What happens if ibuprofen overdose

Taking too much ibuprofen, which is called an overdose, can cause dangerous side effects, including damage to your stomach or intestines. In rare cases, an overdose can be fatal. If you think that you or someone you know has overdosed on ibuprofen, contact your local poison center or your local emergency services. In the United States, you can reach the poison center by calling The medication is used by millions to treat:.

The recommended dosage for adults is one or two milligram mg tablets every four to six hours. Adults should not exceed mg at once or 3, mg per day. Adults over the age of 60 should take as little ibuprofen as possible to manage their symptoms.

Older adults have a higher risk of kidney and gastrointestinal side effects. Ibuprofen for children is available in infant drops, liquids, and chewable tablets. Liquid measurements are given in milliliters mL. Make sure to read the label and measure carefully.

Mixing ibuprofen with alcohol can also increase your risk of having serious side effects, like stomach or intestinal bleeding. Not everyone will experience symptoms of an ibuprofen overdose right away. Mild symptoms may include:. Infants who overdose may show signs of lethargy unresponsiveness or apnea temporary cessation of breathing following a more serious overdose of ibuprofen.

It should be ensured that the patient is adequately filled with intravenous fluid to sustain blood pressure prior to the commencement of any additional inotropic support. Despite fluid resuscitation and maximal infusion doses of epinephrine and norepinephrine, the patient remained hypotensive with a systolic blood pressure of 80 mmHg.

Additionally her metabolic acidosis remained resistant to intravenous sodium bicarbonate and haemofiltration with a bicarbonate buffer, with only minor improvement to pH 7.

Samples of ante mortem serum were obtained following admission and were analysed for ibuprofen by the Medical Toxicology Laboratory in London. Post mortem samples of peripheral whole blood, urine, gastric contents and liver extract were analysed at the local toxicology laboratory for ibuprofen and other drugs. Ibuprofen concentrations were measured by high-pressure liquid chromatography with ultraviolet detection.

No other drugs were detected in a broad toxicology screen; analysis of the ante mortem and post mortem serum samples only detected atracurium and lignocaine given following admission to the hospital. The cause of death was probably directly related to the ibuprofen overdose, since there was no evidence of another cause of death at the post mortem examination. Of particular note there was no evidence of cerebral oedema, no underlying artherosclerotic disease of the coronary arteries and no evidence of previous myocardial infarction.

Although there was altered blood in the gastric fluid, there was no evidence of oesophageal or gastric erosions. Severe poisoning and death following poisoning with ibuprofen is extremely uncommon. Most cases are either asymptomatic or experience mild gastrointestinal symptoms only [ 4 , 5 ].

In the case presented here the patient presented after ingestion of up to g sustained-release ibuprofen with a reduced Glasgow Coma Scale, a severe metabolic acidosis and significant haemodynamic compromise. Despite meticulous supportive care initially in the Emergency Department and subsequently in the intensive care unit, attempted correction of her metabolic acidosis and the use of multidose activated charcoal to reduce further ibuprofen absorption from the gastrointestinal tract, the patient did not survive.

This is the first reported case of fatality following ingestion of sustained-release ibuprofen and the first fatality following isolated ibuprofen toxicity. Ibuprofen is a NSAID commonly used as an analgesic, as an anti-pyretic agent and as an anti-inflammatory agent [ 1 , 2 ]. Clinical features of toxicity of ibuprofen and other NSAIDs are predictable and occur due to an inhibition of cyclooxygenase activity.

The American Academy of Clinical Toxicology and European Association of Poisons Centres and Clinical Toxicologists have published a position statement on the use of multidose activated charcoal [ 13 ]. In the case reported here a sustained-release preparation of ibuprofen was ingested, and therefore multidose activated charcoal was recommended to try and reduce further absorption of ibuprofen. Another patient who was found dead who had recently been prescribed an mg preparation of ibuprofen, presumed to be a sustained-release preparation, had a post mortem total ibuprofen concentration of mg in the gastric contents [ 8 ].

Both our case and the other presumed sustained-release case would support the use of multidose activated charcoal in the management of patients who have ingested a sustained-release preparation of ibuprofen in any subsequent cases.

The toxicity of ibuprofen following self-poisoning has been reported in five large case series [ 3 - 5 , 10 , 14 ].

Histories in patients presenting with an overdose have been shown to be unreliable [ 16 ], however, so to try and predict those patients who are at risk of severe ibuprofen-induced toxicity, a nomogram based on the time since ingestion and the serum ibuprofen concentration, similar to that used for paracetamol acetaminophen , has been developed [ 4 ].

