Ibuprofen and Renal Failure

1
Ibuprofen and Renal Failure

• Professor Nicholas Moore
• International Ibuprofen Foundation
• University of Bordeaux, France

2
Background

• Renal prostaglandins essential for GFR
• Especially in elderly, children, heart failure
• Known for all NSAIDs
• Some case reports with ibuprofen
• Risk of widespread OTC use?

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In adults

• Better tolerated than aspirin
• Tolerance equivalent to paracetamol
• Including GI and renal events
• In clinical RCT of 8644 adults, used for OTC
  indications

Moore N, et al. The PAIN study. Clin Drug Invest
19991889-98.
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Renal Failure in the Elderly
1799 cases, 9899 controls in Medicaid/care
Griffin MR, Yared A, Ray WA. Nonsteroidal
antiinflammatory drugs and acute renal failure in
elderly persons. Am J Epidemiol
2000151(5)488-96.
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In Children

• Randomized DB clinical trial
• Paracetamol vs ibu 10, 15 mg/kg
• Hospital admissions
• 84 000 children incl 27 000 lt 2 yrs old
• Not a single case of renal failure
• upper bound CI lt 5.4/100 000
• No difference in admission creatinine

S. M. Lesko, A. A. Mitchell, Jama 273, 929-33
(1995). S. M. Lesko, A. A. Mitchell, Pediatrics
100, 954-7 (1997). S. M. Lesko, A. A. Mitchell,
Pediatrics 104, e39 (1999).
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In Newborns

• As effective as indomethacin to close patent
  ductus arteriosus
• Without renal toxicity

L. Cuzzolin, M. Dal Cere, V. Fanos, Drug Saf 24,
9-18 (2001).
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In Overdose

• No need to monitor if less than 6 g (30 tabs)
• Reversible renal failure in severe overdose

A. H. Hall, S. C. Smolinske,et al, J Toxicol Clin
Toxicol 30, 23-37 (1992).