From the Guidelines
Ibuprofen Overdose Symptoms
Ingesting more than 400mg of ibuprofen can lead to symptoms of overdose, as indicated by 1. For an average adult, this could translate to taking approximately 20-40 tablets of 200mg ibuprofen, depending on the individual's weight. However, symptoms can occur at much lower doses, especially in children, the elderly, or those with pre-existing medical conditions.
- Key factors to consider:
- Dose: More than 400mg may induce nausea, anorexia, and mild ataxia, as seen in 1.
- Population: Children, the elderly, or those with pre-existing medical conditions are more susceptible to overdose symptoms at lower doses.
- Weight: The amount of ibuprofen that can lead to overdose symptoms varies depending on the individual's weight. It's crucial to seek immediate medical attention if an overdose is suspected, and to exercise extreme caution when discussing ibuprofen overdose, as also suggested by the management of acute pain in patients with migraine headaches 1.
From the FDA Drug Label
Approximately 1½ hours after the reported ingestion of from 7 to 10 ibuprofen tablets (400 mg), a 19-month old child weighing 12 kg was seen in the hospital emergency room, apneic and cyanotic, responding only to painful stimuli. In two other reported cases where children (each weighing approximately 10 kg) accidentally, acutely ingested approximately 120 mg/kg, there were no signs of acute intoxication or late sequelae A 19-year old male who had taken 8,000 mg of ibuprofen over a period of a few hours complained of dizziness, and nystagmus was noted.
The dose of ibuprofen that leads to symptoms of overdose is:
- 400 mg (7 to 10 tablets) in a 12 kg child, resulting in apnea, cyanosis, and responsiveness only to painful stimuli 2
- 8,000 mg in a 19-year-old male, resulting in dizziness and nystagmus 2
- 120 mg/kg in 10 kg children, with no signs of acute intoxication or late sequelae reported 2
From the Research
Ibuprofen Overdose Symptoms
- Symptoms of ibuprofen overdose are unlikely after ingestion of 100 mg/kg or less, and are usually not life-threatening unless more than 400 mg/kg is ingested 3
- Typical signs and symptoms of NSAID overdose, including ibuprofen, include nausea, vomiting, headache, drowsiness, blurred vision, and dizziness 3
- Seizures are rarely documented, but can occur in severe cases, especially with massive ingestion of ibuprofen 3, 4
- In severe cases, ibuprofen overdose can lead to metabolic acidosis, respiratory depression, and coma 3
Dose-Response Relationship
- The majority of patients who ingest ibuprofen in overdose suffer no or only mild symptoms, with severe toxic effects being unusual 4
- A study of 1,033 enquiries involving ingestion of ibuprofen alone found that 705 (65%) patients were asymptomatic, 199 (18%) experienced mild symptoms, and 23 (2%) experienced moderate symptoms 4
- Fatal overdose with ibuprofen is rare, with only seven case reports documented, often with complicating factors related to other drugs and/or other disease processes 4
Management of Ibuprofen Overdose
- Treatment of ibuprofen overdose is generally straightforward and can be related to the dose ingested 4
- Supportive care, including gastric decontamination with activated charcoal, is the mainstay of treatment 3
- Therapeutic plasma exchange (TPE) may be considered in severe cases with refractory circulatory failure, but its effectiveness in eliminating ibuprofen is unclear 5