Ibuprofen in early and late pregnancy (1-2-3 trimester)

Ibuprofen as an analgesic and antipyretic agent is not the drug of choice for pregnant women, as it is unsafe for the fetus. However, severe, constant pain that cannot be stopped while carrying a child entails anxiety, depression, and even high blood pressure, which can eventually lead to a threat premature birth.

A woman should know that it is impossible to endure severe pain in position. But together with an emergency reception of an analgesic, it must be remembered that pain is a signal of trouble. So, when pain occurs, women should consult a doctor to find out the cause.

Given the benefits to the mother and the risk to the fetus from taking the drug, ibuprofen is allowed for use in emergency cases, after consulting a doctor in the first and second trimesters of pregnancy.

What painkillers are prescribed

• Paracetamol. WHO has recognized that this drug is the safest drug in pregnancy. It has no long-term side effects. At the same time, paracetamol is also an effective dental pain reliever during pregnancy, which has a lasting effect;
• Nurofen. It can be taken up to the 30th week;
• Papaverine. The remedy effectively eliminates pain by relieving spasms;
• No-shpa. It is a safe and effective antispasmodic that relieves pain of various origins.
• Ibuprofen. The remedy effectively fights pain.

When anesthetizing your teeth, you must remember that pregnant women cannot keep them unhealthy, and therefore, if you have a toothache, you should consult a dentist.

The listed drugs cannot be taken by pregnant women without a doctor's prescription!

What analgesics are strictly prohibited

There are a number of medications that pregnant women should not take if they are in pain. So, if you do not know what painkillers are possible during pregnancy, you need to contact your doctor.

• Analgin. It is not without reason that he received a kind of “palm” among unwanted drugs. And it is no coincidence. It has been proven that the regular intake of this drug during pregnancy threatens with irreversible changes in the blood. This negatively affects the condition of the fetus. Disruption of the liver and kidneys is also possible.
• Baralgin and spazmalgon. They can also cause changes in kidney function.
• Ointments based on bee or snake venom. They are prohibited, as they can cause allergies, and some of their components are harmful to the fetus.
• Dimexide-based ointments are also prohibited for use by pregnant women.
• You should not take products based on essential oils, as some of them can cause miscarriage.

In addition, there are a number of diseases for which pain relievers should not be taken. These include:

• ulcerative pathology of the gastrointestinal tract;
• bronchial asthma;
• liver disease;
• dysfunction of the kidneys;
• allergic reactions.

Pregnant women should be aware that if side effects, in particular allergies, appear while taking analgesics, they should be canceled and consult a doctor. This is a prerequisite.

Ibuprofen in I and II trimester of pregnancy

Epidemiological studies have shown that the use of the drug in early pregnancy increases the risk of miscarriage, as well as the occurrence of such pathologies in the embryo as:

• gastroschisis - a defect in the anterior intestinal wall, as a result of which the intestines and other organs of the abdominal cavity fall out of the cleft;
• cardiovascular pathology (heart defects).

These pathologies depend on the dosage and duration of the drug intake.

Therefore, it is not recommended to take ibuprofen during the first and second trimester of pregnancy. An exception can be made only in cases where it is extremely necessary, but the reception in each case should be carried out only under the strict supervision of a doctor.

If, nevertheless, the need to take the drug arises in the I and II trimester of pregnancy or during the period when a woman trying to get pregnant, then you need to take only the minimum dose of ibuprofen and only for the shortest period time.

Ibuprofen in the third trimester of pregnancy

• During the third trimester of pregnancy, the use of ibuprofen must be discontinued (especially after the 31st week), since during this period the drug poses the greatest danger to the fetus.
• For the mother, the course of pregnancy and childbirth, the risks are also great. The following conditions may occur:
  • an increase in the degree and time of bleeding during childbirth;
  • antiplatelet effect, which is possible even at very low doses;
  • a decrease in the activity of uterine contractions, which can lead to a delay in labor or an increase in the duration of labor.

Effect of ibuprofen on the fetus

The inhibition of the synthesis of prostaglandins (physiologically active substances), which ibuprofen has, can adversely affect the course of pregnancy, as well as the development of the embryo or fetus.

The occurrence of such pathologies in a child is possible:

• impaired renal function, which can lead to the onset of chronic diseases and even the appearance of renal failure;
• premature closure of the ductus arteriosus (the vessel that connects the thoracic aorta to the pulmonary artery);
• pulmonary hypertension.

