeds during storage, germination and early seedlings ^[20] .
• Vitamin E is not in vain so popular among bodybuilders – it really is
  helps maintain muscle strength and health.Scientists finally succeeded
  understand how it happens. Vitamin E has long established itself
  as a powerful antioxidant, and has recently been studied without it
  plasma membrane (which protects the cell from leakage of its contents,
  and also controls the intake and output of substances) could not
  fully recover. Since vitamin E is fat-soluble,
  it can actually be incorporated into the membrane, protecting the cell from attack
  free radicals.It also helps preserve phospholipids,
  one of the most important cellular components that is responsible for recovery
  cells after damage. For example, with exercise
  mitochondria burn much more oxygen than usual, which
  leads to more free radical production and damage
  membranes. Vitamin E ensures their complete recovery,
  despite increased oxidation, keeping the process under control ^[21] .
• According to a new study from the University of Oregon,
  zebrafish with vitamin E deficiency produced offspring
  with behavioral disturbances and metabolic problems. Data
  conclusions are of great importance because neurological development
  zebrafish are similar to human neurological development. Problem
  may worsen in women of childbearing age who avoid
  eating foods high in fat and avoiding
  oils, nuts and seeds, which are some of the foods with
  the highest level of vitamin E – an antioxidant required
  for the normal embryonic development of vertebrates.Embryos lacking vitamin E had more deformities
  and a higher incidence of death, as well as altered methylation status
  DNA as early as five days after fertilization. Five days is
  the time it takes for a fertilized egg to become
  floating fish. Research results suggest that deficiency
  vitamin E in zebrafish gives long-term disturbances that are not
  eliminated even with later dietary supplementation
  vitamin E ^[22] .
• A new discovery by scientists proves that the use of salad with
  the addition of vegetable fat helps in the absorption of eight beneficial
  substances. And by eating the same salad, but without oil, we reduce
  the body’s ability to absorb trace elements. According
  with research, certain types of salad dressings can help
  you absorb more nutrients. Researchers have identified
  increased absorption of several fat-soluble vitamins in addition
  to beta-carotene and three other carotenoids.Such a result may
  reassure those who, even while on a diet, cannot resist
  adding a drop of oil to light salad ^[23] .
• According to preliminary data, antioxidant vitamin supplements
  E and selenium – alone or in combination – do not prevent dementia
  in asymptomatic older men. However, such a conclusion cannot
  be final due to insufficient study, inclusion in
  study only in men, short duration of exposure to the drug,
  different dosages and methodological limitations based on
  real incident reporting ^[24] .

Use in cosmetology

Due to its valuable properties, vitamin E is very often
an ingredient in many cosmetics. As part of it indicate
as “ tocopherol ” (“ tocopherol “) or “ tocotrienol ”
(“ tocotrienol “). If the name is prefixed with “d”
(for example, d-alpha-tocopherol), then the vitamin is obtained from natural
sources; if the prefix is ​​”dl”, then the substance was synthesized
in the laboratory.Cosmetologists value vitamin E for the following characteristics:

• vitamin E is an antioxidant and destroys free radicals;
• it has sunscreen properties, namely, it increases the efficiency
  sunscreen effect of special creams, and also relieves
  condition after sunburn;
• has moisturizing qualities – in particular alpha-tocopherol
  acetate which strengthens the natural skin barrier and reduces the amount of
  lost fluid;
• excellent preservative that protects active ingredients
  in cosmetics against oxidation ^[25] .

There are also a very large number of natural recipes
for skin, hair and nails, which effectively nourish them, restore
and give tone. The easiest way to take care of your skin is
rubbing various oils into the skin, and for hair – apply oil
over the entire hair length for at least an hour before washing once or twice a week.
If you have dry or dull skin, try applying a mixture of pink
oils and pharmacy vitamin E – to stimulate collagen production.Another anti-aging recipe includes cocoa butter, sea buckthorn
and a solution of tocopherol. Mask with aloe vera juice and solution nourishes the skin
vitamin E, vitamin A and a small amount of nourishing cream.
An exfoliating universal effect will bring an egg mask
protein, a spoonful of honey and a dozen drops of vitamin E.

