Talk:Ibuprofen/Archive 2

Effect on Animals
The page on Aspirin has this section, and as the drugs are superficially similar (mild NSAIDS), perhaps this page should have that too? Especially when much literature talks about the catastrophic effect even a small overdose can have on dogs. 101.161.70.111 (talk) 10:23, 4 August 2013 (UTC)

References, over several lines
From what I've gathered we generally don't do references over several lines yet this article does this extensively. I am going to fix this, but I thought I'd start a dialogue, in case somebody, has an objection to this. I would wait for a consensus to be reached but this would take months. Brenton (talk|email) (I automatically watch all pages I edit) 16:38, 25 June 2014 (UTC)

Ibuprofen mix-up for Oxcarbazepine by Pharmaceutical Co. 2014
Why can't I find anything about the Pharmaceutical mix up of Ibuprofen substituted for Seizure med Oxcarbazepine in 2014 online? I saw this article in a medical article recently but cannot find it online anywhere. The Pharmaceutical Company's were erroneously putting Ibuprofen into containers for Seizure medication Oxcarbazepine for Brand Name Trileptal. — Preceding unsigned comment added by 66.82.162.21 (talk) 22:30, 28 July 2014 (UTC)

Dosage?
The article says:


 * "A dose of 400 mg per dose and 1200 mg per day is considered the maximum amount for over-the-counter use in the United States and in the United Kingdom"

But the reference does not appear to say anything about doses. I suspect that this is because whoever put that reference in cited a search term, not an actual page. Search terms can give different results at different times, and thus do not make good Wikipedia references.

Here is what I found from a web search. (No fair blasting me if I found the wrong sources; when it comes to medicine, I am an excellent electronics engineer.)

Drugs.com (http://www.drugs.com/pro/ibuprofen.html) says:


 * "Rheumatoid arthritis and osteoarthritis, including flare-ups of chronic disease:''


 * Suggested Dosage: 1200 mg-3200 mg daily (400 mg, 600 mg or 800 mg tid or qid). Individual patients may show a better response to 3200 mg daily, as compared with 2400 mg, although in well-controlled clinical trials patients on 3200 mg did not show a better mean response in terms of efficacy. Therefore, when treating patients with3200 mg/day, the physician should observe sufficient increased clinical benefits to offset potential increased risk.The dose should be tailored to each patient, and may be lowered or raised depending on the severity of symptoms either at time of initiating drug therapy or as the patient responds or fails to respond"

At http://www.ncbi.nlm.nih.gov/pubmed/3522311 we have a double-blind study comparing ibuprofen 1800 mg or 2400 mg daily.

http://www.mims.com/USA/drug/info/Ibuprofen%20Suspension/?type=full says


 * "Rheumatoid arthritis and osteoarthritis, including flare-ups of chronic disease: Suggested dosage: 1200-3200 mg daily (300 mg q.i.d. or 400 mg, 600 mg or 800 mg t.i.d. or q.i.d.). Individual patients may show a better response to 3200 mg daily, as compared with 2400 mg, although in well-controlled clinical trials patients on 3200 mg did not show a better mean response in terms of efficacy. Therefore, when treating patients with 3200 mg/day, the physician should observe sufficient increased clinical benefits to offset potential increased risk."

So, what is the maximum dosage per day?

Related question: When I see "for over-the-counter use" I think Wikipedia is trying to say "don't take more than this unless your doctor tells you to" but it sounds like "don't take more than this if you bought it over the counter". My doctor sometimes tells me which OTC drugs to take and how much of them to take. Should we make this more clear?

Again, I am about as good at medicine as your average MD is at assembly-language programming, so I am throwing this out for more experienced editors to deal with. --Guy Macon (talk) 02:56, 10 March 2014 (UTC)


 * I did some more research, and found the following labels:
 * http://www.motrin.com/product_links/druglabel
 * http://www.drugcite.com/label/?q=20111110_f273a521-1292-40b0-9d41-3522677705ca/f273a521-1292-40b0-9d41-3522677705ca&rx=Ibuprofen
 * http://dailymed.nlm.nih.gov/dailymed/archives/fdaDrugInfo.cfm?archiveid=51050


 * Which come out to 200mg/dose and 1200 mg/day.


