♪ 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. - 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.
