Erosion, 27 ibuprofen

Nonsteroidal anti-inflammatory drugs [P] Inhibition of platelet function, gastric erosions some agents increase hypoprothrombinemic response (unlikely with diclofenac, ibuprofen, or naproxen). 

PGs produced in the gastric mucosa stimulate the secretion of both bicarbonate and the mucus gel to protect the mucosa from damage by gastric secretions. Use of NSAIDs, such as aspirin and ibuprofen, reduces the production of the prostanoids and so decreases the protection of the gastric mucosa, promoting mucosal erosion. 

Some 500 million prescriptions for NSAIDs are written each year in the UK, and 10-15% of patients develop dyspepsia whilst taking these drugs. Gastric erosions develop in up to 80%, but these are usually self-limiting. Gastric or duodenal ulcers occur in 1-5%. The incidence increases sharply with age in those over 60, and the risk of ulcers and their complications is doubled in patients over 75 and those with cardiac failure or a history of peptic ulceration or bleeding. Ibuprofen may be less prone to cause these problems than other NSAIDs. 

As it is seen from Eq. (62b) and (62e), the method allowed for the synthesis of moderately enantioenriched methyl esters of the commercially available drugs ibuprofen (224), 60% ee [136] or naproxen (230), 47% ee [136], from optically active carbamates 222 or 228, respectively. The final step is a reductive removal of the carbamoyloxy group by Pd-catalyzed hydrogenolysis, which proceeds with inversion [138-140] but some erosion of the enantiomeric purity results. 

Magnesium hydroxide increased the initial absorption of ibuprofen and flurbiprofen, but had no effect on ketoprofen. Unexpectedly, a pharmacodynamic study showed increased gastric erosions when ibuprofen was formulated with magnesium hydroxide. 

Ibuprofen may cause gastric ulcers (63 ), and haematemesis has been reported (99 ). Gastric mucosal erythema and oedema with petechial haemorrhages and erosions have been reported (35 ). Tests for faecal occult blood may be positive (106 ). Ibuprofen suppositories may cause local irritation (110 ). 

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