 * BTW, that "t.i.d." and "q.i.d." above appears to mean:
 * q.i.d. = 4 times a day (from the Latin quater in die).
 * q.d. = once a day (quaque die)
 * b.i.d. = two times a day (bis in die)
 * t.i.d. = three times a day (ter in die)
 * q4h = take 2 every 4 hours (quaque?)
 * Source: http://www.medterms.com/script/main/art.asp?articlekey=5157


 * Because nobody has replied, I am going to edit the page to reflect the above sources. --Guy Macon (talk) 00:48, 15 March 2014 (UTC)

I also fee there should be a referenced statement such as "the standard daily adult dose is 200 mg per day". The article does not clearly state what a standard dose is, which is very important information (perhaps the single most important piece for anyone actually consuming the stuff). Paulhummerman (talk) 11:03, 28 August 2014 (UTC)

Pharmakokinetics?
Article needs info about how fast the drug enter the blood, how long it stays, and how it is eliminated. Paulhummerman (talk) 11:06, 28 August 2014 (UTC)

Synthesis
A section on synthesis was deleted with dubious arguments. This article really should have a section on synthesis. V8rik (talk) 17:02, 4 January 2015 (UTC)
 * not clear to me why it should have a section on synthesis. Most drug articles don't - why should this one? (real question) And if we have one, it should be sourced to a WP:SECONDARY source that provides some context. Jytdog (talk) 17:06, 4 January 2015 (UTC)
 * Pharmaceuticals typically include a lab synthesis or biosynthesis section if they're WP:CHEMS tagged, since MOS:CHEM indicates its inclusion; this isn't a WP:CHEMS article though.  Seppi  333  (Insert 2¢ &#124; Maintained) 17:20, 4 January 2015 (UTC)
 * Meds can be synthesis in a lot of ways. Stating this in every article is not needed
 * This bit may be notable is the history section "BHC (now BASF Corporation) devised a synthesis requiring only 3 steps for the Presidential Green Chemistry Challenge "Greener Synthetic Pathways" Award in 1997. " Doc James  (talk · contribs · email) 18:45, 4 January 2015 (UTC)

US EPA SRS Number
Can't seem to see it listed. Looks like the US EPA SRS Internal Tracking Number is 200931. — Preceding unsigned comment added by 64.6.164.150 (talk) 17:49, 24 June 2015 (UTC)

"Advil smadvil" vandalized summary on Google
I see the page for Advil (which redirects to this one) was vandalized and reverted on the 11 Sep 2015. Unfortunately Google picked up the vandalism as its summary for the result here when people search "Advil". I believe it's not updating it to something more sensible because it's a redirect now.

I think the way to fix it would be to place a more worthy snippet of text into this article for a few minutes until Google picks it up, then change it back to a redirect. 66.31.86.213 (talk) 21:44, 16 September 2015 (UTC)


 * Sounds like a good theory to me. Can't hurt to try. Will do. Quercus solaris (talk) 01:14, 17 September 2015 (UTC)
 * I just tried googling it, and the google results that I get already look correct. So I did not pursue. If someone still gets different results elsewhere (entirely possible), feel free. Quercus solaris (talk) 01:17, 17 September 2015 (UTC)

History
[BBC article 15 November 15 — Preceding [[Wikipedia:Signatures|unsigned] comment added by ClemRutter (talk • contribs) 11:56, 15 November 2015 (UTC)

Heart and other problems
Per the addition of "At high doses and long term use" it increases the risk of heart failure, kidney failure, and liver failure. Ref says
 * "The risk of heart attack or stroke can occur as early as the first weeks of using an NSAID"
 * "The risk appears greater at higher doses."
 * "There is an increased risk of heart failure with NSAID use."

