Hello mmo-ga,
To research your question, I turned to the Medlne database of articles
from the professional medical literature which is available on the web
site of the National Library of Medicine
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi
I searched on the terms 1. ibuprofen long-term 2. ibuprofen chronic
use
I also carried out the same searches on the scientific search engine
at http://www.scirus.com This links to Medline at Biomednet. If you
want to access Biomednet, you will need to register with the site
(this does not cost anything).
Here are the combined results of my searches:
Many reports maintained that ibuprofen is well tolerated, even when
used regularly. However, I did find papers which raised some
questions about effects of long-term use.
A study of long-term ibuprofen users titled “Long term follow-up
studies of users of nonprescription medicines purchased from community
pharmacies: some methodological issues. by Sinclair HK, Bond CM,
Hannaford PC. Of Department of General Practice and Primary Care,
University of Aberdeen, Scotland, and published in 2001 in the journal
Drug Safety Vol 24(number12) pages 929-938 concluded: “At 12 months,
long term users were significantly more likely than short term users
(< or =8 weeks total use) or non-users to have experienced dizziness,
skin rash, itchy skin and wheeziness in the previous week.” These
symptoms are very characteristic of allergic reactions.
A study in people taking ibuprofen over the long term for rheumatoid
arthritis, “Double blind evaluation of the long-term effects of
etodolac versus ibuprofen in patients with rheumatoid arthritis by
Neustadt DH of Department of Medicine, University of Louisville School
of Medicine, KY 40202, published in 1997 in Journal of Rheumatology
(Supplement) February, Volume 47, p17-22 found that it was “well
tolerated”, except that “The incidences of adverse events were
comparable, although dyspepsia and rash occurred less frequently with
300 mg/day of etodolac than with 2400 mg/day ibuprofen. A higher
incidence of gastrointestinal ulcers and bleeding was seen with
ibuprofen. Changes in hepatic and renal function were of minor
clinical significance and were similar between the 3 groups.”
Therefore, there is an increased risk of gastrointestinal problems,
but long-term use of ibuprofen does not seem to have any important
effects on the liver and kidneys.
Long-term use of ibuprofen suppositories was linked with damage to the
tissues of the rectum in a case report about one patient “Rectal
stricture associated with the long-term use of ibuprofen
suppositories.” By Alsalameh S, al-Ward R, Berg P, Aigner T, Ell C. of
Department of Molecular and Experimental Medicine, Division of
Arthritis Research, Scripps Research Institute, Mail Drop MEM 161,
10550 N. Torrey Pines Rd., La Jolla, CA 92037, USA. Published in
Zeitschrift Rheumatologie, October 2000, vol. 59(number 5) p. 348-351
The study: “Antiglobulin-tests for detection of auto-immunohaemolytic
anaemia during long-term treatment with ibuprofen.” By Korsager S,
Sřrensen H, Jensen OH, Falk JV, published in
Scandinavian Journal of Rheumatology, 1981 vol 10 p174-176 makes the
following statement: “Auto-immunohaemolytic anaemia is a very unusual
complication during long-term treatment with ibuprofen.” However,
they did conclude: “The type of haemolysis associated with ibuprofen
is discussed, but available data do not permit any definite
classification. It is concluded that ibuprofen is a safe drug which
rarely causes haemolysis and does not seem to cause induction of ANF.”
(ANF = anti-nuclear factor)
Another report of ibuprofen reducing the numbers of blood cells:
A case of severe pancytopenia caused by ibuprofen. By Lindblad R,
Rödjer S in
Journal Internal Medicine 1991 March Vol 229: pp 281-283
“We here present the case of a patient with severe neutropenia,
haemolytic anaemia and thrombocytopenia associated with long-term use
of ibuprofen. The blood parameters rapidly normalized when the drug
was discontinued, and no further treatment, except for a short course
of antibiotics, was required.”
