Home' Australian Pharmacist : Australian Pharmacist June 2016 Contents Australian Pharmacist June 2016 I ©Pharmaceutical Society of Australia Ltd.
CONTINUING PROFESSIONAL DEVELOPMENT
Contrary to popular belief, OTC
ibuprofen has the same low risk of GI
side effects as paracetamol and placebo
when taken as directed.2,9,11
that ibuprofen is also suitable for the
majority (77%) of the population and
the prevalence of inflammation with
pain is high,
14,23 there may be a need
for pharmacists to re-assess their
perceptions about ibuprofen and its
place as a pharmacy analgesic.
1. Reckitt Benckiser. Data on file: recommendation tracking
2. Cegedim strategic data. Omnibus: retail pharmacists. 2012.
3. Core ibuprofen product information. 2005. At: www.tga.
4. Bjarnason I. Ibuprofen and gastrointestinal safety: a
dose-duration-dependent phenomenon. J R Soc Med
5. Ricciotti E, FitzGerald GA. Prostaglandins and inflammation.
Arterioscler Thromb Vasc Biol 2011;31(5):986–1000.
6. Castellsague J, Riera-Guardia N, Calingaert B, et al. Individual
NSAIDs and upper gastrointestinal complications: a
systematic review and meta-analysis of observational
studies (the SOS project). Drug Saf 2012;35(12):1127–46.
7. Ong CK, Lirk P, Tan CH, et al. An evidence-based update
on nonsteroidal anti-inflammatory drugs. Clin Med Res
8. Masso Gonzalez E, Patrignani P, Tacconelli S, et al. Variability
among nonsteroidal antiinflammatory drugs in risk
of upper gastrointestinal bleeding. Arthritis Rheum
9. Rampal P, Moore N, Van Ganse E, et al. Gastrointestinal
tolerability of ibuprofen compared with paracetamol
and aspirin at over-the-counter doses. J Int Med Res
10. Moore N, Ganse E, Le Parc J-M, et al. The PAIN Study:
Paracetamol, aspirin and ibuprofen new tolerability study.
Clin Drug Invest 1999;18(2):89–98 .
11. Kellstein DE, Waksman JA, Furey SA, et al. The safety profile
of nonprescription ibuprofen in multiple-dose use: a meta-
analysis. J Clin Pharmacol 1999;39(5):520–32.
12. Moore RA. Analgesic safety - myths, mysteries and
misconceptions. Int J Clin Pract Suppl 2015(182):24–7 .
13. Derry C, Derry S, Moore RA, et al. Single dose oral ibuprofen
for acute postoperative pain in adults. Cochrane Database
of Systematic Reviews 2009, Issue 3.
14. Clarke GD, Adams IM, Dunagan FM. Using suitability
profiles to better inform consumers’ choice of commonly
used over-the-counter analgesics. Int J Pharm Pract
15. Rainsford KD, Bjarnason I. NSAIDs: take with food or after
fasting? J Pharm Pharmacol 2012;64(4):465–9 .
16. Moore RA, Derry S, Wiffen PJ, et al. Effects of food on
pharmacokinetics of immediate release oral formulations
of aspirin, dipyrone, paracetamol and NSAIDs - a systematic
review. Br J Clin Pharmacol 2015;80(3):381–8 .
17. Rossi S, ed. Australian medicines handbook. Adelaide:
Australian Medicines Handbook; 2016.
18. Sacerdote P, Levrini L. Peripheral mechanisms of dental
pain: the role of substance P. Mediators Inflamm
19. Cathcart S, Winefield AH, Lushington K, et al. Stress
and tension-type headache mechanisms. Cephalalgia
20. Jafri M. Mechanisms of myofascial pain. Int Sch Res Notices
21. Headache Classification Committee of the International
Headache Society (IHS). The international classification
of headache disorders; 3rd edition. Cephalalgia
22. Borghouts JA, Koes BW, Bouter LM. The clinical course and
prognostic factors of non-specific neck pain: a systematic
review. Pain 1998;77(1):1–13.
23. Omoigui S. The biochemical origin of pain: the origin of
all pain is inflammation and the inflammatory response.
Part 2 of 3 – inflammatory profile of pain syndromes. Med
24. Ehrlich G. Low back pain. Bull World Health Organ
1. Ibuprofen is suitable for what
proportion of the population?
2. Which ONE of the following non-
steroidal anti-inflammatory drugs
(NSAIDs) is associated with the lowest
relative gastrointestinal (GI) risk?
3. Which ONE of the following factors
is NOT proven to affect the GI
tolerability of NSAIDs?
b) Duration of therapy.
d) Food pharmacokinetics.
4. Which ONE of the following
statements regarding the food
pharmacokinetics of ibuprofen is
a) Taking ibuprofen without food improves
its rate of absorption and is associated
with better early pain relief.
b) Taking ibuprofen without food results in
c) Taking ibuprofen without food results in
higher early plasma concentrations and
better overall pain relief.
d) Taking ibuprofen without food improves
5. Which ONE of the following
statements regarding the GI
tolerability of ibuprofen is CORRECT?
a) The GI tolerability profile of over-the-
counter (OTC) ibuprofen is at least as
good as paracetamol and placebo when
taken as directed in the majority of the
b) Ibuprofen is one of the best tolerated
NSAIDs due to its mechanism of action
as a selective COX-2 inhibitor.
c) The GI tolerability profile of ibuprofen
is the same regardless of dose and
duration of therapy.
d) While incidence of overall GI adverse
events is statistically equivalent for
OTC ibuprofen and paracetamol, the
incidence of dyspepsia is significantly
higher for ibuprofen.
KEY LEARNING POINTS
OTC ibuprofen is suitable for the majority (77%) of the population, for whom it
has the same low risk of GI side effects as paracetamol and placebo when taken as
There is significant variability in the GI risk profile of different NSAIDs; ibuprofen has
one of the lowest GI risk profiles of all NSAIDs.
The 2016 Australian Medicines Handbook recommends taking ibuprofen with water
alone. Taking ibuprofen on an empty stomach may improve absorption, resulting in
improved efficacy and reduced need for re-medication.
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