♪ Bob and Brad ♪
♪ The two most famous physical therapists ♪
♪ On the internet ♪
- Hi folks, I'm Brad Heineck, physical therapist.
- Hey, I'm Chris.
- And I'm exactly one half
of the Bob and Brad physical therapy channel.
But today, we're gonna go off
into the pharmaceutical world, slightly with ibuprofen.
We are extremely happy to have Chris,
our usual guest for pharmacy expert advice.
And he's been...
Well, you know,
you've been doing this for how many years, Chris?
- A few.
- Yeah. (chuckles)
26 - 26. (laughing)
- 26 Years.
He really understands the topic extremely well.
He's gonna give us up to date information
if you wanna know, should you be taking it,
how much to take, and are there any side effects
or precautions when taking it?
Everything will be answered by this young man,
and I'm gonna quit talking
'cause I just babble on; they're already saying so already.
- All right, well, sounds good.
Well, yep, we're gonna talk about ibuprofen today, guys.
- Oh, your cord, Chris,
it's gettin' in the way. - Oh, my goodness.
- There you are.
- I'm losing style points already,
so my apologies. (Brad laughing)
Dorky pharmacist.
(Brad laughing)
Ibuprofen is actually one of my most favorite pain relievers
because it's so versatile.
It does a lot of different things for the human body.
It helps with pain and inflammation,
which is in the NSAID category,
non-steroidal anti-inflammatory drug.
So basically, aspirin is the granddaddy of 'em all,
but ibuprofen, I would say,
has a lot more utility than aspirin
in so many different ways only
because it's a little bit safer.
So we'll kind of talk about some of those
as we kind of walk down some of the side effects and stuff
when we get there, but.
- So, I always think of ibuprofen as primarily
an anti-inflammatory.
In other words,
if you have swelling and wanna reduce the swelling,
reduce the pain as a result of that swelling-
- Yes.
- that's kind of what it does?
- Yeah, but it also is a great fever reducer.
They call it an antipyretic.
And so, let's say you've got a fever-
- Yep.
- or your little one has a fever,
it's a great fever reducer.
- Oh, really? - So, yeah,
it kind of competes with acetaminophen Tylenol
for that respect.
- Sure. - And so, if you're ever sick
and feeling under the weather,
and right now we're dealing with COVID
and all those different strains.
Or influenza, we're in flu season,
cough and cold in flu season- - Sure, right.
- up here in the hemisphere.
So honestly, when you are achy and feverish,
it's an excellent drug.
I think it actually has got a little bit more utility
than even say acetaminophen
because Tylenol or acetaminophen, or paracetamol,
for the people that are listening to us across the pond,
(Brad laughing)
only works on fever and pain relief.
Whereas this adds the added dimension
of anti-inflammatory to that.
- Sure.
And when you're sick,
there's a lot of different things going on with our body.
And so that anti-inflammatory aspect of the ibuprofen,
I think is very beneficial when we're sick and achy.
- Okay, so let's say, for example,
if I've got a cold, sniffly;
I've got aches and pains, like fluish symptoms;
or I sprained my ankle, and I got swelling;
all of those, ibuprofen would be appropriate to take-
- It covers them all.
- But then how much?
Like how much not to take.
- Yeah, so basically,
for an average human adult or anybody over the age of 12,
so basically we would consider one or two tablets.
And each tablet contains 200 milligrams.
- That's a standard,
isn't it? - That's a standard tablet.
So they make a junior strength for kids that's a chewable.
It's 100 milligram strength.
And then they also make a liquid
that comes as 100 milligrams per five milliliters.
So it can be dosed down (Brad chuckling)
to kids as a teaspoon,
- But that's typically for kid?
- Yeah, that would be for kids
or maybe adults that have swallowing difficulties.
- I see.
- So there's a variety of different ways
that you can obtain ibuprofen, but they all work the same.
I mean, that's the bottom line.
It's a really versatile thing
to have in the medicine cabinet.
But if you're allergic to aspirin
or any component of ibuprofen,
or ibuprofen themselves, or other NSAIDs,
you wanna avoid it because obviously an allergy would be
something that we have to be very, very careful with.