Dry, normal and combination skin transforms from the mixture
banana pulp, high fat cream and a few drops of solution
tocopherol.If you want to give your skin additional
tone, mix the pulp of the cucumber and a couple of drops of oil solution
vitamin E. An effective mask with vitamin E against wrinkles is
mask with pharmacy vitamin E, potato pulp and parsley sprigs.
A mask consisting of 2 milliliters will help get rid of acne
tocopherol, 3 teaspoons of red clay and anise essential oil.
For dry skin, try mixing 1 ampoule of tocopherol and 3 teaspoons
tablespoons of kelp – this mask will moisturize and restore the skin.

If you have oily skin, use a mask containing
includes 4 milliliters of vitamin E, 1 crushed tablet of activated
coal and three teaspoons of ground lentils. For aging skin, apply
also a sheet mask containing germ oil
wheat with the addition of other essential oils – rose, mint, sandalwood,
neroli.

Vitamin E is a powerful stimulant for eyelash growth: for this
castor oil, burdock, peach oil are used, which
applied directly to the eyelashes.

Masks are indispensable for the health and beauty of hair, which include
includes vitamin E. For example, a nourishing mask with jojoba oil
and burdock oil. For dry hair, a burdock mask is suitable,
almond and olive oils, as well as an oil solution of vitamin
F. If you notice that your hair is starting to fall out, try
apply a mixture of potato juice, juice or aloe vera gel,
honey and pharmacy vitamins E and A. To give hair shine,
you can mix olive and burdock oil, vitamin oil solution
E and one egg yolk.And, of course, you shouldn’t forget about the oil.
wheat germ – a vitamin “bomb” for hair. For refreshment
and to add shine to the hair, mix banana pulp, avocado, yogurt,
oil solution of vitamin E and wheat germ oil. All of the above
masks should be applied for 20-40 minutes, wrapping hair with plastic
bag or cling film, then rinse with shampoo.

To keep your nails healthy and beautiful, it is useful to use
following masks:

• sunflower or olive oil, a few drops of iodine and a few
  drops of vitamin E – will help with peeling nails;
• vegetable oil, oil solution of vitamin E and some red
  pepper – to accelerate nail growth;
• oil
  walnut, vitamin E and lemon essential oil – for brittle nails;
• olive oil and vitamin E solution – for softening cuticles.

Use in livestock

All animals need a sufficient level of vitamin E in the body
to support healthy growth, development and reproduction. Stress,
exercise, infection and tissue injury increase the need
the animal’s body in vitamin.

It is necessary to ensure its entry through food – fortunately,
this vitamin is widely distributed in nature. Vitamin deficiency
E in animals manifests itself in the form of diseases that most often attack
body tissues, muscles, and also manifested in the form of apathy or
depression ^[36] .

Use in crop production

Several years ago, researchers from the Universities of Toronto and Michigan
made a discovery that talked about the benefits of vitamin E for plants.
As it turns out, adding vitamin E to the fertilizer will reduce the susceptibility
plants to cold temperatures. As a result, it makes it possible
discover new, cold-resistant varieties that will bring the best harvest.
Gardeners who live in colder climates can experiment
with the use of vitamin E and observe how it affects
plant growth and longevity ^[27] .

Industrial use of vitamin E

Vitamin E is widely used in the cosmetic industry –
it is a very common ingredient in creams, oils, ointments, shampoos,
masks, etc. In addition, it is used in the food industry.
as a food additive E307. This supplement is completely harmless and has
same properties as natural vitamin ^[28] .

Interesting Facts

Vitamin E is contained in the protective coating of the grains, so its
the amount is sharply reduced when they are crushed.To save
vitamin E, nuts and seeds must be extracted
in a natural way, for example, by cold pressing, and not
by thermal or chemical extraction used in food
industry.

If you have stretch marks from weight change or pregnancy,
vitamin E can significantly help minimize them. Thanks to
its powerful antioxidant compounds that stimulate
the body to create new skin cells, it also protects the fibers
collagen from damage that free radicals can cause.In addition, vitamin E stimulates skin elasticity to prevent
new stretch marks ^[30.31] .

Contraindications and warnings

Vitamin E is a fat-soluble vitamin, it is not destroyed by exposure
sufficiently high temperatures (up to 150-170 ° C). Is influenced
ultraviolet rays and loses activity when frozen.

Signs of vitamin E deficiency

True vitamin E deficiency is very rare.Obvious symptoms
in healthy people who receive at least a minimal amount of the vitamin
from food were not found.