Scientists from Harvard University (USA) conducted a study in which they examined the relationship between the use of ibuprofen during pregnancy and nervous disorders in young children. So, when conducting research, which involved 1225 pairs of mothers with children, scientists estimated use of ibuprofen, as well as paracetamol in early, middle pregnancy and newborns children. This experiment showed that prenatal and postnatal exposure to ibuprofen and paracetamol leads to behavioral disturbances in children and hyperactivity as they grow older.

Suppositories are prescribed for children from 3 to 12 months. The syrup is prescribed for children from 3 months to 12 years old.

Tablets can be given from the age of 6.

The effect of the drug on pregnant women with hypertension

Christina Penfield, Associate Professor, Department of Maternal and Fetal Medicine, NYU Medical Center during the experiment, found out the effect of ibuprofen in pregnant women suffering from arterial pressure. These studies involved 2 groups of women who received anesthesia with ibuprofen or paracetamol after childbirth. During the experiment, it turned out that the group of pregnant women with hypertension who took ibuprofen did not have an increase in blood pressure compared to women who did not take this NSAID.

Be careful!

Avoid taking ibuprofen during pregnancy. If, nevertheless, there is a need to reduce the temperature or pain syndrome, then it is imperative consult your doctor about which drug will have minimal risks to the fetus and the course of pregnancy.

Ibuprofen when planning a pregnancy

According to research data, a negative effect on female fertility (fertility) has been found - there is a decrease in the ability to conceive.

Information for women planning pregnancy: the drug inhibits cyclooxygenase and synthesis prostaglandins, affects ovulation, disrupting female reproductive function (reversible after withdrawal of treatment).

Ibuprofen during breastfeeding

There is evidence that small amounts of ibuprofen can pass into breast milk without any adverse effects for the health of the infant, therefore, usually with a short-term admission, the need to stop breastfeeding is not arises. If it is necessary to use the drug for a long time, it is necessary to consult a doctor to resolve the issue of stopping breastfeeding for the period of using the drug.

Brief instructions for Ibuprofen

Ibuprofen is a non-steroidal anti-inflammatory drug.

Dosage forms

For adults - tablets;

For children - candles, suspension, ointment, gel

Pharmacodynamics

Ibuprofen is a non-steroidal anti-inflammatory drug (NSAID) derived from propionic acid.

The mechanism of action of ibuprofen is due to the indiscriminate inhibition of enzymes - cyclooxygenase 1 (COX-1) and cyclooxygenase 2 (COX-2) leading to inhibition of the synthesis of prostaglandins - mediators of pain, inflammation and hyperthermic reaction.

Ibuprofen has a rapid analgesic, antipyretic and anti-inflammatory effect. In addition, ibuprofen reversibly inhibits platelet aggregation.

The analgesic effect of the drug lasts up to 8 hours.

Pharmacokinetics

Suction

After oral administration, absorption of ibuprofen is high. It is rapidly and almost completely absorbed from the gastrointestinal tract (GIT).

After taking the drug on an empty stomach, the maximum concentration (Cmax) of ibuprofen in the blood plasma is achieved after 45 minutes when taken with meals - after 1-2 hours.

Distribution

Communication with blood plasma proteins - 90%. It slowly penetrates into the joint cavity and lingers in the synovial tissue, creating higher concentrations in it than in the blood plasma. In the cerebrospinal fluid, lower concentrations of ibuprofen are found compared to blood plasma.

In limited studies, ibuprofen has been found in breast milk at very low concentrations.

Metabolism

After absorption, about 60% of the pharmacologically inactive R-form is slowly transformed into the active S-form. It is metabolized in the liver.

Withdrawal

It is excreted by the kidneys mainly in the form of metabolites and their conjugates (not more than 1% unchanged), to a lesser extent, excreted in the bile and excreted through the intestines. Half-life (T1 / 2) -2 hours.

Indications

Ibuprofen is used for headache, migraine, toothache, painful periods, neuralgia, back pain, muscle pain, rheumatic pain and joint pain; as well as with a febrile condition with flu and colds.

