Ibuprofen

(eye-byou-pro-fen)

Trade/other name(s): Advil, Cap-profen, Genpril, Haltran, IBU, Ibuprin, Ibuprohm, Ibu-tab, Menadol Captabs, Midol Cramp, Motrin, Motrin IB, Profen

Why would this drug be used?

Ibuprofen may be used to treat mild to moderate pain from cancer, surgery, or other causes, and is especially helpful in relieving bone pain related to cancer. For severe pain, it is more helpful when used along with other pain-relieving drugs. It is also used to reduce fever and inflammation, as well as for other purposes. You can buy small doses of ibuprofen over the counter, without a prescription. Larger doses can only be obtained by prescription.

How does this drug work?

Ibuprofen is a non-opioid pain medicine, meaning that it is not in the same family as morphine or codeine. It belongs to the general class of drugs called non-steroidal anti-inflammatory drugs (NSAIDs). Ibuprofen's action is not fully understood, but it helps block the body from making prostaglandins. (Prostaglandins are substances made by most of the cells in the body. They have a role in many body functions, including pain and inflammation.) Ibuprofen helps prevent pain receptors from passing pain messages to the brain. Ibuprofen helps reduce inflammation that prostaglandins can cause. It also reduces fever by helping enlarge blood vessels near the skin so that heat is lost from the body.

Before taking this medicine

Tell your doctor…

• If you are allergic to anything, including medicines, dyes, additives, or foods.
• About any reactions you have had when taking aspirin or other non-steroidal anti-inflammatory medicines in the past. If you have had problems with any of these medicines, you are more likely to have problems taking ibuprofen.
• If you have ever had any medical conditions such as asthma, nasal polyps, allergies, high blood pressure, kidney disease, liver disease (including hepatitis), stroke, high cholesterol, diabetes, or heart disease. These conditions increase the risk of serious side effects from or reactions to ibuprofen, and you may need a different medicine. If you take the drug, you may need to be watched more closely during treatment.
• If you have congestive heart failure or fluid retention (swelling, usually of the legs and feet). Ibuprofen may worsen this problem.
• If you are taking blood pressure medicines. Ibuprofen may cause some blood pressure medicines to stop working properly. In some cases, the combination of medicines may damage the kidneys.
• If you have ever had stomach or intestinal ulcers, especially if you had bleeding. Ibuprofen can worsen these problems or make them come back.
• If you have hemophilia or any other bleeding problem, or if you are taking blood thinners such as warfarin or heparin. Ibuprofen can increase your risk of bleeding from the stomach or intestine.
• If you are pregnant or trying to get pregnant. Taking ibuprofen, especially later in pregnancy, can harm the baby and delay delivery.
• If you are breast-feeding. It is not known if ibuprofen is excreted in breast milk. If it is, it may affect the baby.
• About any other prescription or over-the-counter medicines you are taking, including vitamins and herbs. In fact, keeping a written list of each of these medicines (including the doses of each and when you take them) with you in case of emergency may help prevent complications if you get sick.

Interactions with other drugs

If you take ibuprofen while you are taking lithium, your lithium level may go up. This can increase your risk of toxic effects from lithium. You may need more frequent monitoring of lithium levels while on ibuprofen.

Taking ibuprofen while using "blood thinners" (such as warfarin and heparin) can increase your risk of serious bleeding.

Probenecid can cause ibuprofen to build up in the body, and should not be taken during the time you are taking ibuprofen.

Alcohol may increase your risk of stomach irritation or bleeding, as may aspirin. Steroids that are taken by mouth, such as prednisone, prednisolone, hydrocortisone, betamethasone, budesonide, triamcinolone, can also increase this risk.

Medicines for high blood pressure, such as diuretics (water pills) and ACE inhibitors (such as captopril, lisinopril, enalapril, benazepril, and others) may not work as well if taken during treatment with ibuprofen. You may need more frequent blood pressure checks and possibly a change of medicines.

Methotrexate may have more toxic effects if ibuprofen is taken during the same time.

Check with your doctor, nurse, or pharmacist about whether other medicines, vitamins, herbs, and supplements can cause problems with this medicine.

Interactions with foods

No serious interactions with food are known at this time. Check with your doctor, nurse, or pharmacist about whether foods may be a problem.

Tell all the doctors, dentists, nurses, and pharmacists you visit that you are taking this drug.

How is this drug taken or given?

Ibuprofen is a pill or liquid that can be taken by mouth with milk, food, or antacids. It is usually taken 3 or 4 times a day. The dose depends on why the drug is being used.

Take this drug exactly as directed by your doctor, or follow the directions on the label for the non-prescription doses. If you do not understand the instructions, ask your doctor or nurse to explain them to you.

Store the medicine in a tightly closed container away from heat and moisture and out of the reach of children and pets.

