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Painkillers, ibuprofen

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Painkillers, ibuprofen



Introduction 

Ibuprofen is a painkiller, which is available over-the-counter, without a prescription.

It is one of a group of painkillers called non-steroidal anti-inflammatory drugs (NSAIDs), and can be used to:


ease mild to moderate pain – such as toothache, migrainesand period pain

control a fever (high temperature, also known as pyrexia) – for example, when someone has the flu (influenza)

ease pain and inflammation (redness and swelling) caused by rheumatic diseases (conditions that affect the joints) and musculoskeletal disorders (conditions that affect the bones and muscles) – such as rheumatoid arthritis and osteoarthritis

ease pain and swelling caused by sprains and strains, such as sports injuries


Types of ibuprofen

Ibuprofen is made by many different companies, under many different brand names and in a wide range of forms, including:


tablets or caplets

gels

sprays

liquids


In some products, ibuprofen is combined with other ingredients. For example, it is sometimes combined with a decongestant (a medicine for a blocked nose) and sold as a cold and flu remedy – for example, Sudafed.

How it works

Ibuprofen works as a painkiller by affecting chemicals in the body called prostaglandins.

Prostaglandins are substances released in response to illness or injury. They cause pain and swelling (inflammation). Prostaglandins that are released in your brain can cause a high temperature (fever).

The painkilling effect of ibuprofen begins soon after a dose is taken, but the anti-inflammatory effect is weak and will take longer to begin. It can sometimes take up to three weeks to get the best results, and ibuprofen should not be used to treat conditions that are mainly related to inflammation.

Ibuprofen can cause side effects such as nausea and vomiting. 

Uses of ibuprofen

Ibuprofen should be avoided by people with certain health conditions, such as a current or recent stomach ulcer, or a history of bad reactions to NSAIDs.

It should be used with caution by older people, and people with certain health conditions, including asthma or kidney or liver problems.

Ideally, pregnant women should not take ibuprofen unless recommended by a doctor. But ibuprofen appears in breast milk in small amounts, so it’s unlikely to cause any harm to your baby while you’re breastfeeding. It’s best to tell your GP, pharmacist or health visitor about any medicines you’re taking.

Paracetamol is recommended as an alternative to ease short-term pain or reduce a high temperature.

Ibuprofen can also interact with a range of other medicines. It is important to check that it's safe to take ibuprofen alongside these medications by asking your doctor, pharmacist or checking the patient information leaflet.

Ibuprofen and children

Ibuprofen may be given to children who are aged three months or over and weigh at least 5kg (11lbs), to relieve:


pain

inflammation

fever


In certain cases, your GP or another healthcare professional may recommend ibuprofen for younger children. For example, babies who are aged two to three months can take ibuprofen to control a fever following a vaccination, if paracetamol is unsuitable. This will be a single dose that can be repeated once after six hours, if necessary.

Ibuprofen may also be given to children with rheumatic conditions, such as juvenile idiopathic arthritis.

An injection of ibuprofen can be given to premature babies (born before week 37 of the pregnancy) to treat patent ductus arteriosus (when a blood vessel in the heart does not close normally after birth).

When ibuprofen is given to babies or children, the correct dose may depend on:


the child’s age

the child’s weight

the strength of the ibuprofen, which is usually in mg (milligrams)


If your baby or child has a high temperature that does not get better, or they continue to experience pain, speak to your GP or call 111.

Special considerations 

Some people should avoid using ibuprofen. Others, including older people, should use it with caution.

If you have any queries about using ibuprofen, or any other medicines, speak to your GP or pharmacist, or call  111.

Do not use

Do not take ibuprofen if you:


have a history of hypersensitivity (a strong, unpleasant reaction) to aspirin or other non-steroidal anti-inflammatory drugs (NSAIDs)

have a current or recent stomach ulcer (an open sore that develops on the inside lining of the stomach or small intestine) or you have had one in the past

have severe heart failure (when your heart is not pumping blood around your body very efficiently)

have severe liver disease

are taking low-dose aspirin for the prevention of cardiovascular disease


Use with caution

Use ibuprofen with caution if you are aged 65 or over, or if you're breastfeeding (see below).

You should also use ibuprofen with caution if you have:


asthma

kidney problems

liver problems

a connective tissue disorder such as lupus

Crohn’s disease (inflammation of the lining of the digestive system)

ulcerative colitis (a long-term condition that affects the large intestine)

previously had any bleeding in your stomach

high blood pressure (hypertension)

peripheral arterial disease (narrowing of the arteries)

any problems with your heart, such as angina (symptoms caused by a restricted blood supply to the heart), heart attacks (when the blood supply to your heart is blocked), or mild or moderate heart failure

cerebrovascular disease (problems with the blood supply in the brain) such as a stroke (when the blood supply to the brain is restricted or interrupted)


Ibuprofen and older people

Ibuprofen should also be used with caution in people who are aged 65 or over, because they have a higher risk of developing more serious side effects.

For example, bleeding is more common among older people and is more likely to have a serious outcome. People receiving long-term treatment with ibuprofen are also prescribed a medicine to reduce stomach acid and prevent stomach bleeding, such as a proton pump inhibitor (PPI) or an H-2 antagonist. 

Older people are also more likely to have a heart or kidney problem, which ibuprofen can make worse.

Speak to your GP or pharmacist for further guidance on whether ibuprofen is safe for you.

