Renal failure ibuprofen

NSAID-induced acute renal decompensation is a pharmacologically predictable phenomenon that possesses a dose-dependent component. In a triplecrossover study of 12 females with mild renal failure, ibuprofen (800 mg three times daily) was discontinued in 3 pahents after 8 days because of worsening renal function (> 133 pmol/L - > 1.5 mg/dl increase in serum creahnine) or hyperkalemia (potassium > 6 mmol/ml). When these 3 pahents were rechallenged at a 50% lower dose of ibuprofen, two developed evidence of acute renal deteriorahon [45]. 

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... 

These drugs are the most prescribed medicines in the world. For certain NSAIDs, ibuprofen and indomethacin, there has been shown a dose response relation for renal failure risk. For individual NSAIDs, those with longer half lives than 12 hours have proved to be more dangerous. There has not been shown any clear advantages for selective cox-2-inhibition to the more unselective in this aspect. 

Ramachandran S, Giles PD, Hartland A. Acute renal failure due to rhabdomyolysis in presence of concurrent cipro-fibrate and ibuprofen treatment. BMJ 1997 314(7094) 1593. 

The concomitant administration of ibuprofen antagonizes the irreversible platelet inhibition induced by aspirin. Thus, treatment with ibuprofen in patients with increased cardiovascular risk may limit the cardioprotective effects of aspirin. Rare hematologic effects include agranulocytosis and aplastic anemia. Effects on the kidney (as with all NSAIDs) include acute renal failure, interstitial nephritis, and nephrotic syndrome, but these occur very rarely. Finally, hepatitis has been reported. 

Sanders LR (1995) Exercise-induced acute renal failure associated with ibuprofen, hydrochlorothiazide, and triamterene. J Am Soc Nephrol 5 2020-2023... 

Fong HJ, Cohen AH. Ibuprofen-induced acute renal failure with acute tubular necrosis. Am J Nephrol 1982 2(1) 28-31. 

Kovesi TA, Swartz R, MacDonald N. Transient renal failure due to simultaneous ibuprofen and aminoglycoside therapy in children with cystic fibrosis. N Engl J Med 1998 338(l) 65-6. 

Whelton A, Stout RL, SpUman PS, Klassen DK. Renal effects of ibuprofen, piroxicam, and sulindac in patients with asymptomatic renal failure. A prospective, randomized, crossover comparison. Ann Intern Med 1990 112(8) 568-76. 

Sheiner PA, Mor E, Chodoff L, Glabman S, Emre S, Schwartz ME, Miller CM. Acute renal failure associated with the use of ibuprofen in two liver transplant recipients on FK506. Transplantation 1994 57(7) 1132-3. 

Patients with chronic renal impairment because of diminished renal prostaglandin production may also be at increased risk of NSAID-induced renal failure. NSAID-induced acute kidney injury has been documented in patients with asymptomatic, but mild chronic renal failure, defined as a recruitment serum creatinine between 133 pmol/L and 265 pmol/L (1.5 and 3.0 mg/dl) [45]. Baseline excretion of urinary prostaglandin and 6-keto-prostaglandin F was quantitatively lower in the individuals who developed NSAID-induced renal decompensation than in those who did not. Upon initiation of ibuprofen, urinary prostaglandin excretion fell in all patients, but trough concentrations were quantitatively lower in the subset of patients who experienced acute kidney injury. 

An additional important finding from this study was the hme of onset of acute renal decompensation. Ibuprofen-induced renal failure occurred rapidly (within 8 days), but piroxicam and sulindac were not associated with any deterioration of renal function during the 11-day treatment period [39]. A pharmacokinetic analysis of the drugs used in these patients suggested the following Ibuprofen, which has a short elimination half-life, reached maximum serum concen-... 

Two prospective, crossover, placebo controlled, double-bhnd evaluations of the nephroprotective role of misoprostol in patients with mild stable chronic renal failure, taking either ibuprofen or indomethacin have been reported [183]. The mean baseline GFR of the patients at the time of entry into the study was 53 ml/min (misoprostol)/55 ml/min (placebo), and 57 ml/min (misoprostol)/57 ml/min (placebo) in Study I (ibuprofen) and Study II (indomethacin) respectively. At this level of renal functional impairment, the use of the non-selective NSAIDs did not produce additional significant impairment of renal function, hence a renal protective role for misoprostol could not be... 

The mechanisms of ibuprofen-induced toxicity have not been clearly defined. Acute renal failure is postulated to result from decreased production of intrarenal prostaglandins via inhibition of the cyclooxygenase pathway. In turn, this will decrease the renal blood flow and glomerular filtration rate. Ibuprofen also interferes with prostaglandin synthesis in the gastrointestinal system that can contribute to its irritating effect on the mucosa of the gastrointestinal tract. 

Ibuprofen is not recommended for use in animals. Dogs appear to be exquisitely sensitive to the propionic acid group of nonsteroidal anti-inflammatory drugs (NSAIDs) and easily develop gastric ulcers and renal failure. Seizures have been reported in both dogs and cats after ingestion of ibuprofen. 

The majority of patients who acutely overdose on ibuprofen remain asymptomatic. In one retrospective study of ibuprofen overdoses, only 19% of patients developed symptoms. Abdominal pain, nausea, vomiting, lethargy, and drowsiness are the most frequently reported symptoms. In rare instances of massive acute overdose, apnea, seizures, hypotension, metabolic acidosis, renal failure, and coma have occurred. 

Renal failure can occur within days of initiating therapy, particularly with a short-acting NSAID such as ibuprofen. Urine volume and sodium concentration are usually low, edema and/or weight gain is noticeable, and BUN, serum creatinine, and potassium are typically elevated. The urine sediment is usually unchanged from baseline, but may show granular casts. 

Ibuprofen 3200 2-4 Massive overdose may cause coma, renal failure, metabolic acidosis, and cardiorespiratory depression. 

A. With the more toxic agents oxyphenbutazone, phenylbutazone, mefe-namic acid, or piroxicam, and with massive ibuprofen or fenoprofen overdose, seizures, coma, renal failure, and cardiorespiratory arrest may occur. Hepatic dysfunction, hypoprothrombinemia, and metabolic acidosis ate also reported. 

Two iiver transplant patients taking tacrolimus developed acute renal failure after also taking ibuprofen. 

Two patients with liver transplants taking tacrolimus developed acute but reversible renal failure, one after taking four Motrin (ibuprofen) tablets (strength not stated) and the other after three 400-mg tablets of ibuprofen taken over 24 hours. Both had stable renal function before taking the ibuprofen. ... 

NSAIDs are known to inhibit prostaglandin synthesis and as a result may decrease renal blood flow, which in certain circumstances can lead to renal failure. Renal impairment is more likely to occur in the presence of renal vasoconstrictors. Tacrolimus is known to cause renal vasoconstriction and thus the combined effects of ibuprofen and tacrolimus may have led to acute renal failure. Both patients also had a degree of liver impairment, which the authors suggest may have potentiated the toxicity of tacrolimus with ibuprofen. 

An isolated report describes a patient taking ciprofibrate who developed acute renal failure and rhabdomyolysis after taking ibuprofen. 

Kimberly, R.P., Sherman, R.L., Mouradian, J. and Lockshin, M.D. (1979). Apparent acute renal failure associated with therapeutic aspirin and ibuprofen administration. Arthr. Rheum., 22, 281-85... 

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