Contraindications for use

Hypersensitivity to ibuprofen; erosive and ulcerative lesions of the gastrointestinal tract in the acute phase or ulcerative bleeding in the active phase or in history (2 or more confirmed episodes of peptic ulcer or ulcer bleeding); history of bleeding or perforation of gastrointestinal ulcers, provoked by the use of NSAIDs; severe heart failure (NYHA functional class IV); severe renal and / or liver dysfunction; diseases of the optic nerve, "aspirin triad", hematopoiesis disorders; the period after coronary artery bypass grafting; intracranial or other bleeding; hemophilia and other blood clotting disorders (including hypocoagulation), hemorrhagic diathesis; III trimester of pregnancy.

With care: concomitant use of other NSAIDs; a history of a single episode of gastric ulcer and duodenal ulcer or gastrointestinal ulcer bleeding; gastritis, enteritis, colitis, presence of Helicobacter pylori infection, ulcerative colitis; bronchial asthma or allergic diseases in the acute stage or in history; systemic lupus erythematosus or mixed connective tissue disease (Sharp's syndrome) - increased risk of aseptic meningitis; chicken pox; renal failure, incl. with dehydration (CC less than 30-60 ml / min), nephrotic syndrome, liver failure, liver cirrhosis with portal hypertension; hyperbilirubinemia; arterial hypertension and / or heart failure; cerebrovascular diseases; blood diseases of unknown etiology (leukopenia and anemia); severe somatic diseases; dyslipidemia / hyperlipidemia; diabetes; peripheral arterial disease; smoking; frequent alcohol consumption; the simultaneous use of drugs that can increase the risk of ulcers or bleeding, in particular, oral corticosteroids (including prednisolone), anticoagulants (incl. warfarin), selective serotonin reuptake inhibitors (including citalopram, fluoxetine, paroxetine, sertratine) or antiplatelet agents (including acetylsalicylic acid, clopidogrel); I-II trimester of pregnancy; period of breastfeeding; elderly age.

Methods of administration and dosage

Pills

Adults and children from the age of 14 can be given no more than 4 tablets per day. Depending on the condition, the dose can be adjusted and increased to 6 tablets (the dose is divided into several doses). When there is an improvement in the condition, the dose should be reduced to the original. The first pill should be drunk in the morning before meals with a glass of water. Then take 1 tablet after meals.

Without consulting a doctor, tablets can be used for no more than 5 days.

Candles

Suppositories are placed rectally. For painful sensations and fever, the dose is determined taking into account the age and body weight of the baby. You can use no more than 10 mg per 1 kg at a time. Candles can be placed up to 4 times per day. The optimal duration of use is 3 days. If suppositories are used as an analgesic, then they can be administered for 5 days.

If after the allotted time the fever has not disappeared, then you should consult a pediatrician.

Gel

You can use a 5-9 cm strip of gel at a time. With smooth light movements, you need to rub the gel into the problem area until the composition is completely absorbed. It is allowed to use the gel no more than 4 times per day, with repeated use no earlier than 4 hours later.

The duration of the treatment course can be 15-20 days.

Ointment

The scheme for using the ointment is similar in everything to applying a gel. The drug is rubbed into the problem area of ​​the skin 3-4 times a day. Can be used within 15-20 days.

Children's suspension

Ibuprofen suspension can be given to a child no more than 3 times a day. If the child is not yet a year old, then before using it, you must definitely consult with a specialist. If the fever appeared as a result of vaccination, then the suspension is given 2 times a day. There should be a break of at least 6 hours between meals.

Overdose

Do not exceed the indicated dose. If you have exceeded the dose, contact your doctor or the nearest medical facility immediately. Take the package of the drug with you.
Symptoms: abdominal pain, nausea, vomiting, lethargy, drowsiness, depression, headache, tinnitus, metabolic acidosis, coma, acute renal failure, lowering blood pressure, bradycardia, tachycardia, atrial fibrillation, arrest breathing.
Treatment: gastric lavage (only within an hour after ingestion), activated charcoal, alkaline drinking, forced diuresis, symptomatic therapy
(correction of acid-base state, blood pressure).

Side effect

The risk of side effects can be minimized by taking the drug in a short course, in the minimum effective dose necessary to eliminate symptoms.

In elderly people, there is an increased frequency of adverse reactions associated with the use of NSAIDs, especially gastrointestinal bleeding and perforation, in some cases with a fatal outcome.

