Bleeding ibuprofen

Although extraordinary in its powers, aspirin is also more dangerous than commonly believed. Only about 15 g can be fatal to a small child, and aspirin can cause stomach bleeding and allergic reactions in long-term users. Even more serious is a condition called Reye s syndrome, a potentially fatal reaction to aspirin sometimes seen in children recovering from the flu. As a result of these problems, numerous other NSAIDs have been developed in the last several decades, most notably ibuprofen and naproxen. 

Use with caution in patients with renal failure (dehydration) and bleeding Ibuprofen children 10 mg/kg every 6-8 hours adult 200-400 mg/dose Naproxen 5 mg/kg every 12 hours adult 250-500 mg/dose... 

Low-dose aspirin is associated with a reduced risk of major bleeding, particularly GI bleeding. Other GI disturbances (e.g., dyspepsia, nausea) are infrequent with low-dose aspirin. Ibuprofen should not be administered on a regular basis concurrently with aspirin because it may block aspirin s antiplatelet effects. 

The FDA approved this selective cyclooxigenase (COX)-2 inhibitor (Vioxx) for the treatment of pain and inflammation in 1999. This NSAID demonstrated to have a lower risk of side effects such as gastrointestinal ulcers and bleeding than nonse-lective COX inhibitors, for example, ibuprofen. In 2004, a long-term study of Vioxx in patients at increased risk of colon polyps was halted because of an increased cardiovascular risk (heart attack, stroke) in the rofecoxib group. Subsequently, Merck withdrew the drug from the world market at the end of September 2004 [46]. 

Recent advances with other anti-inflammatory drugs, ibuprofen and naproxen, which only work by physically blocking the channel to arachidonic acid, mean that the adverse effect of stomach bleeding can be avoided. 

COX-1 is found in healthy individuals and is important in maintaining a balanced physiological role in kidneys and stomach. COX-2, on the other hand, is induced in the case of inflammation where it mediates the inflammation process. Aspirin, ibuprofen, and naproxen inhibit both COX-1 and COX-2 indiscriminately. While this reduces the production of PGE2 through the inhibition of COX-2, it upsets the hemostasis function of COX-1, which has a protective function for the mucosal lining, and leads to bleeding and ulcer formation. 

Other- Gastritis (etodolac) pyrosis (meclofenamate) heartburn (naproxen, meclofenamate, ibuprofen, mefenamic acid, piroxicam) Gl distress (tolmetin) epigastric pain (ibuprofen) indigestion (ibuprofen) Gl tract fullness (ibuprofen) Gl pain (sulindac) gross bleeding (mefenamic acid). 

HydroNarcotic Analgesic/NSAID] Uses Mod-severe pain (<10 d) Action Narcotic w/ NSAID Dose 1—2 tabs q4-6h PRN Caution [C, M] Renal insuff -1- effect w/ ACE inhibitors diuretics t effect w/ CNS d ressants, EtOH, MAOI, ASA, TCA, anticoagulants Contra Component sensitivity Disp Tabs SE Sedation, fatigue, GI upset see Hydrocodone Acetaminophen Interactions -1- Effects OF ACEIs, diuretics EMS See Hydrocodone Acetaminophen T risk of bleeding w/ heparin use OD See individual agents... 

Fenoprofen (Nalfon) is chemically and pharmacologically similar to ibuprofen and is used in the treatment of rheumatoid arthritis, osteoarthritis, and mild to moderate pain. GI effects such as dyspepsia and pain are most common, although dizziness, pruritus, and palpitations may occur. GI bleeding, sometimes severe, has been reported, and interstitial nephritis has been rarely associated with this drug. Concomitant administration of aspirin decreases the biological half-Ufe of fenoprofen by increasing the metabolic clearance of hydroxy-lated fenoprofen. Chronic administration of pheno-barbital also decreases the drug s half-life. 

Naproxen (Naprosyn) also has pharmacological properties and clinical uses similar to those of ibuprofen. It exhibits approximately equal selectivity for COX-1 and COX-2 and is better tolerated than certain NSAIDs, such as indomethacin. Adverse reactions related to the GI tract occur in about 14% of all patients, and severe GI bleeding has been reported. CNS complaints (headache, dizziness, drowsiness), dermatological effects (pruritus, skin eruptions, echinoses), tinnitus, edema, and dyspnea also occur. 

C. The likelihood of gastric ulceration and GI bleeding is increased by heavy alcohol use, poor health, advanced age, long-term NS AID use, and use of drugs such as corticosteroids and anticoagulants. Ibuprofen is not converted to a cardiotoxic metabolite. Dermal toxicities, such as epidermal necrolysis, are rare complications of ibuprofen therapy, but necrotizing fasciitis is not one of them. Confusion and ataxia are not side effects associated with ibuprofen, nor is eosinophilia. 

Avoid alcohol and aspirin during ibuprofen therapy because these substances increase the risk of G1 bleeding... 

The incidence of upper gastrointestinal bleeding in over-the-counter use is low but still double that of over-the-counter ibuprofen (perhaps due to a dose effect). Rare cases of allergic pneumonitis, leukocytoclastic vasculitis, and pseudoporphyria as well as the common NSAID-associated adverse effects have been noted. 

Because of reported antiplatelet effects, patients using anticlotting medications (eg, warfarin, aspirin, ibuprofen) should use garlic cautiously. Additional monitoring of blood pressure and signs and symptoms of bleeding is warranted. Garlic may reduce the bioavailability of saquinavir, an antiviral protease inhibitor, but it does not appear to affect the bioavailability of ritonavir. 

Aspirin (now a generic name) is one of a number of nonsteroidal antiinflammatory drugs (NSAIDs) others include ibuprofen and naproxen (see Fig. 21-15), all now sold over the counter. Unfortunately, aspirin reduces but does not eliminate the side effects of salicylates. In some patients, aspirin itself can produce stomach bleeding, kidney failure, and, in extreme cases, death. New NSAIDs with the beneficial effects of aspirin but without its side effects would be medically valuable. 

A 55-year-old woman with Von Willebrand s disease was found comatose (44). She had received desmopressin as prophylaxis for bleeding several times before without problems. On this occasion she had also received ibuprofen as a pain killer. She was hyponatremic. 

Cyclooxygenase (COX) forms prostanoids that are active throughout the body. Beyond pain and inflammation, prostanoids also play a role in maintaining the mucosal lining of the stomach. Long-term use of NSAIDs like aspirin, ibuprofen, and naproxen can lead to increased incidence of ulcers and stomach bleeding in patients. 

Ibuprofen should not be combined with acetaminophen or other anti-inflammatory medications, because of the possibility of toxic effects on the liver and kidneys. In addition, repeatedly taking ibuprofen in combination with alcohol may cause stomach ulcers or bleeding. 

Ibuprofen is associated with the lowest risk of GI bleeding compared to other NSAIDs. 

Diclofenac may be a second-line option, but it has a higher risk of both hepatotoxicity and GI bleeding than ibuprofen. 

---