What is Ibuprofen Toxicity?
Ibuprofen is a type of medication that falls into a group called nonsteroidal anti-inflammatory drugs (NSAIDs), and it was discovered by Dr. Stewart Adams in 1961. It was introduced in the United Kingdom in 1969, and then hit the markets in the United States in 1974. As a pain reliever, fever reducer and inflammation reducer, Ibuprofen is often used to treat conditions such as osteoarthritis, rheumatoid arthritis, a type of arthritis in children called juvenile idiopathic arthritis, and general muscle pain. It’s also used in ways not officially approved by regulatory health authorities – such as slowing down disease progression in cystic fibrosis patients. Additionally, ibuprofen is used in newborn babies to close a blood vessel called the patent ductus arteriosus.
Understanding the key properties of ibuprofen and how it works, recognizing what an overdose might look like, and knowing how to manage ibuprofen toxicity is critical in ensuring safe and effective use of the medication.
What Causes Ibuprofen Toxicity?
Taking too much ibuprofen can happen on purpose or by accident. Some people might intentionally take a lot of ibuprofen if they’re trying to harm themselves. Accidental overdoses can happen when someone takes more ibuprofen than the recommended daily amount, typically because they’re dealing with strong or long-lasting pain. Young children can also accidentally ingest too much ibuprofen out of curiosity, which can lead to toxicity.
Risk Factors and Frequency for Ibuprofen Toxicity
Ibuprofen is one of the most widely used and prescribed drugs worldwide. Recent reports indicate that ibuprofen, and similar painkillers, are frequently associated with cases of accidental overdose in both adults and children. In fact, these reports indicate that more than a quarter of overdoses linked to painkillers involved the use of ibuprofen. In the UK, inquiries about ibuprofen are second only to inquiries about acetaminophen. Notably, a recent study in Croatia found that ibuprofen was the most common drug involved in accidental ingestions among young children.
- Ibuprofen is one of the most commonly used and prescribed drugs globally.
- According to a US report, ibuprofen-related cases make up 11.5% of adult drug exposures and 9.54% of child exposures.
- 28.5% of painkiller overdoses involve ibuprofen usage.
- In the United Kingdom, ibuprofen is the second-most common substance in phone and database inquiries, following acetaminophen.
- A Croatian study revealed that ibuprofen is the most common drug involved in accidental ingestion by preschool children.
Signs and Symptoms of Ibuprofen Toxicity
If you’ve taken too much ibuprofen, it’s important for your doctor to know how much you took, when you took it, and if you took any other medications with it. Parents should also be clear about whether their child has taken acetaminophen because it’s sometimes mistaken for ibuprofen. Most people who take too much ibuprofen have mild or no symptoms. If there are symptoms, they usually start within 4 hours of taking the pills. A stomach ache and bleeding in the stomach are the most common symptoms. Serious overdoses can cause drowsiness, seizures, and even coma. Most of the time, the results of a physical exam will be normal after taking too much ibuprofen. If the overdose is severe, patients may have a fast heart rate and low blood pressure, and their stomach may be tender when touched.
Too much ibuprofen can affect different parts of your body in different ways:
- Gastrointestinal Toxicity: Ibuprofen can damage the lining of your stomach, leading to bleeding within a few hours of taking the pills. This can lead to stomach ulcers or even rupture of the stomach or other organs. Symptoms can include nausea, vomiting, indigestion, and stomach pain. There have been cases where people experienced severe bleeding or a tear in the small intestine after a large dose of ibuprofen.
- Hepatotoxicity: Injury to the liver from ibuprofen is common, both in people who overdose and in those who take it regularly. Symptoms can include stomach pain, nausea, vomiting, fever, rash, and yellowing of the skin and eyes (jaundice). There have been cases where people developed a severe skin reaction called Stevens-Johnson syndrome.
