Thread by @PaulNWilliamz

I see a lot of ibuprofen 800 mg given with wild abandon. I thought I remembered learning from @02Satz that analgesic efficacy didn't increase much over 400 mg, but bleeding risks did.

So I decided to revisit this.

1/5

So it seems I slept on a nifty little 2019 ER study that randomized a convenience sample of patients presenting with acute pain to a 400 mg, 600 mg, or 800 mg dose of ibuprofen. pubmed.ncbi.nlm.nih.gov/31383385/

Turns out, all 3 doses have similar analgesic efficacy. 2/5

Okay, but is the risk of GI bleeding dose-dependent? It makes sense, but I had a harder time finding data to support this. This paper is often cited, and found a "striking" dose-response: pubmed.ncbi.nlm.nih.gov/12236853/

3/5

My takeaways from this?

1) ER doctors are smart and I should talk to them more often
2) No reason to prescribe the higher "anti-inflammatory" doses of ibuprofen when 400 mg seems to do the trick
3) Especially when there is a signal for increased bleeding the higher the dose
4/5

Am I misinterpreting this? Did you know this already? Other thoughts?

5/5

Thanks for all the nice comments and thoughtful questions, most of which I won't be able to address! Obviously, the right dose is the one that helps the most while causing the least amount of harm. Just glad we're not all reflexively starting at the highest dose!