The first bit is hardly long term use. And while the risk is greater at higher doses it does not mean the risk is not present at normal doses. Thoughts? Doc James (talk · contribs · email) 21:38, 10 March 2016 (UTC)
 * this is the actuall research which our friends from FDA are refering to: research of NSAID in general,not just ibuprofen(2400mg a day used in the study. you would have to take 12 (twelve) 200mg pills a day - LONG TERM and be over 60 ). Risk increases with higher doses and long term use. We are talking about high doses NSAID used daily by people with chronic pain.Risc for Healthy person with low doses and short time use is not mentioned in any links here or research study articles about NSAID online. 12:57, 11 March 2016 (UTC) 72.185.200.232 (talk) 13:01, 11 March 2016 (UTC)
 * That however is not the ref associated with the content in question. Nor the statement from the FDA website. I shall request further opinions. I do not think "At high doses and long term use" is needed. Doc James  (talk · contribs · email) 20:07, 11 March 2016 (UTC)
 * agree w/ DocJames--Ozzie10aaaa (talk) 21:21, 11 March 2016 (UTC)
 * that ref is exactly research that FDA is referring to. Please don't let common misconception about ibuprofen cloud your judgement. Those are hard statistical facts from the research. There is no heart attack issue for healthy person using ibuprofen at recommended daily doses for short term. You don't have to take my world for it. Read the researcher opinion in the source I have provided.  72.185.200.232 (talk) 22:17, 11 March 2016 (UTC)
 * Our content did not specify health people. The FDA refers to a lot of literature not just a single study. We use secondary sources and positions statements such as the FDA as sourcing.
 * While I agree the risk is greater at a higher dose and greater with long term use the ref does not say it is nothing with normal doses or short term use. Doc James  (talk · contribs · email) 00:33, 12 March 2016 (UTC)
 * The MRC newspiece above refers to a meta-analysis, which is http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2813%2960900-9/ and it is summarized at http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)61128-9/fulltext with: "Someone at moderate risk for both outcomes would have a 4–19% chance of a treatment-related vascular or gastrointestinal complication over 10 years of high-dose NSAID use." LeadSongDog come howl!  19:10, 30 November 2016 (UTC)

Split of Ibuprofen brand names
I have reverted a split of Ibuprofen brand names as I am not sure it is needed. Discussion here Doc James  (talk · contribs · email) 23:14, 16 December 2016 (UTC)

Dosage?
This article seems to go out of its way to avoid saying what the proper dosage of Ibuprofen is. Is somebody afraid of a lawsuit or something?

This article says, "Ibuprofen is commonly available in the United States up to the FDA's 1984 dose limit OTC,..." but it does not say what the FDA's limit actually is.

The article states that the overdose limit is "Toxic effects are unlikely at doses below 100 mg/kg, but can be severe above 400 mg/kg (around 150 tablets of 200 mg units for an average man)", but that number is sky-high, and does not hint at what a safe, normal dose is. Because I weigh about 77 kilograms, an overdose for me would be more than 7700 mg, or more than 39 each 200mg tablets, maybe as much as 4 times that amount. Obviously, there is a Grand-Canyon-sized gap between safe dosage and overdose. So it would be reasonable and helpful to say what a proper, ordinary dose is. AOrange (talk) 19:36, 24 December 2016 (UTC)
 * We per WP:MEDMOS do not provide dosing. Doc James  (talk · contribs · email) 00:52, 25 December 2016 (UTC)

Structural formula
There is a line drawing of the molecule with a wavy line, what is that wavy line? Also, that drawing and the ball and stick model depicted below it should (I humbly suggest) be aligned with one another. 109.153.241.137 (talk) 15:07, 27 January 2017 (UTC)
 * The wave line in the skeletal formula indicates a mixture of stereochemistry (details at Skeletal_formula). -- Ed (Edgar181) 16:55, 27 January 2017 (UTC)
 * Thank you. The "problem" was just my ignorance of the notation! — Preceding unsigned comment added by 31.52.253.124 (talk) 18:28, 28 January 2017 (UTC)

1200 to 3200 mg orally per day in divided doses
The article says too little about the available dosing sizes and typical lo-med-hi dosing schedules for various short and long-term purposes. (200mg tabs most common in US, but 100-800mg tabs exist.)

