Drugs List

Therapeutic Indications

Uses

Symptomatic relief of minor muscular sprains and cramps

Contraindications

Children under 12 years
Nasal polyps, angioedema, and bronchospastic reactivity to NSAIDs
Third trimester of pregnancy

Precautions and Warnings

Children aged 12 to 14 years
Asthma
Breastfeeding
First trimester of pregnancy
Peptic ulcer
Renal impairment
Second trimester of pregnancy

May precipitate bronchospasm in patients with asthma or allergy
Not all available brands are licensed for all age groups
Some formulations contain propylene glycol
Advise patient to wash hands after use
Avoid broken or inflamed skin
Avoid contact with eyes
Avoid contact with mucous membranes
Avoid occlusive dressings
Discontinue treatment if rash occurs
Maintain treatment at the lowest effective dose
Advise patient residue on clothing/bedding may cause fire hazard
Advise patient that photosensitivity possible
Fire hazard: Keep away from naked flames and potential sources of ignition
Refer to doctor if symptoms persist after 2 weeks treatment

Pregnancy and Lactation

Pregnancy

Ibuprofen is contraindicated during the 3rd trimester of pregnancy and should be used with caution in the first 2 trimesters.

Whilst no teratogenic effects have been demonstrated in animal experiments, the use of ibuprofen during the first and second trimesters should, if possible, be avoided. NSAIDs have been associated with spontaneous abortions and congenital abnormalities. During the 3rd trimester, Ibuprofen is contraindicated as there is a risk of premature closure of foetal ductus arteriosus with possible persistent pulmonary hypertension. The onset of labour may be delayed and the duration increased with an increased bleeding tendency in both mother and child. There is limited evidence that drugs which inhibit cyclooxygenase / prostaglandin synthesis may cause impairment of female fertility by an effect on ovulation. This is reversible on withdrawal of treatment. The use of systemic ibuprofen is therefore not recommended in women attempting to conceive (Schaefer, 2007).

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Use ibuprofen with caution in breastfeeding.

At the time of writing there are is limited published experience concerning the use of Ibuprofen during breast feeding. Ibuprofen appears in breast milk in very low concentrations and unlikely to affect the breast-fed infant adversely. Because of its extremely low levels in breast milk and short half-life ibuprofen is a preferred choice as an analgesic or anti-inflammatory agent in nursing mothers.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Side Effects

Abdominal pain
Aggravation of existing asthma
Allergic reaction
Anaphylaxis
Angioedema
Application site reaction
Asthma
Bronchospasm
Bullous dermatoses
Dyspepsia
Dyspnoea
Erythema multiforme
Hypersensitivity reactions
Pruritus
Purpura
Rash
Renal failure
Renal impairment
Toxic epidermal necrolysis
Urticaria

Presentation

Topical formulations of ibuprofen

Drugs List

Therapeutic Indications

Uses

Symptomatic relief of minor muscular sprains and cramps

Dosage

Therapy should be reviewed after few weeks.

Undesirable effects may be reduced by using the minimum effective dose for the shortest possible duration.

Adults

Elderly

Children

Contraindications

Children under 12 years
Nasal polyps, angioedema, and bronchospastic reactivity to NSAIDs
Third trimester of pregnancy

Precautions and Warnings

Children aged 12 to 14 years
Asthma
Breastfeeding
First trimester of pregnancy
Peptic ulcer
Renal impairment
Second trimester of pregnancy

May precipitate bronchospasm in patients with asthma or allergy
Not all available brands are licensed for all age groups
Some formulations contain propylene glycol
Advise patient to wash hands after use
Avoid broken or inflamed skin
Avoid contact with eyes
Avoid contact with mucous membranes
Avoid occlusive dressings
Discontinue treatment if rash occurs
Maintain treatment at the lowest effective dose
Advise patient residue on clothing/bedding may cause fire hazard
Advise patient that photosensitivity possible
Fire hazard: Keep away from naked flames and potential sources of ignition
Refer to doctor if symptoms persist after 2 weeks treatment

Pregnancy and Lactation

Pregnancy

Ibuprofen is contraindicated during the 3rd trimester of pregnancy and should be used with caution in the first 2 trimesters.