- Renal Toxicity: Ibuprofen can damage the kidneys. This has been reported in people who took a therapeutic dose as well as those who took too much. One case involved a 2-year-old child who took a large amount of ibuprofen and developed kidney failure, but the child’s kidney function returned to normal after 72 hours. Kidney damage can normally be reversed with care and intravenous fluids.
- Neurotoxicity: A serious overdose of ibuprofen can affect the brain and nervous system. Examples include drowsiness, low consciousness, and seizures. One patient became unconscious after taking 40 to 60 ibuprofen 600mg pills. She had to be put on a breathing machine, and she developed kidney failure and bleeding in the stomach. However, she recovered after one day in the intensive care unit
- Biochemical Toxicity: Taking too much ibuprofen can also lead to a high anion gap metabolic acidosis, a disorder that disrupts the pH balance in your body and could be dangerous. Metabolic acidosis, along with excessive urination, has also been reported. There have been cases of dangerously low levels of potassium in the blood following an ibuprofen dosage, which has been identified as secondary to renal tubular acidosis
- Hematological Toxicity: After overdosing on ibuprofen, it is common to experience a decrease in the number of platelets, the cells that help your blood clot – this is called thrombocytopenia. This could also be due to immune-mediated thrombocytopenia, thrombotic thrombocytopenic purpura, and hemolytic-uremic syndrome. Prolonged prothrombin time could also be a result. There have been reports of Pulmonary infiltrates with eosinophilia syndrome. In severe cases, there could be a severe decrease in all blood cells (pancytopenia).
Testing for Ibuprofen Toxicity
If you have accidentally overdosed but don’t have any symptoms, routine lab tests are not generally needed. This is true unless you have also taken too much acetaminophen, which could have serious effects on your liver. In cases where you’ve taken a lot of ibuprofen, tried to harm yourself, or if you’re showing any signs of symptoms, then lab tests might be needed. These can include blood tests to count the cells, measure gases and minerals in your blood, and check how your kidneys and liver are functioning.
In some people, these tests can show signs of increased white blood cells, changes in the blood’s acidity, damage to the kidneys (shown by higher than normal creatinine levels), and unusual levels of salts and minerals in the blood. Although it’s less common, some people can get drug-induced liver injury that isn’t linked to acetaminophen. This can cause elevated liver function tests.
Based on your symptoms, the doctors might also need to check for co-ingestion (that is, consuming other substances like alcohol or certain medications like acetaminophen and aspirin). Please note that blood tests for measuring the ibuprofen concentration are not usually available in emergency care settings and aren’t typically used to guide treatment decisions. However, if confirmation of ibuprofen exposure is needed, these levels can be tested by specialized laboratories.
Treatment Options for Ibuprofen Toxicity
If someone accidentally takes too much ibuprofen, the treatment is mainly focused on alleviating the symptoms. Many individuals don’t experience any symptoms, or might have mild stomach issues which are treatable. Those people who don’t show any symptoms but have normal vital signs should be watched for 4 to 6 hours to make sure no symptoms develop. For children, if they’ve consumed more than 400 mg/kg of ibuprofen, they are at a higher risk and should be checked by a medical professional. On the other hand, if the child has consumed less than 100 mg/kg, they can be safely observed at home by their caregiver.
To cleanse the stomach of the drug, activated charcoal might be used, especially for individuals who have taken a significant amount of ibuprofen (more than 400 mg/kg in children) in the last two hours. People with serious symptoms like difficulty breathing, low blood pressure, seizures, or metabolic acidosis, which means the body is too acidic, should receive intense treatment. Individuals who are unable to breathe properly or who have compromised airways should be intubated, meaning a tube is placed in their throat to help them breathe, and might even require mechanical ventilation or a machine to help them breathe. Seizures, if they occur, can be treated with a class of medications referred to as benzodiazepines. If low blood pressure is present, intravenous fluids (fluids given through veins) and certain medications called vasopressors might be needed. If the liver is affected, corticosteroids might help with symptoms.
