Despite ibuprofen having a wide safety margin, it is possible to overdose on it, but death from ibuprofen overdose is rare. Children are more susceptible to the effects of ibuprofen and likely to experience an overdosage of ibuprofen if dosages of more than 400mg/kg (in the range of 8000mg for a 20kg child [the equivalent of 40 x 200mg ibuprofen tablets]) are ingested. Studies have reported patients ingesting less than 99 mg/kg are unlikely to have symptoms.
Ibuprofen toxicity rather than ibuprofen overdose is much more likely, and this can happen at any dose above the recommended range. Ibuprofen toxicity can even occur at recommended dosages in people with other medical conditions, such as high blood pressure, heart failure, or kidney disease; with dehydration; or in those taking other medications that also have effects on the kidneys such as ACE inhibitors, ARBs, or diuretics.
Ibuprofen can irritate the stomach and the risk increases the more ibuprofen you take, although serious gastrointestinal effects (such as bleeding or ulcers) are rare. Symptoms of ibuprofen toxicity may include:
- Abdominal pain
- Dizziness
- Drowsiness
- Elevated creatinine levels
- High blood pressure
- Indigestion and dyspepsia
- Increased liver enzymes
- Impaired renal function (more likely in people who already have poor renal function)
- Lack of urination or reduced urination
- Nausea.
Overdose symptoms
Most people report no or mild symptoms following an ibuprofen overdose and symptoms are more likely in adults. They tend to occur within 4 hours. Symptoms and laboratory findings may include:
- Abdominal pain
- Acute renal failure
- Acute tubular necrosis
- Aggression and irritability
- Agitation
- Apnea and respiratory depression
- Blood loss from the digestive tract (may be seen as dark, tarry stools)
- Blue lips or fingertips
- Cholestasis
- Cold or clammy skin
- Decreased levels of consciousness
- Dizziness
- Drowsiness
- Gastrointestinal hemorrhage
- Gastric ulcer
- Hepatitis
- High blood pressure
- Hypokalemia (may be life-threatening)
- Indigestion and dyspepsia
- Jaundice
- Little to no urination
- Low breathing rate (less than 10 breaths per minute)
- Memory loss
- Metabolic acidosis (due to the accumulation of acidic metabolites of ibuprofen, acute renal failure, or lactic acidosis)
- Nausea and vomiting
- Nephrotic syndrome
- Pancreatitis
- Polyuria
- Prolonged prothrombin time
- Reduced heart rate
- Seizures
- Thrombocytopenia
- Death.
What should you do if you suspect an ibuprofen overdose?
Call a poison center (1-800-222-1222 or visit POISONHELP.ORG) if you suspect ibuprofen overdose/toxicity or report to an emergency department.
The emergency physician and other supporting staff should:
- Establish what has been ingested and how much. Acetaminophen is often ingested alongside ibuprofen, or mistaken for ibuprofen, and this requires different management
- Maintain airway, breathing, circulation, and decontamination
- Order relevant laboratory tests, which should include acetaminophen levels, blood gas, CBC, renal and liver function tests, electrolytes, and blood sugar levels
- Correct any electrolyte, fluid, or blood gas abnormalities
- Consider the use of activated charcoal
- Consult with other specialists (eg, psychiatry, nephrology) if required.
- People without any symptoms may be observed for 4 to 6 hours in the emergency department.