From the Guidelines
Ibuprofen should not be prescribed to someone with certain medical conditions, such as renal disease, congestive heart failure, or cirrhosis, due to the risk of acute renal failure, as stated in the American Family Physician study 1. When considering prescribing ibuprofen to someone taking liquid medications, it's essential to evaluate the patient's overall health and potential interactions with other medications. According to the Mayo Clinic Proceedings study 1, NSAIDs, including ibuprofen, should be avoided in patients with or at risk for cardiovascular disease (CVD) and chronic kidney disease (CKD). Key considerations for prescribing ibuprofen include:
- Monitoring renal function and avoiding use in patients with eGFR <30 ml/min per 1.73 m2 1
- Using the lowest clinically effective dose and not exceeding 3200 mg per day
- Considering alternative treatments, such as acetaminophen, for patients with certain medical conditions
- Being aware of potential drug interactions with anticoagulants, antihypertensives, diuretics, or corticosteroids
- Taking ibuprofen with food to minimize gastrointestinal irritation and monitoring for signs of GI bleeding, kidney dysfunction, or cardiovascular effects, especially with prolonged use. The American College of Rheumatology 2012 recommendations 1 also provide guidance on the use of NSAIDs, including ibuprofen, in patients with osteoarthritis, emphasizing the importance of considering individual patient factors and potential risks.
From the FDA Drug Label
In a Danish National Registry study of patients with heart failure, NSAID use increased the risk of MI, hospitalization for heart failure, and death. Additionally, fluid retention and edema have been observed in some patients treated with NSAIDs. Use of Ibuprofen may blunt the CV effects of several therapeutic agents used to treat these medical conditions [e.g., diuretics, ACE inhibitors, or angiotensin receptor blockers (ARBs)] Advanced Renal Disease No information is available from controlled clinical studies regarding the use of ibuprofen tablets in patients with advanced renal disease. Therefore, treatment with ibuprofen tablets is not recommended in these patients with advanced renal disease
The patient is on liquid, which may indicate fluid retention or advanced renal disease.
- Fluid retention is a potential side effect of ibuprofen, and its use may worsen this condition.
- Advanced renal disease is a contraindication for the use of ibuprofen, as stated in the drug label. Therefore, it is not recommended to prescribe ibuprofen to someone that is on liquid, due to the potential risks of worsening their condition 2.
From the Research
Ibuprofen Prescription Considerations
- When considering prescribing ibuprofen to someone on a liquid diet, it is essential to evaluate the potential risks and benefits associated with its use.
- According to 3, ibuprofen has a favorable safety profile and is an effective analgesic for many acute and chronic pain conditions, although it is not without risk.
- The study 4 suggests that ibuprofen has a good safety profile comparable to paracetamol at low doses (800-1,200 mg day(-1)), which are approved for non-prescription sale in many countries.
Gastrointestinal Safety
- Research 5 indicates that the rate of serious GI adverse events associated with the use of NSAIDs, including ibuprofen, is comparatively low, especially at OTC doses.
- The incidence of GI adverse events in both adults and children receiving ibuprofen has been shown to be similar to that of paracetamol 5.
- However, upper GI bleeding is infrequent and usually associated with long-term use of prescription doses of ibuprofen 5.
Liquid Diet Considerations
- There is no direct evidence in the provided studies addressing the specific consideration of prescribing ibuprofen to someone on a liquid diet.
- However, the overall safety profile of ibuprofen, as discussed in 3, 4, and 5, suggests that it may be a viable option for pain management, but the decision should be made on a case-by-case basis, taking into account the individual's specific health status and medical history.