Perforation ibuprofen

The same warning applies to evaluation of the incidence of complicated ulcers (bleeds, perforation, and obstructions). The incidence of these serious events with celecoxib was 2.7% (11 events) versus 5% (20 events) in patients taking diclofenac or ibuprofen, a non-significant difference. 

To study effects on clinically important GI complications with celecoxib, the CLASS study used celecoxib (400 mg twice daily, or twice the highest FDA-approved dose) compared to diclofenac and ibuprofen at standard dose. Celecoxib use was reported to be associated with a reduced incidence for the combined end point of symptomatic ulcers and ulcer complications (perforations, gastric outlet obstruction, or bleeding). Some subjects also used aspirin for car-dioprotection, but there is concern that GI safety of COX-2 inhibitors is blunted with use of concomitant aspirin (even 30 mg of aspirin can suppress gastric prostaglandin prodnction)." For patients taking aspirin and celecoxib, nicer complications were higher than with celecoxib only, but lower than with traditional NSAIDs. 

The risk of serious upper gastrointestinal bleeding was inereased by the use of more than one NSAID in a meta-analysis of data from three ease-eontrolled studies (odds ratio 4.9 with one NSAID and 10.7 with two). Another study provided similar findings the odds ratio was 7.1 with one NSAID and 12.3 with two or more NSAIDs. Similar findings have been reported with aspirin and NSAIDs, see NSAIDs + Aspirin Anti-inflammatory dose , p.l42. Analysis of yellow eard reports to the CSM in the UK, of gastrointestinal perforation, obstruetion, uleeration or bleeding with diclofenac, naproxen, and ibuprofen, revealed that 6% of the patients were reeeiving another non-aspirin NSAID. ... 

NSAIDs, including ibuprofen, are contraindicated in patients with active bleeding, ulceration, or perforated viscous. NSAIDs are contraindicated in the setting of acute or chronic renal dysfunction. NSAIDs have been shown to increase the risk of cardiovascular thrombotic events, myocardial infarction, and stroke, especially in patients with known cardiovascular disease or with known risk factors for cardiovascular... 

Serious gastrointestinal toxicity such as ulceration, bleeding, and perforation can occur at any time, with or without warning symptoms in patients receiving chronic ibuprofen treatment. In patients... 

A lower gastrointestinal risk with coxibs was confirmed in a retrospective case-control study of the incidence of peptic ulcer bleeding and perforation in users of COX-2 selective and non-selective NSAIDs [3 ]. The study was based on 2.2 million adults taking celecoxib, diclofenac, ibuprofen, naproxen, rofecoxib, or valdecoxib. Adjusted odds ratios (OR) compared with naproxen were ibuprofen 0.86 (95% Cl = 0.68, 1.09), rofecoxib 0.79 (0.62, 1.02), diclofenac 0.66 (0.47, 0.94), valdecoxib 0.50 (0.26, 0.97), and celecoxib 0.45 (0.35, 0.58). The overall... 

Gastrointestinal Esophageal perforation has been attributed to ibuprofen [42 ]. 

An 18-year-old man developed sudden onset, severe, retrosternal pain, dysphagia, and odynophagia after taking ibuprofen capsules. An X-ray and CT scan showed esophageal perforation. 

Singh NP, Rizk JG. Oesophageal perforation following ingestion of over-the-counter ibuprofen capsules. J Laryngol Otol 2008 122(8) 864-6. 

NSAIDs, such as aspirin, IND, ketoprofen, ibuprofen, naproxen, sulindac and flurbiprofen, are widely used in treatment of chronic inflammatory diseases. Recent studies have also shown that they have activity in retardation of colonic tumor growth [89-91]. However, oral administration of NSAIDs usually generates gastrointestinal side effects (e.g. gastric ulcers and gastric perforation) [92]. Therefore, colon-specific and controlled release of NSAIDs are important to achieve sustained pharmacologic effects and reduce the side effects. 

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