Whilst no teratogenic effects have been demonstrated in animal experiments, the use of ibuprofen during the first and second trimesters should, if possible, be avoided. NSAIDs have been associated with spontaneous abortions and congenital abnormalities. During the 3rd trimester, Ibuprofen is contraindicated as there is a risk of premature closure of foetal ductus arteriosus with possible persistent pulmonary hypertension. The onset of labour may be delayed and the duration increased with an increased bleeding tendency in both mother and child. There is limited evidence that drugs which inhibit cyclooxygenase / prostaglandin synthesis may cause impairment of female fertility by an effect on ovulation. This is reversible on withdrawal of treatment. The use of systemic ibuprofen is therefore not recommended in women attempting to conceive (Schaefer, 2007).

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Use ibuprofen with caution in breastfeeding.

At the time of writing there are is limited published experience concerning the use of Ibuprofen during breast feeding. Ibuprofen appears in breast milk in very low concentrations and unlikely to affect the breast-fed infant adversely. Because of its extremely low levels in breast milk and short half-life ibuprofen is a preferred choice as an analgesic or anti-inflammatory agent in nursing mothers.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Side Effects

Abdominal pain
Aggravation of existing asthma
Allergic reaction
Anaphylaxis
Angioedema
Application site reaction
Asthma
Bronchospasm
Bullous dermatoses
Dyspepsia
Dyspnoea
Erythema multiforme
Hypersensitivity reactions
Pruritus
Purpura
Rash
Renal failure
Renal impairment
Toxic epidermal necrolysis
Urticaria

Overdosage

It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

The following number will direct the caller to the relevant local centre (0844) 892 0111

Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Further Information

Last Full Review Date: September 2013

Reference Sources

British National Formulary, 66th Edition (September 2013-March 2014) Pharmaceutical Press, London.

Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment, 2nd edition (2007) ed. Schaefer, C., Peters, P. and Miller, R. Elsevier, London.

Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 9th edition (2011) ed. Briggs, G., Freeman, R. and Yaffe, S. Lippincott Williams & Wilkins, Philadelphia.

Summary of Product Characteristics: Fenbid 5% Gel. Amdipharm Mercury Company Ltd. Revised September 2012.
Summary of Product Characteristics: Fenbid Forte 10% Gel. Amdipharm Mercury Company Ltd. Revised September 2012.

Summary of Product Characteristics: Ibuderm. Dermal Laboratories Ltd. Revised October 2010.

Summary of Product Characteristics: Ibugel. Dermal Laboratories Ltd. Revised October 2007.
Summary of Product Characteristics: Ibugel Forte 10%. Dermal Laboratories Ltd. Revised October 2007.

Summary of Product Characteristics: Ibuleve Gel. Diomed Developments Ltd. Revised May 2010.
Summary of Product Characteristics: Ibuleve Speed Relief Gel. Diomed Developments Ltd. Revised October 2010.
Summary of Product Characteristics: Ibuleve Speed Relief 5% spray. Diomed Developments Ltd. Revised November 2010.
Summary of Product Characteristics: Ibuleve Speed Relief Max Strength Gel. Diomed Developments Ltd. Revised June 2010.
Summary of Product Characteristics: Ibuleve Maximum Strength Gel. Diomed Developments Ltd. Revised October 2007.

Summary of Product Characteristics: Ibuspray. Dermal Laboratories Ltd. Revised November 2010.

Summary of Product Characteristics: Nurofen Joint & Back Pain Relief 5% Gel. Reckitt Benckiser Healthcare (UK) Ltd. Revised December 2015.
Summary of Product Characteristics: Nurofen Joint & Back Pain Relief Max Strength 10% Gel. Reckitt Benckiser Healthcare (UK) Ltd. Revised October 2015.

Summary of Product Characteristics: Nurofen Maximum Strength 10% Gel. Reckitt Benckiser Healthcare (UK) Ltd. Revised February 2013.

Summary of Product Characteristics: Phorpain Gel 5%. Amdipharm Mercury Company Ltd. Revised September 2012.
Summary of Product Characteristics: Phorpain Gel Maximum Strength. Amdipharm Mercury Company Ltd. Revised September 2012.

Summary of Product Characteristics: Radian B Ibuprofen 5% Gel. Thornton & Ross Ltd. Revised August 2013.

US National Library of Medicine. Toxicology Data Network. Drugs and Lactation Database (LactMed).
Available at: https://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT
Ibuprofen. Last revised: September 7, 2013
Last accessed: September 12, 2013