Ibuprofen and adverse reactions.

Question: Ibuprofen is NSAIDs with the lowest risk for GI bleeding, is it true or not?

Answer:

NSAIDs (or non-steroidal anti-inflammatory drugs), which usually mean the conventional NSAIDs or non-selective NSAIDs that inhibit prostaglandin by inhibiting cyclooxygenase enzyme (COX), both COX-1 and COX-2.

Drugs in this group have pain relief, can reduce fever and reduce inflammation. So they usually used to relieve pain and reduce inflammation in arthritis and more.

Inhibiting COX-1 cause irritation in the stomach and cause bleeding in the digestive tract, so adverse drug reaction is gastro-intestinal bleeding (GI bleeding)

The adverse reactions occurred more or less is based on the type of drugs that affect COX-1 more or less.

It also depends on the dose and age of the patient.

The adverse reactions occurred more or less is based on the type of drugs that affect COX-1 more or less. It also depends on the dose and age of the patient. (elderly often have more adverse drug reaction).

NSAIDs not only cause adverse reactions on the stomach but  also affect  the intestine.

Non-selective NSAIDs (such as Ibuprofen, diclofenac, naproxen, indomethacin and piroxicam) and the risk of GI bleeding, compared with the paracetamol.

From the above image.

Ibuprofen 1200 mg / day had the lowest risk of GI bleeding, compared with paracetamol. But ibuprofen ≥1,200 mg / will has the risk of GI bleeding more than paracetamol.

The other drugs mentioned above, even in low doses, namely diclofenac <75 mg / day, indomethacin ≤50 mg / day, naproxen <500 mg / day and piroxicam ≤10 mg / day. These increase the risk of GI bleeding a lot, especially piroxicam (see image).

References:

(1) Moore N, Pollack C, Butkerait P. Adverse drug reactions and drug-drug interactions with over-the-counter NSAIDs. Ther Clin Risk Manag 2015; 11: 1061-75; (2) Scarpignato C, Lanas A, Blandizzi C, Lems WF, Hermann M, Hunt RH, et al. Safe prescribing of non-steroidal anti-inflammatory drugs in patients with osteoarthritis - an expert consensus addressing benefits as well as gastrointestinal and cardiovascular risks. BMC Med 2015; 13: 55. doi: 10.1186 / s12916-015-0285-8.