Side effects are predominantly dose-dependent. In particular, the risk of gastrointestinal bleeding depends on the dose range and duration of treatment.

The following adverse reactions were observed with short-term use of ibuprofen in doses not exceeding 1200 mg / day (6 tablets - 200 mg; 3 tablets - 400 mg). In the treatment of chronic conditions and with prolonged use, other adverse reactions may occur.

The assessment of the incidence of adverse reactions was made on the basis of the following criteria: very frequent (≥1 / 10), frequent (from ≥1 / 100 to <1/10), infrequent (≥1 / 1000 to <1/100), rare (≥1 / 10000 to <1/1000), very rare (<1/10000), frequency unknown (estimated frequency absent).

Blood and lymphatic system disorders

Very rare: hematopoietic disorders (anemia, leukopenia, aplastic anemia, hemolytic anemia, thrombocytopenia, pancytopenia, agranulocytosis). The first symptoms of such disorders are fever, sore throat, superficial ulcers in the mouth, flu-like symptoms, severe weakness, nosebleeds and subcutaneous hemorrhages, bleeding and bruising unknown etiology.

Immune system disorders

Uncommon: hypersensitivity reactions - nonspecific allergic reactions and anaphylactic reactions, reactions from the respiratory tract (bronchial asthma, including its exacerbation, bronchospasm, shortness of breath, dyspnoea), skin reactions (itching, urticaria, purpura, Quincke's edema, exfoliative and bullous dermatoses, including toxic epidermal necrolysis (Lyell's syndrome), Stevens-Johnson syndrome, erythema multiforme), allergic rhinitis, eosinophilia.

Very rare: severe hypersensitivity reactions, including edema of the face, tongue and larynx, shortness of breath, tachycardia, arterial hypotension (anaphylaxis, Quincke's edema or severe anaphylactic shock).

Gastrointestinal disorders

Infrequent: abdominal pain, nausea, dyspepsia (including heartburn, bloating).

Rare: diarrhea, flatulence, constipation, vomiting.

Very rare: peptic ulcer, perforation or gastrointestinal bleeding, melena, bloody vomiting, some fatal cases, especially in elderly patients, ulcerative stomatitis, gastritis.

Frequency unknown: exacerbation of colitis and Crohn's disease.

Liver and biliary tract disorders

Very rare: abnormal liver function, increased activity of "hepatic" transaminases, hepatitis and jaundice.

Disorders of the kidneys and urine excretory tract

Very rare: acute renal failure (compensated and decompensated), especially with prolonged use, in combination with increased concentration urea in blood plasma and the appearance of edema, hematuria and proteinuria, nephritic syndrome, nephrotic syndrome, papillary necrosis, interstitial nephritis, cystitis.

Nervous system disorders

Infrequent: headache.

Very rare: aseptic meningitis.

Cardiovascular disorders

The frequency is unknown: heart failure, peripheral edema, with prolonged use, the risk of thrombotic complications (for example, myocardial infarction), increased blood pressure is increased.

Respiratory and mediastinal disorders

Frequency unknown: bronchial asthma, bronchospasm, shortness of breath.

Laboratory indicators

• hematocrit or hemoglobin (may decrease);
• bleeding time (may increase);
• plasma glucose concentration (may decrease);
• creatinine clearance (may decrease);
• plasma creatinine concentration (may increase);
• the activity of "hepatic" transaminases (may increase).

If side effects appear, you should stop taking the drug and consult a doctor.

Drug interactions

With the simultaneous use of ibuprofen reduces the effect of antihypertensive drugs (ACE inhibitors, beta-blockers), diuretics (furosemide, hydrochlorothiazide).

With simultaneous use with anticoagulants, their effect may be enhanced.

With simultaneous use with GCS, the risk of developing side effects from the gastrointestinal tract increases.

With simultaneous use, ibuprofen can displace indirect anticoagulants from compounds with blood plasma proteins (acenocoumarol), hydantoin derivatives (phenytoin), oral hypoglycemic derivatives sulfonylureas.

With simultaneous use with amlodipine, a slight decrease in the antihypertensive effect of amlodipine is possible; with acetylsalicylic acid - the concentration of ibuprofen in the blood plasma decreases; with baclofen - a case of intensification of the toxic effect of baclofen is described.

