is this NSAID overdose?

[softlight]

I prescribed someone ibuprofen 600 mg to be taken 3x /day as needed. I dispensed 21 tabs and permitted one refill. She now has a good two weeks worth of ibuprofen.

But I recently found out that she takes Naproxen 500 mg for backpain and/or arthritis. I don't know how frequently she takes this.

What will happen?

What should I do to protect myself legally?

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[dragonfly99]

You can generally give up to 800mg tid of ibuprofen, so you really aren't at the top dose on that.
If the patient goes and takes 1 naproxen 500mg once or twice during the 2 weeks she is on ibuprofen, then realistically, nothing is going to happen to her.
However, if she's taking 600mg tid of ibuprofen and then bid naproxen every day for a couple of weeks, I guess there would be some risk of acute renal failure.

This isn't something you need to panic about, but you should try and contact the patient. Is this your clinic patient? Just try to call her and discuss with her how she shouldn't be taking both of these at once. If you can't get hold of her by phone, then send a letter, but really do try to get hold of her by phone. Nothing is going to happen to her in 1 or 2 days, but you wouldn't want her doubling up on NSAIDS for weeks.

 

[softlight]

You can generally give up to 800mg tid of ibuprofen, so you really aren't at the top dose on that.
If the patient goes and takes 1 naproxen 500mg once or twice during the 2 weeks she is on ibuprofen, then realistically, nothing is going to happen to her.
However, if she's taking 600mg tid of ibuprofen and then bid naproxen every day for a couple of weeks, I guess there would be some risk of acute renal failure.

Suppose she takes naproxem 500 twice a day and ibuprofen 600 three times a day. By how much is she overdosing per day?

How serious is this really? What would happen if I never get in touch with this patient? Any steps I can take to protect myself legally?

 

[Encephalopathy]

Suppose she takes naproxem 500 twice a day and ibuprofen 600 three times a day. By how much is she overdosing per day?

How serious is this really? What would happen if I never get in touch with this patient? Any steps I can take to protect myself legally?

Um, I think the best step to protect yourself legally would be to call the patient and tell her before she actually ODs. You seem averse to this...?

 

[angel80]

You can't really "overdose" on ibuprofen. If a patient takes too much, they can have GI or renal side effects. You should just call the patient and advise them not to take both.

 

[softlight]

So nobody knows how severe this overdosage is? How likely is it for renal or GI damage?

Assuming the patient is around 54 kg, do you think he is beyond 100 mg / kg in ibuprofen overdosage ? ( I don't know how the naproxen dose would factor into this )

I can't get in touch with the patient by the way.

 

[Wrigleyville]

There is a general consensus that patients shouldn't be on a bunch of NSAIDs due to GI + renal effects, but I don't think there is any calculation such as "X Ibuprofen + Y naproxen = kidney failure."

Both of those meds can be bought OTC in giant containers from your local pharmacy; I wouldn't get too excited about getting sued over "prescribing" your patient a small supply of PRN meds they are probably familiar with anyway.

 

[mrantarctica]

What was the indication for ibuprofen in the first place? why not just tinker with her existing NSAID?

Contact the patient - and advise that there may be some issue with her pain relief. Clarify the doses of ALL her tablets. Is she on anything else nephrotoxic? Thiazides? ACE inhibitors? Frusemide? Make necessary adjustments. Don't worry if you can't get hold of her though, it doesnt sound like she has too many tablets. I just hope she's not taking aspirin too, for your sake (and hasn't had ulcers before)

This highlights the importance of taking a good/complete drug history.