Human Toxicity of Ibuprofen
In the experience of Poisons Information Centres, all drugs, whatever their formulation and intended use, have the potential to be misused in overdosage, either deliberately or accidentally. Ibuprofen, in common with other nonsteroidal anti-inflammatory drugs (NSAIDs), can be shown to cause renal toxicity through inhibition of cyclooxygenase, which in turn blocks production of the renal vasodilators PGE2 and prostacyclin. In contrast to aspirin and paracetamol, ibuprofen does not appear to manifest an additional pathophysiological mechanism in overdosage. The earliest surveys of ibuprofen overdosage all found a low incidence of toxic effects, but their authors also emphasized the need for continuing surveillance for new problems that might emerge only after some years, as had been the case with paracetamol. Patients with evidence of renal impairment related to long-term use of ibuprofen and other NSAIDs are a regular experience in nephrology clinics. Metabolic acidosis is an uncommon but initially alarming clinical finding in both adults and children after acute ibuprofen overdosage.