Precautions

Avoid aspirin or other non-steroidal anti-inflammatory drugs like naproxen while taking ibuprofen. Many drugs are combined with ibuprofen, aspirin, and other NSAIDs. The larger amounts you get if you take extra doses may increase the risk of bleeding or stomach irritation. Ask your pharmacist, doctor, or nurse what is in your prescription drugs before taking ibuprofen. Read the ingredient list on any non-prescription remedies for pain, headache, sinus, cold or flu before taking them, or check with your pharmacist.

Avoid ibuprofen if you have a stomach or duodenal ulcer. Ibuprofen can cause severe bleeding or holes in the intestine.

If you have ever had trouble breathing, rash, itching, or swelling in the mouth or throat after taking aspirin or other anti-inflammatory drugs, do not take ibuprofen.

If your blood counts are low due to chemotherapy or radiation, check with your doctor or nurse before taking ibuprofen. It may increase your chance of bleeding.

Ibuprofen must be stopped a few days before any type of surgery. Make sure you tell your doctor or dentist at least a week before surgery if you are taking ibuprofen to be sure of your instructions.

Your doctor may want to check your lab work and blood pressure more often if you are taking ibuprofen for more than a few weeks. This is to help find problems early, before they worsen.

Call your doctor or nurse right away if you are vomiting blood, or a coffee-ground material, notice blood in your stools, or stools appear black and tarry. Talk to your doctor if you have pain in your belly or severe indigestion. Stop taking ibuprofen until after you talk with your doctor.

Call your doctor or nurse right away if your vision is blurred, you don't see colors well, or if you see spots in front of your eyes. Stop taking ibuprofen until you talk to your doctor or nurse.

If you notice any type of rash, especially if you also have a fever, stop the ibuprofen and call your doctor right away.

Ibuprofen can cause fluid retention and worsen heart failure. If you have unexplained weight gain or swelling, stop the ibuprofen and call your doctor.

Rarely, ibuprofen can cause damage to the liver. If you notice nausea, tiredness, itching, tenderness below the right side of your rib cage, flu-like symptoms, or yellowing of the skin or eyes, stop the medicine and call your doctor or nurse right away.

Ibuprofen can increase your risk of heart attack and stroke. If you develop shortness of breath, chest pain, weakness in one part or on one side of the body, or slurred speech, get help right away.

If you have trouble breathing, itchy welts on the skin, or swelling of your mouth, face, or throat, get emergency help. This may mean an allergic reaction.

Smoking or drinking alcohol increases your risk of bleeding from the stomach or intestine.

Most cancer pain can be controlled. Keep your doctor or nurse informed about how well your pain medicines are working and any side effects you are having. Your cancer team may need to adjust your medicines several times before they find the medicines that work best for you.

If your doctor prescribes another medicine for pain, ask your doctor or nurse whether you should continue taking ibuprofen along with the new medicine. Severe pain usually requires more than one type of medicine to control it.

If you have chronic cancer pain, take your pain medicines on a regular schedule to keep it from worsening. If you wait until the pain is bad, it takes more medicine to get it under control. If pain gets bad between doses, talk to your cancer team about changing your medicine or adding an extra one for "breakthrough" pain.

Possible side effects

You will probably not have most of the following side effects, but if you have any talk to your doctor or nurse. They can help you understand the side effects and cope with them.

Common

• heartburn, stomach/abdominal pain, or nausea

Less common

• dizziness
• vomiting
• diarrhea
• sores in mouth or on lips
• headache
• tiredness (fatigue)
• confusion
• mood swings
• loss of appetite
• constipation
• itching or rash*
• bloating or swelling, especially of the legs and feet*
• peptic (stomach) ulcers*
• bleeding from the stomach or intestines*
• nervousness
• anxiety
• depression

Rare

• decreased hearing
• vision changes*
• double vision*
• hepatitis (liver inflammation)*
• liver damage, which may cause yellow skin or eyes (jaundice)*
• high blood pressure*
• low white blood cell count with increased risk of infection
• low platelet count with increased risk of bleeding
• low red blood cell count (anemia) which can cause tiredness and other symptoms
• kidney damage (usually gets better after medicine is stopped)
• kidney failure
• blood in urine
• hair loss
• acne
• facial flushing
• allergic reaction with trouble breathing, raised itchy welts on the skin, or swelling of the face, mouth, or throat*
• heart attack or stroke*

*See "Precautions" section for more detailed information.

There are some other side effects not listed above that can also occur in some patients. Tell your doctor or nurse if you develop these or any other problems.

FDA approval

Yes – first approved before 1984 (FDA cannot verify dates of drugs approved before 1984).

Disclaimer: This information does not cover all possible uses, actions, precautions, side effects, or interactions. It is not intended as medical advice, and should not be relied upon as a substitute for talking with your doctor, who is familiar with your medical needs.