With simultaneous use with warfarin, an increase in bleeding time is possible, microhematuria, hematomas were also observed; with captopril - it is possible to reduce the antihypertensive effect of captopril; with cholestyramine - a moderately pronounced decrease in the absorption of ibuprofen.

With simultaneous use with lithium carbonate, the concentration of lithium in the blood plasma increases.

With simultaneous use with magnesium hydroxide, the initial absorption of ibuprofen increases; with methotrexate - the toxicity of methotrexate increases.

The simultaneous use of NSAIDs and cardiac glycosides can lead to worsening of cardiac failure, a decrease in the glomerular filtration rate and an increase in the concentration of cardiac glycosides in blood plasma.

There is evidence of the likelihood of an increase in the concentration of methotrexate in the blood plasma during the use of NSAIDs.

With the simultaneous use of NSAIDs and cyclosporine, the risk of nephrotoxicity increases.

NSAIDs can reduce the effectiveness of mifepristone; therefore, NSAIDs should be started no earlier than 8-12 days after the end of mifepristone.

With the simultaneous use of NSAIDs and tacrolimus, an increase in the risk of nephrotoxicity is possible.

The simultaneous use of NSAIDs and zidovudine can lead to an increase in hematotoxicity. There is evidence of an increased risk of hemarthrosis and hematomas in HIV-positive patients with hemophilia who received co-treatment with zidovudine and ibuprofen.

In patients receiving concomitant treatment with NSAIDs and quinolone antibiotics, the risk of seizures may increase.

In patients receiving both NSAIDs and myelotoxic drugs, hematotoxicity increases.

With the simultaneous use of ibuprofen and cefamandol, cefoperazone, cefotetan, valproic acid, plikamycin, the incidence of hypoprothrombinemia increases.

With the simultaneous use of ibuprofen and drugs that block tubular secretion, there is a decrease in excretion and an increase in the plasma concentration of ibuprofen.

With the simultaneous use of ibuprofen and inducers of microsomal oxidation (phenytoin, ethanol, barbiturates, rifampicin, phenylbutazone, tricyclic antidepressants) there is an increase in the production of hydroxylated active metabolites, an increase in the risk of developing severe intoxications.

The information on prescription drugs posted on this site is intended for professionals only.
The information contained on the site should not be used by patients to make independent
decisions on the use of the presented medicinal products and cannot serve as a substitute for full-time
doctor's advice.

special instructions

It is recommended to take the drug in the shortest possible course and in the minimum effective dose necessary to eliminate symptoms. If you need to take the drug for more than 10 days, you must consult a doctor.

In patients with bronchial asthma or an allergic disease in the acute stage as well as in patients with a history of bronchial asthma / allergic disease, the drug can provoke bronchospasm.

The use of the drug in patients with systemic lupus erythematosus or mixed connective tissue disease is associated with an increased risk of aseptic meningitis.

During long-term treatment, it is necessary to monitor the peripheral blood picture and the functional state of the liver and kidneys.

When symptoms of gastropathy appear, careful monitoring is shown, including an esophagogastroduodenoscopy, a general blood test (determination of hemoglobin), a fecal occult blood test.

If it is necessary to determine 17-ketosteroids, the drug should be discontinued 48 hours before the study.

During the period of treatment, it is not recommended to take ethanol.

Patients with renal insufficiency should consult a doctor before using the drug as there is a risk of deterioration in the functional state of the kidneys.

Patients with arterial hypertension, including a history and / or chronic heart failure, need consult a doctor before using the drug since the drug can cause fluid retention, increased arterial pressure and swelling.

Patients with uncontrolled arterial hypertension, NYHA class II-III chronic heart failure, coronary artery disease, peripheral arterial disease and / or for cerebrovascular diseases, ibuprofen should be prescribed only after careful assessment of the benefit-risk ratio, and high doses of ibuprofen should be avoided (> 2400 mg / day).

The use of NSAIDs in patients with chickenpox may be associated with an increased risk of developing severe purulent complications of infectious and inflammatory diseases of the skin and subcutaneous fat (for example, necrotizing fasciitis). In this regard, it is recommended to avoid the use of the drug for chickenpox.

Information for women planning pregnancy: the drug inhibits cyclooxygenase and synthesis prostaglandins affect ovulation by disrupting female reproductive function (reversible after withdrawal treatment).