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Cross-Sensitivity and/or Related Problems: Patients sensitive to one of the NSAIDs, may also be sensitive to any of the other NSAIDs. NSAIDs may cause bronchoconstriction or anaphylaxis in aspirin-sensitive asthmatics, especially those with aspirin-induced nasal polyps, asthma and other allergic reactions (the "aspirin triad").
Use in pregnancy & lactation: Safety in pregnancy and lactation has not been established.
Use in children: Safety in children <2 years has not been established.
Use in the elderly: NSAID-induced GI ulceration and/or bleeding may be more likely to cause serious consequences, including fatalities, in geriatric patients than in younger adults. In addition, elderly patients are more likely to have age-related renal function impairment, which may increase the risk of NSAID-induced hepatic and renal toxicity and may also require dosage reduction to prevent accumulation of the medication. Also, careful monitoring of the patient is recommended.
Dental: NSAIDs may cause soreness, irritation or ulceration of oral mucosa. Ibuprofen may rarely cause leukopenia and/or thrombocytopenia, which may result in an increased incidence of microbial infection, delayed healing and gingival bleeding. If leukopenia or thrombocytopenia occurs, dental work should be deferred until blood counts have returned to normal and patients should be instructed in proper oral hygiene, including caution in use of regular toothbrushes, dental floss and toothpicks.
Surgical: Caution is recommended in patients who require surgery. Most NSAIDs inhibit platelet aggregation and may prolong bleeding time, which may increase intra- and postoperative bleeding. Recovery of platelet function may occur within 1 day after discontinuation of ibuprofen. Consideration should be given to discontinuing NSAID treatment for an appropriate length of time prior to elective surgery, depending on the potency and duration of effect of the individual agent on platelet aggregability.
Special Precautions: Mild allergic reaction eg, allergic rhinitis, urticaria or skin rash induced by aspirin or other NSAIDs; anemia; asthma; conditions eg, compromised cardiac function, congestive heart disease, preexisting edema, renal function impairment; conditions predisposing to GI toxicity, eg, active alcoholism, inflammatory or ulcerative disease of upper or lower GIT, including Crohn's disease, diverticulitis, peptic ulcer disease or ulcerative colitis and recent history of tobacco use; hemophilia or other bleeding problems including coagulation or platelet function disorders; hepatic cirrhosis or hepatic function impairment; renal function impairment; stomatitis; systemic lupus erythematosus.
