1. Ibuprofen and Renal Failure Professor Nicholas Moore International Ibuprofen Foundation University of Bordeaux, France

2. Background Renal prostaglandins essential for GFR Especially in elderly, children, heart failure Known for all NSAIDs Some case reports with ibuprofen Risk of widespread OTC use?

3. In adults Better tolerated than aspirin Tolerance equivalent to paracetamol –Including GI and renal events In clinical RCT of 8644 adults, used for OTC indications Moore N, et al. The PAIN study. Clin Drug Invest 1999;18:89-98.

4. Renal Failure in the Elderly DoseOR95%CI ≤ 1200 mg0.940.58 - 1.51 1200 - 2400 mg1.891.34 - 2.67 ≥ 2400 mg2.321.45 - 3.71 Griffin MR, Yared A, Ray WA. Nonsteroidal antiinflammatory drugs and acute renal failure in elderly persons. Am J Epidemiol 2000;151(5):488-96. 1799 cases, 9899 controls in Medicaid/care

5. In Children Randomized DB clinical trial –Paracetamol vs ibu 10, 15 mg/kg –Hospital admissions –84 000 children incl 27 000 < 2 yrs old Not a single case of renal failure –upper bound CI < 5.4/100 000 No difference in admission creatinine S. M. Lesko, A. A. Mitchell, Jama 273, 929-33 (1995). S. M. Lesko, A. A. Mitchell, Pediatrics 100, 954-7 (1997). S. M. Lesko, A. A. Mitchell, Pediatrics 104, e39 (1999).

6. In Newborns As effective as indomethacin to close patent ductus arteriosus Without renal toxicity L. Cuzzolin, M. Dal Cere, V. Fanos, Drug Saf 24, 9-18 (2001).

7. In Overdose No need to monitor if less than 6 g (30 tabs) Reversible renal failure in severe overdose A. H. Hall, S. C. Smolinske,et al, J Toxicol Clin Toxicol 30, 23-37 (1992).