It is odd that the half-life in the body is only about 2 hours, yet typical dosing schedules are often much less frequent (eg 600mg every 6 hours).

A typical OTC dosage for ordinary adults seems to be up to about 1200mg/24 hours. Max-max dose 3200mg/24 hours. -71.174.176.136 (talk) 18:02, 15 February 2017 (UTC)
 * we don't discuss dosing per WP:MEDMOS; that in turn goes back to WP:NOTHOWTO. Jytdog (talk) 19:21, 15 February 2017 (UTC)

External links modified
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Based on primary source
"Concern has been raised over declining male reproductive health in humans. A 2018 PNAS study addressed this issue by extending data showing antiandrogen effects of analgesics and suggests that such compounds may be involved in adult male reproductive problems. Using a unique combination of a randomized, controlled clinical trial and ex vivo and in vitro approaches, the study reports a univocal depression of important aspects of testicular function, including testosterone production, after use of over-the-counter ibuprofen. The study shows that ibuprofen use results in selective transcriptional repression of endocrine cells in the human testis. This repression results in the elevation of the stimulatory pituitary hormones, resulting in a state of compensated hypogonadism, a disorder associated with adverse reproductive and physical health disorders." "


 * Also appears to be copyright issues Doc James  (talk · contribs · email) 11:12, 9 February 2018 (UTC)
 * Hmm, well, I've learned of the need for secondary sources just now so I guess this subject will have to stay in the dark for now I'm assuming. As I mentioned earlier, I didn't really see a need for much paraphrasing when I read the results and stated which journal had published this finding, but thanks for informing me of the copyright issue (will avoid that in the future now) in stating word for word much of what the study reported. Assuming a secondary source is found at some point in time to complement this primary source, would it work to state that the study found the following and then put the relevant research in quotations without it being copyright infringement? Looking forward to hearing your response! Best. Reixus (talk) 09:36, 12 February 2018 (UTC)
 * We need to generally paraphrase sources. And we nearly always wait for secondary sources. If the issue is important secondary sources do not take long to be published. Doc James  (talk · contribs · email) 09:46, 12 February 2018 (UTC)

Paracetamol study
I would like to ask you to return that you have made by justifying it as containing a primary source. I know what you wanted to do but I intentionally specified the study's results cited by the study's own source itself (primary source). I didn't drew general conclusion backed by single study which would be outright wrong per se. The source is reliable for the information it was cited for.

In order to make our dialogue less contentious here are several reasons of why I've introduced that statement:
 * Believing it would be beneficial to know that ibuprofen may be combined with paracetamol and the safety is uncertain
 * There are drug formulations which use both ibuprofen and paracetamol combined into one single tablet (note: I haven't put this statement into article yet, it's here just for the reasons sake)

I also would like you to consult WP:BABY's second and third sections.  DAVRONOV A.A. ✉ ⚑ 18:02, 27 January 2019 (UTC)


 * Secondary sources are avaliable. The primary source is not needed and is undue. Doc James  (talk · contribs · email) 19:05, 27 January 2019 (UTC)
 * So how about to return back what you've removed?  DAVRONOV A.A. ✉ ⚑ 19:22, 27 January 2019 (UTC)


 * References

Quotes
Can go inline and do not need to be in their own indented section. IMO that gives them undue weight. Doc James (talk · contribs · email) 20:59, 1 February 2019 (UTC)