Vitamin E deficiency can be experienced by premature infants born
weighing less than 1.5 kg. Also the risk of developing vitamin deficiency
have people who have problems with the absorption of fat in the digestive
path. Symptoms of vitamin E deficiency are peripheral
neuropathy, ataxia, skeletal myopathy, retinopathy and disorder
immune response.A sign that your body is not getting enough
the amount of vitamin E may also have the following symptoms:

• Difficulty walking and coordination difficulties;
• muscle pain and weakness;
• visual disturbances;
• general weakness;
• decreased sex drive;
• anemia.

If you notice any of these symptoms, it is worth considering a visit
to the doctor.Only an experienced specialist will be able to determine the presence of that
or any other medical condition and prescribe appropriate treatment. How
as a rule, vitamin E deficiency occurs as a result of genetic
diseases such as Crohn’s disease, ataxia, cystic fibrosis
and other diseases. Only in this case, large doses are prescribed.
medicinal supplements of vitamin E.

Precautions

For most healthy people, vitamin E is very useful – as
when taken orally and when applied directly to the skin.Most people do not experience any side effects with
taking the recommended dose, but using high doses may
there are adverse reactions. It is dangerous to exceed the dose if
You have heart disease or diabetes.
In this case, the dose of 400 International Units must not be exceeded.
(about 0.2 grams) per day.

Some studies show that taking high doses of the vitamin
E, which is 300 to 800 IU every day, can increase
the likelihood of hemorrhagic stroke by 22%.Another
a serious side effect of consuming too much
vitamin E is an increased risk of bleeding.

Avoid taking supplements containing vitamin E or any other
antioxidant vitamins immediately before and after angioplasty.

Very high vitamin E supplements can potentially
lead to the following health problems:

• heart failure in people with diabetes;
• worsening bleeding;
• risk of recurrent cancer of the prostate, neck and head;
• increased bleeding during and after operations;
• increase in the likelihood of death from heart attack or stroke.

One study found that vitamin E supplementation can also
be harmful to women who are in the early stages
pregnancy. High doses of vitamin E can also sometimes cause
to nausea, diarrhea,
abdominal cramps, fatigue, weakness, headache, clouding
vision, rash, bruising and bleeding.

Interaction with other drugs

Since vitamin E supplementation can slow down clotting
blood, then they should be taken with caution with similar medicines
(aspirin, clopidogrel, ibuprofen and warfarin), so they can significantly increase this effect.

Medicines intended to lower cholesterol levels, also
may interact with vitamin E. It is not known exactly, decreases
is the effectiveness of such medications when taking only a vitamin
E, but in combination with vitamin C, beta-carotene and selenium such
the effect is observed very often ^[6,7,29] .

We have collected the most important points about vitamin E in this illustration and
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Sources of information

1. Top 24 Vitamin E Rich Foods You Should Include In Your Diet, source
2. 20 Foods That Are High in Vitamin E, source
3. The Discovery of Vitamin E, source
4. National Nutrient Database for Standard Reference, ref.
5. VITAMIN E // TOCOPHEROL.Intake recommendations, source
6. Vitamin E, source
7. How to Identify and Treat a Vitamin E Deficiency, source
8. Vitamin E, source
9. Vitamin E, Physical and chemical properties. Source
10. Vitamin E, source
11. What is The Best Time to Take Vitamin E? source
12. Vitamin E: Function and Metabolism, ref.
13. Vitamin and Mineral Interactions: The Complex Relationship of Essential Nutrients, source
14. Vitamin E interactions with other nutrients, Source
15. 7 Super-Powered Food Pairings, Source
16. 5 Food Combination Tips for Maximum Nutrient Absorption, Source
17. VITAMIN E.Uses. Dosing, source
18. Nikolay Danikov. A large home clinic. p. 752
19. G. Lavrenova, V. Onipko. A thousand golden recipes for traditional medicine. page 141
20. Vitamin E discovery in maize could lead to more nutritious crop, source
21. How vitamin E keeps muscles healthy, source
22. Vitamin E-deficient embryos are cognitively impaired even after diet improves, source
23. A spoonful of oil: Fats and oils help to unlock full nutritional benefits of veggies, study suggests, ref.
24. Vitamin E, selenium supplements did not prevent dementia, source
25. VITAMIN E IN COSMETICS Source
26. DSM in Animal Nutrition & Health, source
27. What Kinds of Vitamins Do Plants Need ?, source
28. E307 – Alpha-tocopherol, vitamin E, source
29. Vitamin E Benefits, Foods & Side Effects, Source
30. Why Is Vitamin E Important to Your Health ?, source
31. 12 Absolutely Mind-Blowing Facts About Vitamin E, source

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