Thursday, December 1

Ibuprofen 400mg: how many pills can I take in a day?

This week we learned of the warning from the European Medicines Agency, EMA, about the consequences of taking long-term combinations of ibuprofen and codeine.

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Know more

According to that agency, and as echoed by the Spanish agency for medicines and medical devicesAEMPS, “severe cases of renal, gastrointestinal and metabolic toxicity have been reported, some with fatal outcome, associated with codeine abuse and dependence with drugs containing the combination of codeine and ibuprofen.”

The reported reactions, according to the AEMPS, have been gastrointestinal perforations, gastrointestinal bleeding, severe anemia, kidney failure, renal tubular acidosis and severe hypokalaemia after prolonged use of this combination at doses higher than those recommended, in patients who have developed dependence on the codeine.

In Spain, these drugs are prescription drugs and their use is low in relation to other combinations of analgesics at fixed doses. To date, no case of suspected adverse reaction similar to those described in this context has been recorded, but it should be remembered that we can obtain ibuprofen, without codeine, freely in pharmacies in doses of 400 mg.

Risks of overdose

And this medicine also has its limitations and specifications, with some of the consequences that are described in the following paragraphs if they are abused for a long time.

Thus, most patients who have ingested significant amounts of ibuprofen have manifested symptoms within 4 to 6 hours. The most frequently reported symptoms in cases of overdose include abdominal pain, nausea, vomiting, lethargy and drowsiness.

Central nervous system (CNS) effects included headache, tinnitus, dizziness, seizures, or loss of consciousness in some cases, according to a pamphlet from the AEMPS. Rare cases of involuntary rapid eye movements, metabolic acidosis, hypothermia, impaired renal function, gastrointestinal bleeding, coma, apnea, and CNS and respiratory depression have also been reported. And in cases of significant overdose, kidney failure and liver damage can occur.

What do we understand by overdose?

In other words, if we more or less widely exceed the maximum daily dose of ibuprofen, we are exposed to suffering these symptoms. But what is that daily maximum?

It depends on the weight and corpulence of each person, as well as gender and age. The study ‘Fatality after deliberate ingestion of sustained-release ibuprofen: a case report‘ collects the daily amounts that can be considered overdose. To do this, it makes a consumption table in relation to the person’s body weight.

For its part, the North American medical and pharmacological information magazine establishes that reaching 3,200 milligrams a day in adults can be established as a de facto overdose. This would imply taking eight doses of ibuprofen in one dayone dose every three hours.

This would be the upper limit to begin to feel the adverse effects; At the lower limit, that of the recommended dosage and without risks, would be the recommendations of the AEMPS, which are one pill every six to eight hours. That is, ingest between 1200 and 1600mg per day in one day. In other words, three to four 400mg ibuprofen pills a day.

Beyond that, we enter the risk zone, although there is still a gray area between four and eight pills that, although it is not at all advisable to explore, it is true that it can have a variable effect depending on the health of the person, their age, their weight or even their sex. And this without rule out people with the following contraindications:

  • Hypersensitivity to the active substance, to other NSAIDs or to any of the excipients.
  • Patients who have experienced asthma attacks, acute rhinitis, urticaria, angioneurotic edema or other allergic-type reactions after using substances with a similar action (for example acetylsalicylic acid or other NSAIDs).
  • Severe renal insufficiency (glomerular filtration less than 30ml/min).
  • Severe liver failure.
  • Diseases involving an increased tendency to bleeding.
  • History of gastrointestinal bleeding or perforation related to previous NSAID treatment.
  • Active or recurrent peptic ulcer/gastrointestinal bleeding (two or more distinct episodes of proven ulceration or bleeding).
  • Severe heart failure (NYHA class IV).
  • Patients with severe dehydration (caused by vomiting, diarrhea or insufficient fluid intake).
  • Third trimester of pregnancy.

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