NSAIDs should be given with care to patients with a history of gastrointestinal disease (ulcerative colitis, Crohn's disease) as these conditions may be exacerbated (see section 4.8). This is reversible on withdrawal of treatment.
There is some evidence that drugs which inhibit cyclooxygenase/ prostaglandin synthesis may cause impairment of female fertility by an effect on ovulation. hypertension, hyperlipidaemia, diabetes mellitus, smoking), particularly if high doses of ibuprofen (2400 mg/day) are required. Patients with uncontrolled hypertension, congestive heart failure (NYHA II-III), established ischaemic heart disease, peripheral arterial disease, and/or cerebrovascular disease should only be treated with ibuprofen after careful consideration and high doses (2400 mg/day) should be avoided.Ĭareful consideration should also be exercised before initiating long-term treatment of patients with risk factors for cardiovascular events (e.g. ≤1200mg/day) is associated with an increased risk of arterial thrombotic events. Overall, epidemiological studies do not suggest that low dose ibuprofen (e.g. Hepatic dysfunction (see sections 4.3 and 4.8)Ĭardiovascular and cerebrovascular effects:Ĭaution (discussion with doctor or pharmacist) is required prior to starting treatment in patients with a history of hypertension and/or heart failure as fluid retention, hypertension and oedema have been reported in association with NSAID therapy.Ĭlinical studies suggest that use of ibuprofen, particularly at a high dose (2400mg/day) may be associated with a small increased risk of arterial thrombotic events (for example myocardial infarction or stroke). There is a risk of renal impairment in dehydrated children and adolescents Renal impairment as renal function may further deteriorate (see sections 4.3 and 4.8). Systemic lupus erythematosus and mixed connective tissue disease – increased risk of aseptic meningitis (see section 4.8) The use of Ibuprofen with concomitant NSAIDs including cyclooxygenase-2 selective inhibitors should be avoided (see section 4.5). The elderly have an increased frequency of adverse reactions to NSAIDs especially gastrointestinal bleeding and perforation which may be fatal.īronchospasm may be precipitated in patients suffering from, or with a history of, bronchial asthma or allergic disease. Undesirable effects may be minimised by using the lowest effective dose for the shortest duration necessary to control symptoms (see GI and cardiovascular risks below).