Ibuprofen is a widely used non-steroidal anti-inflammatory drug (NSAID) belonging to the propionic acid derivatives class. It is a non-selective inhibitor of cyclooxygenase (COX-1 and COX-2) enzymes, providing analgesic, anti-inflammatory, and antipyretic effects. In the Indian market, the 400mg strength is one of the most common over-the-counter and prescription doses for moderate pain and inflammation.
Adult: Analgesia/Antipyresis: 200-400 mg every 4-6 hours as needed. Maximum daily dose: 1200 mg (OTC) to 2400 mg (prescription, under supervision). Inflammatory conditions: 400-800 mg three times daily (1200-2400 mg/day).
Note: Take with food or a full glass of milk/water to minimize gastric irritation. Do not crush or chew sustained-release formulations. Swallow tablet whole. Maintain adequate hydration during therapy.
Ibuprofen exerts its therapeutic effects primarily through the non-selective, reversible inhibition of the cyclooxygenase (COX) enzymes, COX-1 and COX-2. This inhibition blocks the conversion of arachidonic acid to prostaglandin G2 (PGG2) and subsequently to prostaglandin H2 (PGH2), the precursor for various prostanoids including prostaglandins (PGs), prostacyclin, and thromboxanes.
Pregnancy: Category C (first and second trimester): Use only if potential benefit justifies potential risk to fetus. Avoid in third trimester (Category D) due to risk of premature closure of ductus arteriosus, oligohydramnios, and inhibition of labor.
Driving: Usually does not impair ability. However, dizziness, drowsiness, vertigo, or blurred vision may occur rarely. Patients should be cautioned until they know how the drug affects them.
| Aspirin (low-dose) | Ibuprofen may antagonize the antiplatelet cardioprotective effect of aspirin. Increased risk of GI toxicity. | Major |
| Warfarin, Acenocoumarol | Increased risk of bleeding due to antiplatelet effect, potential displacement from protein binding, and GI irritation. | Major |
| Lithium | Ibuprofen decreases renal clearance of lithium, leading to increased lithium levels and toxicity. | Major |
| Methotrexate (high-dose) | May decrease renal clearance of methotrexate, increasing risk of methotrexate toxicity (myelosuppression). | Major |
| ACE Inhibitors (e.g., Enalapril, Ramipril) / ARBs (e.g., Telmisartan) | Antagonizes hypotensive effect. Increased risk of renal impairment, especially in volume-depleted patients. | Moderate |
| Diuretics (e.g., Furosemide, Hydrochlorothiazide) | Reduces diuretic and antihypertensive efficacy. Increased risk of renal failure. | Moderate |
| Corticosteroids (e.g., Prednisolone) | Synergistic increase in risk of GI ulceration and bleeding. | Major |
| Selective Serotonin Reuptake Inhibitors (SSRIs) e.g., Sertraline | Increased risk of upper GI bleeding. | Moderate |
| Cyclosporine, Tacrolimus | Increased risk of nephrotoxicity. | Major |
| Other NSAIDs (including topical) | Increased risk of GI and renal adverse effects without added benefit. | Major |
Same composition (Ibuprofen (400mg)), different brands: