Ibuprofen

Ibuprofen is a non-steroidal anti-inflammatory drug, usually shortened to NSAID. It blocks the cyclo-oxygenase enzymes, so the body produces fewer prostaglandins, the messengers behind much of the pain, swelling and raised temperature that follow an injury or a flare of arthritis. Over-the-counter labels in Britain cover tension headache, dental pain, period cramps, lower back and muscle strain, rheumatic aches, cold and flu symptoms and a high temperature. At 600 mg the medicine moves into prescription territory, where the target is rheumatoid arthritis, osteoarthritis and sprains or strains. The effect is symptomatic: the tablets calm the pain, but they do not cure a joint disease or clear an infection.

Pack counts depend on the strength: 30, 60 or 90 tablets for both 200 mg and 400 mg, but only 60 or 90 for 600 mg. The stock is imported, so the carton and the foil strip may follow the layout of another country. Before the first dose, read the strength and expiry date printed on the strip itself and make sure they match what you meant to order. Keep the blisters in a dry place away from heat and out of children’s reach.

There is no single UK category for every ibuprofen tablet, because the status follows each product licence. A 200 mg tablet in a pack of 16 is on the general sale list (GSL). A 400 mg tablet in a pack of 24 is a pharmacy (P) medicine, handed over under a pharmacist’s supervision. Bigger packs of the same tablets also exist in the UK and are classed differently from the small ones, and the 600 mg tablet is a prescription-only medicine (POM). UK brands include Nurofen and Cuprofen alongside many unbranded generics. If you are unsure which category applies to the pack you hold, ask a pharmacist.

The over-the-counter SmPC for the 400 mg tablet allows an adult to take a dose up to three times in a day, with at least four hours between doses, and no more than 1200 mg in 24 hours. Symptoms that outlast 10 days in an adult, or 3 days in a teenager, are a reason to see a doctor instead of carrying on. For the 600 mg prescription tablet, the starting range in arthritis is 1200 to 1800 mg a day in divided doses, and the maintenance range is 600 to 1200 mg. The daily ceiling is 2400 mg, a single dose should not exceed 800 mg, and the product is not intended for anyone under 15. The general rule in every SmPC is the lowest effective dose for the shortest time.

Avoid it if aspirin or another NSAID has ever caused asthma, hives, a runny nose or swelling of the face. A current or repeated stomach or duodenal ulcer, earlier bleeding or perforation linked to NSAIDs, a clotting disorder, severe heart failure and severe liver or kidney failure are also on the exclusion list. In the last three months of pregnancy ibuprofen must not be used at all. Older adults are more prone to gastrointestinal bleeding. Tell the doctor or pharmacist about asthma, Crohn’s disease, ulcerative colitis, lupus, high blood pressure, heart disease or a previous stroke before starting.

Taken with warfarin or another anticoagulant, with aspirin, clopidogrel, corticosteroid tablets or SSRI antidepressants, ibuprofen makes bleeding in the gut more likely. It can also blunt some blood pressure medicines and strain the kidneys when combined with diuretics or ACE inhibitors. Cold and flu remedies sometimes hide a second NSAID, so read labels and never double up. Indigestion, nausea, stomach ache, headache and dizziness are the usual complaints; long courses at high doses slightly raise the risk of heart attack and stroke. Black stools or vomit resembling coffee grounds call for urgent help from A&E or 999. Whether you take ibuprofen, and for how long, is a decision for your doctor or pharmacist.