Additionally, the heart should be continuously monitored with serial electrocardiograms, which capture the electrical activity of the heart to detect any rhythm abnormalities. These can happen due to electrolyte imbalance, such as low potassium levels. If the kidneys fail or if there are severe electrolyte abnormalities or unresponsive metabolic acidosis, a process called hemodialysis can be considered to help the body. However, it is worth mentioning that hemodialysis does not remove ibuprofen from the body as the drug binds heavily to proteins.
What else can Ibuprofen Toxicity be?
When dealing with symptoms that might be due to taking too much ibuprofen, doctors must consider a range of other possible health problems. These include:
- Peptic ulcer disease or inflammation of the stomach lining (gastritis)
- Esophageal varices, which are swollen veins in the lower part of the esophagus that may bleed
- Pancreatitis, an inflammation of the pancreas
- Cholecystitis, an inflammation of the gallbladder
- Blood infection (sepsis)
- Idiopathic thrombocytopenic purpura, a disorder that can lead to easy or excessive bruising and bleeding
- Thrombotic thrombocytopenic purpura, a rare blood disorder causing small clots to form in blood vessels throughout the body
- Bacterial and viral meningitis, inflammation of the protective membranes covering the brain and spinal cord
- Bacterial and viral encephalitis, inflammation of the brain
- Acute cerebrovascular accident, also known as a stroke
- Intracranial hemorrhage, bleeding within the skull
- Diabetic ketoacidosis, a serious diabetes complication where the body breaks down fat too quickly
- Alcoholic ketoacidosis, a metabolic complication of alcohol use and starvation characterized by hyperketonemia and anion gap metabolic acidosis
What to expect with Ibuprofen Toxicity
An overdose of Ibuprofen is rarely life-threatening, but there have been cases where it has caused death. How well someone recovers from an overdose largely depends on how severe the overdose was. However, it’s important to note that most people fully recover with the right supportive care.
Possible Complications When Diagnosed with Ibuprofen Toxicity
Taking too much ibuprofen can lead to problems with your stomach, liver, and kidneys. Bleeding in the stomach and intestines can happen if you take a lot of the drug. This doesn’t happen often but can lead to issues like hidden blood loss, stomach ulcers, serious bleeding, and inflammation of the pancreas. Changes in liver function tests are common, but severe problems like bile build up, yellowing of the skin or eyes, inflammation of the liver, and liver failure are rare.
Issues with the kidneys, such as holding too much urine, not being able to produce enough urine, sudden kidney failure, kidney damage and inflammation, and damage to the small tubes in kidneys, are also possible, especially if your kidneys aren’t working properly to begin with.
Other infrequent problems include high blood pressure, issues with the nervous system like feeling dizzy or sleepy, or inflammation of the brain membranes. There may also be issues with blood cells, like problems with how your platelets work.
Common Side Effects:
- Stomach and intestinal bleeding
- Hidden blood loss
- Stomach ulcers
- Serious stomach or intestinal bleeding
- Inflammation of the pancreas
- Changes in liver function tests
- Bile build up
- Yellowing of the skin or eyes
- Inflammation of the liver
- Liver failure
- Problems with kidneys, like producing very little urine, or not at all
- Kidney failure
- Kidney damage
- Damage to the small tubes in kidneys
- High blood pressure
- Dizziness or feeling sleepy
- Inflammation of the brain membranes
- Problems with blood cells
Preventing Ibuprofen Toxicity
Ibuprofen, a common pain-relieving medicine, can be bought without a doctor’s prescription and is usually less harmful compared to many other pain-relievers. However, it’s crucial for patients to know the correct dosage to avoid unintentional harm. To make sure you take the right amount of ibuprofen, always check the instructions given on the medicine’s packing or the directions provided in your prescription.
If you think you’ve taken too much ibuprofen, it’s important to quickly call your local poison control center and get immediate medical help if symptoms show up. It’s best to keep all medicines in child-resistant containers and so that they are not within children’s reach, to stop unintended ingestion.