- So I wanna go over this a little more detailed
'cause every time I look to figure out
how much of these I should take,
I just texted you anyway,
so I can't remember. - Yeah. (laughing)
- But it is it the body weight or the age that determines?
- You know, in general,
the way the FDA has kind of settled these things
would be basically by age range,
but it's more a specific and more appropriate by weight.
And particularly, with juvenile patients
or pediatric patients,
we are gonna do a milligram per kilogram dose
specifically to make sure that it's on their body weight.
- So you're talking about five-year-old, 10-year old?
- Yeah, so let's say you would calculate it out.
The usual calculation we would use
is 10 milligrams per kilogram per dose.
- So we're talking kilogram, but can we get the pounds?
If you got a 40, 50-pound child?
- Yeah, you gotta 50, so you gotta multiply it by 2.52.
And so basically, yeah, you just do the math,
and you just...
Pounds to kilograms. - I bet you can Google this.
- You can Google this. - And it'll tell you.
- Even easier, just ask your local pharmacist
or your doctor what's appropriate.
What we would tell you in an over-the-counter setting is
to use the package instructions
based on either body weight or age.
- Okay.
- So for most people 12 on up...
I digress, it'd be one or two tablets
every four to six hours (indistinct) as needed
to a maximum of eight tablets a day.
So, that said, 200 tablets,
so it's gonna be 3,200 milligrams
as a maximum daily dose.
- So two tablets, four times per day.
- Yeah, but actually,
prescription is 3,200 milligrams would be the absolute max.
But it's available as a prescription too
as 400, 600, 800 milligram tablets by doctor's orders only.
- Sure.
- So, but 3,200 is the absolute max,
but that would be again by doctor's order.
- Right.
So if you're taking these over the counter, you're sick,
and like, I weigh 175, 180 pounds,
depending on the time of year. (laughing)
- Yep.
- I'm gonna take...
And I take up the four of these at a time
and that's probably max, or maybe I'm overdoing it?
- Yeah. It's probably overdoing it.
I mean, you wanna be careful with that.
Talk it over with your doctor, because again,
one of the side effects that will kind of all devolve into
with this discussion of with the blood pressure issues,
and heart issues, or stomach issues.ª
But, so, 800 milligrams is aggressive.
It's not uncommon, but you'd wanna make sure
your physician is happy with you using that dose
'cause it could cause damage to your stomach.
Stomach ulceration is certainly a big consideration.
- And if someone doesn't have a physician,
or it's too much of a problem to be safe,
three is probably-
- Well, probably two tablets every four to six hours.
- Okay, two.
- Yeah, you would just stick
with the standard over the counter
'cause that would be the straight legalese
from that standpoint too.
You're not gonna overdo it.
When you go to the prescription side,
so let's see you're being treated
for osteoarthritis or arthritis.
You will have doctors writing prescriptions
in the 600 to 800 milligram range-
- Per tablet.
And that dosing level will be more effective,
especially when you're looking at something
as uncomfortable as osteoarthritis,
that wear and tear that we all kind of experience.
- So the average person is gonna take two of these
four times per day maximum.
- Yeah, and we really wouldn't want you using it
for an extended period of time.
We use that, seven is kind of the cutoff.
So if you feel that, you know,
unless you sprained an ankle,
strained a back, fever,
I mean, all these things;
so kind of, seven days is kind of your line in the sand.
You'd wanna be talking to your doctor
if you're not getting any serious relief
or if you're experiencing negative side effects.
- Mm hmm, okay.
- So we wanna be real careful with that.
- So, that many, two of 'em four times a day for seven days.
If it's not showing the obvious signs,
it's not doing anything.
- You should be talking to your physician.
- Sure.
- Or at least pop into your local pharmacist,
which is probably gonna tell you
to turn around and talk to your doctor
or find your provider or run into urgent care
if things are not better.
- All right.
- But you know, one of the things
we have to kind of look at
with ibuprofen use is side effects.
So what can be a negative aspect of using this,
And sometimes side effects can occur very quickly,
or it may take time if you're using it overly often.
So you wanna be careful with that.
So stomach ulceration is the first thing that comes to mind.
So basically the way that these drugs work
is the inhibit prostaglandins,
which are the kind of the thing that helps to maintain
that mucus lining of your stomach.
