Dangers of Ibuprofen and Chiral Class Drugs

Ibuprofen was the first propionic acid derivative introduced as an analgesic and antipyretic for general use and as an alternative to Aspirin (acetylsalicylic acid). Overall Ibuprofen has been assessed as one of the safest non-steroidal anti-inflammatory drugs (NSAID).

Ibuprofen

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Its anti-inflammatory properties appear to be weaker compared to other NSAIDs, its analgesic and anti-inflammatory are considered very effective. The most common way of supplementation is by tablets which can be taken multiple times per day. Within 24 hours after the last administration of the drug, Ibuprofen is completely eliminated through the metabolic processes, which take place in the liver. As is the case with numerous other drugs, Ibuprofen is a chiral compound.

The human body with its numerous homochiral compounds will interact with each racemic drug differently and metabolize each enantiomer by a separate pathway to generate a different pharmacokinetic and pharmacodynamic activity. In other words, one isomer may produce the desired therapeutic effect, whilst the other may be inactive or even produce an undesired effect.

Further therapeutic applications of Ibuprofen

In premature infants, patent ductus arterosus (blood from the left heart may flow back to the lungs) is frequently encountered. Ibuprofen has been successfully used for the closure of ductus arteriosus, and it is as effective as indomethacin (which was previously used) with a lesser chance of complications.  

Rheumatoid and osteoarthritis, and joint pain issues in general, have been managed (but not cured) by administering Ibuprofen in medium to high doses. However, there is a moderate chance of developing gastric toxicity issues. In one study, the approach of utilizing NSAIDs for reducing breast cancer rate was examined. It was found that regular intake of Ibuprofen reduced the breast cancer expansion rate by 50% which highlighted the potential of NSAIDs as chemopreventive agents.

Dangers of Ibuprofen administration

Ibuprofen has certain drug-drug interactions (pharmacokinetic and pharmacodynamic) that need to be taken into account. It has been found that it can interfere with antihypertensive therapies by causing a significant rise in systolic and diastolic blood pressure.

Other studies have reported that Aspirin and Ibuprofen compete for the binding sites on platelets, and therefore the cardioprotective effects of aspirin may be blocked when Ibuprofen is administered simultaneously. Overdosing with Ibuprofen is not a rare occurrence. The medicinal literature has reported many different cases with symptoms such as seizures, hypertension, apnea along with renal and hepatic issues.

Children are much more likely to overdose on Ibuprofen since their tolerance is on average 8 times lower than those of adults. The current body of literature suggests that there is also a low risk for asthma-related morbidity when Ibuprofen is administered to febrile children.

However, there are many contradicting results in the literature; in some cases, it was shown that Ibuprofen may preserve pulmonary function in children with mild lung disease, while another theory suggests it can increase the risk of acute bronchospasm in children with asthma and no prior experience of aspirin-induced asthma.

Other adverse issues caused by Ibuprofen use include damage to the gastrointestinal tract (GIT), the kidney, and the coagulation system. Clinical trial data suggests, that GIT complications can occur prompting the withdrawal of treatment because of hematemesis (blood vomiting), peptic ulcer, gastric pain, and vomiting. However, the likelihood of Ibuprofen being the sole culprit was quite low, 10 times lower compared to aspirin.

Further issues with a very low frequency of occurrence were gastrointestinal bleeding, renal failure, epistaxis (nose bleeds), heart failure, hyperkalemia (high potassium levels in the blood), and confusion. Lastly, it has been estimated that 1 in 5 chronic users (being users of for years) of NSAIDs (including Ibuprofen) will develop gastric damage which can be initially hard to identify.

Conclusion

The advantages of a drug like Ibuprofen far outweigh the drawbacks it may have. However, further optimization can be definitely achieved. At the moment many NSAIDs are still used as racemates (which may be the source of the side effects that can manifest in some cases) due to the difficulty of the separation and the costs it incurs.

There are however exceptions to this rule and a racemate can sometimes be more beneficial to the patient rather than using the single isomer. The multiple isomers can in some cases complement each other instead of adding unwanted or toxic effects. It is imperative that further future research will aim towards developing new chiral separation techniques, but also in understanding why and how certain racemic forms of drugs can be more advantageous than their single isomers counterparts.

References

  • Rabia Bushra and Nousheen Aslam, An Overview of Clinical Pharmacology of Ibuprofen, Oman Med J. 25(3) pp.155–1661.
  • Dipak Kanabar; Stephen Dale, and Mariyam Rawat, A Review of Ibuprofen and Acetaminophen Use in Febrile Children and the Occurrence of Asthma-Related Symptoms Clinical Therapeutics, Volume 29(12), pp. 2716-2723.
  • Lien Ai Nguyen, Hua He, and Chuong Pham-Huy, Chiral Drugs: An Overview, Int J Biomed Sci. 2006 Jun; 2(2): pp.  85–100.

Further Reading

Last Updated: Nov 23, 2020

Dr. Georgios Christofidis

Written by

Dr. Georgios Christofidis

Georgios is an experienced researcher who started as a freelance science editor during the last stages of his Ph.D. studies. He has a B.Sc. in Chemistry from the Aristotle University of Thessaloniki and an M.Sc. in Forensic Science from the University of Amsterdam. Currently, he is nearing the end of his Ph.D. project in Liverpool John Moores University, which is about latent fingermark development on fired cartridge cases.

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