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Undesirable effects may be minimized by using the lowest effective dose for the dose for the shortest duration necessary to control symptoms (see GI and cardiovascular risk as follows).
The elderly have an increased frequency of adverse reaction to NSAIDs especially gastrointestinal bleeding and perforation which may be fatal.
Respiratory: Bronchospasm may be precipitated in patients suffering from, or with a previous history of bronchial asthma or allergic disease.
Other NSAIDs: The use of ibuprofen with concomitant NSAIDs including cyclooxygenase-2 selective inhibitors should be avoided (see Interactions).
SLE and Mixed Connective Tissue Disease: Systemic lupus erythematosus and mixed connective tissue disease - increased risk of aseptic meningitis (see Side Effects).
Renal: Renal impairment as renal function may further deteriorate (see Contraindications and Side Effects).
Hepatic: Hepatic dysfunction (see Contraindications and Side Effects).
Cardiovascular and Cerebrovascular Effects: Caution (discussion with physician and pharmacist) is required prior to starting treatment in patients with a history of hypertension and/or heart failure as fluid retention, hypertension and oedema have been reported in association with NSAID therapy. Clinical trial and epidemiological data suggest that use of ibuprofen, particularly at high doses (2400 mg daily) and in long-term treatment may be associated with a small increased in risk of arterial thrombotic events (for example myocardial infarction or stroke). Overall, epidemiological studies don not suggest that low dose ibuprofen e.g. ≤1200 mg daily) is associated with an increased risk of myocardial infarction.
Impaired Female Fertility: There is limited evidence that drugs which inhibit cyclo-oxygenase/prostaglandin synthesis may cause impairment of female fertility by an effect on ovulation. This is reversible upon withdrawal of treatment.
Gastrointestinal: NSAIDs should be given with care to patients with a history of gastrointestinal disease (ulcerative colitis, Crohn's disease) as these conditions may exacerbated (see Side Effects). GI bleeding, ulceration or perforation, which can be fatal has been reported with all NSAIDs at anytime during treatment, with or without warning symptoms or a previous history of GI events. The risk of GI bleeding with haemorrhage or perforation (see Contraindications), and in the elderly. These patients with a history of ulcer, particularly in the initial stages of treatment. Caution should be advised in patients receiving concomitant medications which could increase the risk of ulceration or bleeding, such as oral corticosteroids, anticoagulants such as warfarin, selective serotonin-reuptake inhibitors or anti-platelet agents such as aspirin (see Interactions). When GI bleeding or ulceration occurs in patients receiving ibuprofen, the treatment should be withdrawn.
Dermatological: Serious skin reactions, some of them fatal, including exfoliative dermatitis, Stevens-Johnson syndrome, and toxic epidermal necrolysis, have been reported very rarely in association with the use of NSAIDs (see Side Effects). Patients appear to be at highest risk for these reactions early in the course of therapy: The onset of the reaction occurring in the majority of cases within the first month of treatment. Ibuprofen should be discontinued at the first appearance of skin rash, mucosal lesions, or any sign of hypersensitivity.
Effects on Ability to Drive and Use Machines: None expected at recommended dose and duration of therapy.