Subsequent studies have shown conflicting results as to whether this nomogram is accurate [ 5 ] or inaccurate [ 10 ] at predicting those at risk of severe toxicity. Since ibuprofen concentrations are not routinely available in most emergency departments or hospitals, there are concerns about the accuracy of the nomogram, the toxic effects of ibuprofen are predictable and unlike paracetamol poisoning there is no effective antidote, we would not recommend use of the ibuprofen nomogram in routine clinical practice.

Management of patients presenting following deliberate self-poisoning with ibuprofen consists of gut decontamination with activated charcoal, if they present within one hour of a potentially toxic overdose, and generalised supportive care [ 17 , 18 ]. As already discussed, multidose activated charcoal may be appropriate in patients who have ingested a potentially toxic amount of a sustained-release preparation.

Other more severe features of ibuprofen toxicity should be managed appropriately. Ibuprofen-induced seizures that are nonself-limiting should initially be managed with intravenous diazepam 0. For resistant metabolic acidosis that is not responding, then haemofiltration with a nonlactate bicarbonate buffer may be beneficial.

Although ibuprofen has a relatively low volume of distribution 0. Previous studies have demonstrated no accumulation of ibuprofen in patients with renal impairment [ 20 ] and, in functionally anephric patients undergoing renal replacement therapy with haemodialysis, no accumulation of ibuprofen was seen and there was no detectable ibuprofen in the dialysate, indicating that the ibuprofen was eliminated through metabolism [ 21 ].

This provides further support that extracorporeal treatments will probably not be beneficial in increasing the clearance of ibuprofen in overdose, and there have been no previous reported cases of their attempted use in patients with ibuprofen toxicity. There have been no published studies on the routine prophylactic use of H 2 histamine receptor antagonists or proton pump inhibitors in trying to reduce the risk of ibuprofen or other NSAID-related gastrointestinal toxicity.

There have been nine reported cases of fatality following ibuprofen self-poisoning in the literature to date, although other factors probably contributed to death in eight of these cases [ 3 - 11 ]. The co-ingestion of other drugs at the time of the overdose, such as aspirin, paracetamol, theophylline and cyclobenzaprine, contributed to death in four cases [ 3 , 6 , 7 , 9 ].

You should not take this medicine if you are allergic to acetaminophen, ibuprofen, aspirin, or another NSAID. Ibuprofen can increase your risk of fatal heart attack or stroke, even if you don't have any risk factors. These conditions can occur without warning while you are using acetaminophen and ibuprofen, especially in older adults. If you are pregnant, you should not take acetaminophen and ibuprofen unless your doctor tells you to.

Taking an NSAID during the last 20 weeks of pregnancy can cause serious heart or kidney problems in the unborn baby and possible complications with your pregnancy. Use exactly as directed on the label, or as prescribed by your doctor. Use the lowest dose that is effective in treating your condition.

Do not take more than 6 caplets in a hour period. An ibuprofen overdose can damage your stomach or intestines. An acetaminophen overdose can damage your liver or cause death. Call your doctor if your pain does not improve after 10 days, or if you have any new symptoms such as redness or swelling. Since this medicine is used when needed, you may not be on a dosing schedule.

Skip any missed dose if it's almost time for your next dose. Do not use two doses at one time. Seek emergency medical attention or call the Poison Help line at Overdose symptoms may include weakness, nausea, vomiting, stomach pain, loss of appetite, dark urine, black or bloody stools, coughing up blood, yellowing of your skin or eyes, shallow breathing, fainting, or coma.

Do not use any other medicine that may contain acetaminophen sometimes abbreviated as APAP , or you could have a fatal overdose. They may contain ingredients similar to ibuprofen such as aspirin, ketoprofen, or naproxen.

Avoid taking this medicine if you are taking aspirin to prevent stroke or heart attack. Overdose An overdose is when you take more than the normal or recommended amount of something, often a drug. An overdose may result in serious, harmful sympt Tinnitus is the medical term for "hearing" noises in your ears.

It occurs when there is no outside source of the sounds. Tinnitus is often called "r There are many types of eye problems and vision disturbances, such as: Halos Blurred vision the loss of sharpness of vision and the inability to see Abdominal pain is pain that you feel anywhere between your chest and groin. This is often referred to as the stomach region or belly. Breathing difficulty may involve:Difficult breathing Uncomfortable breathingFeeling like you are not getting enough air.

Breathing that stops from any cause is called apnea. Slowed breathing is called bradypnea. Labored or difficult breathing is known as dyspnea Agitation is an unpleasant state of extreme arousal. An agitated person may feel stirred up, excited, tense, confused, or irritable. Confusion is the inability to think as clearly or quickly as you normally do.

You may feel disoriented and have difficulty paying attention, remembe Drowsiness refers to feeling abnormally sleepy during the day. People who are drowsy may fall asleep in inappropriate situations or at inappropriate A headache is pain or discomfort in the head, scalp, or neck. Serious causes of headaches are rare.