Long-term ibuprofen may slow down the progress of cystic fibrosis. A
web page from the Cystic Fibrosis Center at the Medical School,
Wiscondin at http://www2.medsch.wisc.edu/childrenshosp/CF/cfpages/ibuprofen.html
has these comments: “In the March 30, 1995 issue of The New England
Journal of Medicine, the results of a 4 year study of ibuprofen
("Effect of High-Dose Ibuprofen in Patients with Cystic Fibrosis") was
published. This study showed that patients who took high doses of
ibuprofen had a slower decline of pulmonary function over time and
better maintenance of body weight compared to patients who took
placebo.” However, they have some caveats: “The dose for CF is higher
than normal, and blood levels must be checked to assure that the dose
is appropriate. In animals, a low dose of ibuprofen can enhance the
movement of neutrophils. Too low of a dose could make your lung
disease worse!… …Side effects seen in the New England Journal study
included conjunctivitis (an irritation of the eye) and nosebleeds.
Although ibuprofen can cause abdominal discomfort, the researchers did
not see more abdominal pain in the ibuprofen treated patients compared
to those who took placebo. There were no changes in kidney function.
Ibuprofen can cause a decrease in blood flow to the kidneys, and this
is of concern to us. Although that side effect was not seen in the
study, the number of subjects was quite small and we do not have
definitive information on the side effects of high dose ibuprofen.
Many patients with CF will require treatment of the bacteria
Pseudomonas with drugs called aminoglycosides (gentamicin or
tobramycin). These drugs can be toxic to the kidneys. We are concerned
that there could be an additive effect of ibuprofen and
aminoglycosides on kidney side effects. It is possible that as
thousands of patients with CF across the country are be placed on
ibuprofen, there may be reports in the future of kidney side effects.”
Ibuprofen does seem safer than aspirin, with respect to
gastrointestinal effects:
Antiinflammatory drugs and gastrointestinal bleeding: a comparison of
aspirin and ibuprofen.
Schmid FR, Culic DD in Journal Clinical Pharmacology 1976 Aug-Sep vol
16 p 418-425
“Gastrointestinal blood loss provoked by short-term and long-term
therapy with aspirin and ibuprofen was compared in patients with
rheumatoid arthritis. Blood loss was assessed by isotope counting of
four-day stool collections after infusion of 51Cr-labeled autologous
erythrocytes. After two weeks on drug or after one year on drug,
aspirin consistently caused more bleeding than ibuprofen.”
Rxlist.com, a web site founded by a pharmacist that provides drug
information to patients and practitioners has the following
information about chronic use of ibuprofen in a general fact sheet
about the drug at http://www.rxlist.com/cgi/generic/ibup_wcp.htm
“In patients observed in clinical trials of several months to two
years duration, symptomatic upper GI ulcers, gross bleeding or
perforation appear to occur in approximately 1% of patients treated
for 3-6 months, and in about 2-4% of patients treated for one year.”
“Liver Effects: As with other nonsteroidal anti-inflammatory drugs,
borderline elevations of one or more liver function tests may occur in
up to 15% of patients. These abnormalities may progress, may remain
essentially unchanged, or may be transient with continued therapy.”
“Kidney Effects: As with other nonsteroidal anti-inflammatory drugs,
long-term administration of ibuprofen to animals has resulted in renal
papillary necrosis and other abnormal renal pathology. In humans,
there have been reports of acute interstitial nephritis with
hematuria, proteinuria, and occasionally nephrotic syndrome.. A second
form of renal toxicity has been seen in patients with prerenal
conditions leading to a reduction in renal blood wflow or blood
volume, where the renal prostaglandins have a supportive role in the
maintenance of renal perfusion... …Those patients at high risk who
chronically take ibuprofen should have renal function monitored if
they have signs or symptoms which may be consistent with mild
azotemia, such as malaise, fatigue, loss of appetite, etc. Occasional
patients may develop some elevation of serum creatinine and BUN levels
without signs or symptoms.”
I hope this helps |
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