Pregnancy and breastfeeding

Ideally, pregnant women should not take ibuprofen unless recommended by a doctor. But ibuprofen appears in breast milk in small amounts, so it’s unlikely to cause any harm to your baby while you’re breastfeeding. It’s best to tell your GP, pharmacist or health visitor about any medicines you’re taking.

Paracetamol is the preferred medication to help ease short-term pain or reduce a high temperature (fever) during pregnancy or breastfeeding.

Side effects of ibuprofen 

Ibuprofen can cause a number of side effects.

For this reason, take the lowest possible dose of ibuprofen for the shortest possible time needed to control your symptoms.

Common side effects of ibuprofen include:


nausea (feeling sick)

vomiting (being sick)

diarrhoea (passing loose, watery stools)

indigestion (dyspepsia)

tummy (abdominal) pain


Less common side effects include:


headache

dizziness

fluid retention (bloating)

raised blood pressure

gastritis (inflammation of the stomach)

a stomach ulcer

allergic reactions – such as a rash

worsening of asthma symptoms by causing bronchospasm (narrowing of the airways)

kidney failure


Less common side effects can also include black stools and blood in your vomit. These side effects can indicate that there is bleeding in your stomach.

See the patient information leaflet that comes with your medicine or the ibuprofen medicines information section for a full list of side effects.

If you feel unwell after taking ibuprofen or have concerns about an ibuprofen side effect, seek advice from your GP or pharmacist, or call 111.

Increased risks

Taking ibuprofen, particularly at high doses over long periods of time, can increase your risk of:


stroke – when the blood supply to the brain is disturbed

heart attacks – when the blood supply to the heart is blocked


In women, long-term use of ibuprofen might be associated with reduced fertility. This is usually reversible when you stop taking ibuprofen.

Ability to drive

Ibuprofen is unlikely to affect your ability to drive safely, although some people may feel dizzy after taking ibuprofen. If you experience dizziness, do not drive.


Reporting side effects

The Yellow Card Scheme allows you to report suspected side effects from any type of medicine you are taking.

It is run by a medicines safety watchdog called the Medicines and Healthcare Products Regulatory Agency (MHRA).

See the Yellow Card Scheme website for more information.

Interactions with other medicines 

When two or more medicines are taken at the same time, the effects of one medicine can be altered by the other.

This is known as a drug-drug interaction. In some cases, it may not be safe to take one medicine with another because of this interaction.

Ibuprofen, including ibuprofen products applied to the skin (such as gels), can interact with the following medicines:


aspirin – an antiplatelet medicine used to reduce your risk of having a heart attack or stroke 

ciclosporin – used to treat inflammatory conditions, such as rheumatoid arthritis

colestyramine – used to treat itching

fluconazole – used to treat certain types of fungal infections

lithium – used to treat depression, mania, bipolar disorder, self-harming and aggressive behaviour

methotrexate – used to treat some types of cancer and rheumatoid arthritis

mifepristone – used to terminate pregnancy

tacrolimus – used to prevent organ rejection during organ transplants

voriconazole – used to treat fungal infections, such asaspergillosis (a range of infections that are caused by a fungal mould called aspergillus)

warfarin – an anticoagulant medicine, used to stop the blood from clotting

zidovudine – used to treat HIV


Ibuprofen can also interact with ginkgo biloba, a controversial dietary supplement some people claim can treat memory problems and dementia.

To check that your medicines are safe to take with paracetamol, you can:


ask your GP or local pharmacist

read the patient information leaflet that comes with your medicine

check the medicines information tab at the top of this page


Non-steroidal anti-inflammatory drugs (NSAIDs)

Ibuprofen is a type of non-steroidal anti-inflammatory drug (NSAID). These have many interactions with other medicines, including:


some types of antidepressants, which are used to treat depression

beta-blockers, which are used to treat high blood pressure (hypertension)

diuretics, which reduce the amount of fluid in your body


Do not take more than one type of NSAID at a time or you will have an increased risk of developing side effects.


Food and alcohol

There are no known interactions between ibuprofen and food. Taking ibuprofen with or after food will help reduce any irritation to the stomach.

There are also no known interactions with ibuprofen and moderate alcohol intake. However, the risk of bleeding in the stomach is higher in people who take ibuprofen and drink excessive amounts of alcohol.

Missed or extra doses of ibuprofen 

Take ibuprofen as directed on the packet or patient information leaflet, or as recommended by your GP or pharmacist.

Missed doses

If you forget to take your dose of ibuprofen, check the patient information leaflet that comes with your medicine. You may be able to take the missed dose when you remember, or you may need to miss it out completely.

Doses of ibuprofen are usually taken three or four times a day. Make sure you leave the recommended time between doses and do not exceed the maximum dose for a 24-hour period.

Extra doses

If you accidentally take an extra dose of ibuprofen, miss out the next dose so you are not taking more than the recommended maximum dose for a 24-hour period. If you feel unwell or you are concerned, contact your GP or call 111.

If you have taken more than your recommended daily dose of ibuprofen, contact your GP or call  111. If you have taken a large overdose, go to your nearest accident and emergency (A&E) department immediately.

Taking too much ibuprofen can cause:


nausea (feeling sick)

vomiting (being sick)

epigastric pain (pain in the upper part of your tummy)

tinnitus (the perception of noise in one ear, both ears or in your head, when the noise comes from inside your body rather than from an outside source)


Further advice

If you need further advice about missed or extra doses of ibuprofen, contact your GP or pharmacist, or call  111.
Painkillers ibuprofen