Has a low OTC dose of ibuprofen an antiinflammatory effect?

Information on products containing low doses of ibuprofen available over the counter (OTC) sometimes states that these products are indicated apart from pain and/or fever also for inflammatory disorders. The aim of the present study was to ascertain whether there is a good evidence for antiinflammatory activity in low OTC doses of ibuprofen in medical literature published during 1983-2007. Antiinflammatory effects of ibuprofen at single doses 5-10 mg/kg in children or 200-400 mg in adults were assessed according to their published effects on several biochemical markers of inflammation (such as C-reactive protein) or clinical signs of inflammation. Clinical antiinflammatory effects of ibuprofen were evaluated in rheumatoid arthritis, osteoarthritis, cystic fibrosis and inflammation after oral surgery. The present evaluation was difficult because of differences in methodical standards and orientation of published clinical studies, differences in the number of patients, employment of disparate measures of inflammation, problems in extrapolating effects from dosage used in animals to man or from dosage of S-ibuprofen to that of the usual racemic form of the drug. Published effects of low doses of ibuprofen on activity of cyclooxygenases or biochemical markers of inflammation did not bring evidence for their anti-inflammatory activity (with the exception of one oral surgery study which found that 1200 mg of ibuprofen per day reduced an increase of C-reactive protein). Studies testing doses 5-10 mg/kg of ibuprofen in children confirmed their analgesic and antipyretic activity but did not supply evidence for their anti-inflammatory effects. None of 22 studies assessing effects of ibuprofen in rhematoind arthritis or osteoarthritis reported antiinflammatory effects at low doses of this drug. No publication was found reporting effects of low doses of ibuprofen in cystic fibrosis. In conclusion, the data published until now have not provided good evidence for stating that products containing low OTC doses of ibuprofen have anti-inflammatory activity. This applies particularly to products containing 200 mg of ibuprofen in one dosage form for oral administration in adults.