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 cases of acute overdosage, the stomach should be emptied by vomiting or lavage, though little drug will likely be recovered if more than an hour has elapsed since ingestion. Because the drug is acidic and is excreted in the urine, it is theoretically beneficial to administer alkali and induce diuresis In addition to supportive measures, the use of oral activated charcoal may help to reduce the absorption and reabsorption of ibuprofen tablets.
To manage ibuprofen overdose, the following steps can be taken:
- Empty the stomach by vomiting or lavage, if the overdose was recent (within an hour of ingestion)
- Administer alkali to help with excretion
- Induce diuresis to increase urine production and help eliminate the drug
- Use oral activated charcoal to reduce absorption and reabsorption of the drug
- Provide supportive measures, such as oxygen, parenteral fluids, and monitoring of the patient's condition 1
From the Research
If you suspect an ibuprofen overdose, immediately call poison control (1-800-222-1222) or seek emergency medical attention. For significant overdoses (more than 400 mg/kg), activated charcoal may be administered within one hour of ingestion to reduce absorption, as supported by a recent meta-analysis 2. Medical professionals will provide supportive care including IV fluids to maintain hydration and kidney function, sodium bicarbonate to correct acidosis, and monitoring of vital signs, electrolytes, and organ function. Symptoms of overdose include nausea, vomiting, abdominal pain, drowsiness, headache, tinnitus, and in severe cases, metabolic acidosis, kidney failure, and seizures. The severity depends on the amount ingested, with doses exceeding 100 mg/kg potentially causing toxicity, as reported in a study of 126 cases 3. Some key points to consider in managing ibuprofen overdose include:
- Activated charcoal can reduce drug exposure following ingestion, and its use is supported by recent evidence 2
- Supportive care is crucial in managing overdose, with a focus on maintaining hydration, correcting acidosis, and monitoring organ function
- The majority of patients who overdose on ibuprofen experience mild or no symptoms, but severe cases can occur, as reported in a case study of a massive overdose requiring extracorporeal membrane oxygenation 4
- Treatment focuses on preventing further absorption and supporting organ systems while the body eliminates the drug, with most patients recovering completely with prompt medical attention. Never induce vomiting unless specifically instructed by medical professionals. It is also important to note that while ibuprofen overdose is generally considered to have low toxicity, severe cases can occur, and prompt medical attention is essential to prevent complications, as highlighted in a review of ibuprofen overdose management 5.