Cardiovascular warning for high-dose ibuprofen

The cardiovascular risk associated with high doses of ibuprofen is similar to that of COX 2 inhibitors and diclofenac, an EU review has confirmed.

Use of high-dose ibuprofen should be avoided in patients with ischaemic heart disease, peripheral arterial disease, cerebrovascular disease, congestive heart failure or uncontrolled hypertension. | iSTOCK
Use of high-dose ibuprofen should be avoided in patients with ischaemic heart disease, peripheral arterial disease, cerebrovascular disease, congestive heart failure or uncontrolled hypertension. | iSTOCK

A meta-analysis of clinical trial data showed that people taking 2.4g or more of ibuprofen per day are at a higher risk of arterial thrombotic events, such as heart attack and stroke, than people taking placebo.

Further information
MHRA Drug Safety Update

No increased risk of arterial thrombotic events is seen with ibuprofen at doses up to 1.2g per day - the highest dose available over the counter.

When prescribing or dispensing ibuprofen, the MHRA advises prescribers to:

  • avoid use of high-dose ibuprofen (≥2.4g per day) in patients with established:
    • ischaemic heart disease
    • peripheral arterial disease
    • cerebrovascular disease
    • congestive heart failure (New York Heart Association [NYHA] classification IIIII)
    • uncontrolled hypertension
  • review the treatment of patients with the above conditions who are taking high-dose ibuprofen at their next routine appointment
  • carefully consider the benefits and risks of long-term ibuprofen treatment in patients with significant risk factors for cardiovascular events (eg, hypertension, hyperlipidaemia, diabetes mellitus, smoking), particularly if high doses are required
  • note that ibuprofen is contraindicated in patients with severe heart failure
These recommendations also apply to dexibuprofen (a high dose of dexibuprofen is 1.2g or more per day, which is equivalent to 2.4g ibuprofen).

The review also examined the latest data on the possible interaction between ibuprofen and low-dose aspirin, and concluded that occasional ibuprofen use is unlikely to have a clinically meaningful effect on the benefits of low-dose aspirin.

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