- Sure.
- And ibuprofen helps to slow down the process
of how prostate glands are made.
That's why it's an anti-inflammatory when you look at this.
So not to get overly technical,
but so repeated use in most cases,
but sometimes even short-term use,
it can cause bleeding ulcers or gastritis,
or just a lot of irritation to the gut.
So we like people always to take it with food
or at least a glass of milk to protect their stomach.
- Okay.
- So to make sure that that doesn't happen.
It just slows down the absorption.
It's not so much that...
It doesn't burn a hole in your stomach,
which is kind of
a misconception. - Before you eat,
after you eat?
- Eat first,
then take the medication. - Okay.
- That's most ideal.
If you take it on an empty stomach,
it absorbs pretty quickly, which is good,
but the problem is it could cause damage
to your stomach lining. - Sure.
- So you wanna be mindful with that.
- Now, I've heard there's issues with..
Is it your liver, your kidneys, I guess, can...
- Liver and kidney, yeah.
It's primarily metabolized in the liver,
but oftentimes, it's really difficult to get liver failure
from using NSAIDs like ibuprofen,
but it's still problematic.
And if you were hepatically compromised,
dosage adjustments would be definitely priority number one,
which your physician would let you know
what you could safely get away with.
- So if you have liver problems-
- Liver failure, cirrhosis. - You've gotta be careful
with this.
- Exactly. - Talk to your doctor.
- But more importantly are the kidneys.
- Okay.
So it's just basically the way that NSAIDs work
and how prostaglandins work
and how they affect blood pressure,
and it gets kind of complex and kind of techie,
but the reality of it is we have
to be real careful with how we use this.
If you're somebody that has renal failure,
it's probably something that should not be utilized
because not only can it shut down those kidneys,
but it can also be very dangerous for your heart
from that regard.
- What if you're on blood pressure medication?
- Well, and that's, yeah...
And they'll touch on that
because a lot of those blood pressure medications
like ACE inhibitors, ARBs, and diuretics,
all kind of work on some areas of the kidney.
And so that can actually complicate things for the body
when they're trying to metabolize
those types of medications.
So it's important to check with your doctor,
your pharmacist,
to make sure it's safe or appropriate to use.
And in most cases, short-term use, it's probably okay.
There are other drugs that can be problematic.
Blood thinners like warfarin specifically,
or some of the newer anticoagulants,
the DOACs like Eliquis and Xarelto,
which are prescription drugs.
But if they're anticoagulants,
they're things that help stop clotting.
When you take drugs like ibuprofen,
because it is related to aspirin,
it can thin the blood a little bit.
And so that could read your risk
for stroking out on the bleeding risk.
- So yeah, people that are taking these blood thinners,
if you will, or typically,
maybe have a history
or a possibility of a stroke- - Correct.
- or they have some cardiac, some heart problems.
- Yeah, there could be a lot of different reasons.
I mean, if you're on a blood thinner,
and you had a clotting issue,
and so what happens is when we add a drug
like aspirin or ibuprofen,
it swings the scale the other way.
So you were clotting too much-
- Yep.
- well, now we're taking these drugs
to help to minimize that clotting process.
And so now we add ibuprofen on top of that,
and that can make you bleed.
The risk raises even more. - So if you cut yourself,
it may continue- - It'll bleed more.
- to bleed- - Yeah, bleed or bruise.
- More than you'd like.
- Conceivably, and that's why you do not want
to use ibuprofen with any anti-coagulation type of therapy.
So it's very important to be in touch
with your doctor and pharmacist.
Always check because even though
it's an over-the-counter product that is readily available,
either online, or in the grocery store, or the gas station;
you can get it anywhere;
you do have to treat it with respect
because it could 'cause
some negative problems. - Sure, yep.
- All right, excellent job, Chris.
This is always a good review for me.
We've done this before,
but I think there's a lot of people
who aren't aware of these things,
and now they can feel comfortable
with their knowledge. - Absolutely.
Yeah, safe stuff, good stuff.
Just be careful when you use it.
And if there's ever a question,
talk to your doctor, your pharmacist,
we'll will be happy to help you out any way we can.
- That's right.
And be careful as always.
- All right, thanks guys.