Update on ibuprofen: review article.

Non-steroidal anti-inflammatory drugs (NSAIDs) have become the principal mode of therapy for rheumatic diseases and their use has continued to increase despite concern expressed recently regarding potential hazards (Figure 1). Prior to 1969, a limited number of NSAID drugs were available. Aspirin and indomethacin became the mainstay of treatment but tolerability, particularly gastric irritation, at doses necessary to control rheumatic symptoms limited the usefulness of these valuable agents. The pyrazolone, phenylbutazone, showed slightly better gastro-intestinal (GIT) tolerability but has since been associated with an increased risk of blood dyscrasiae and is now only available for restricted use in most countries. Ibuprofen was the first of a new breed of NSAIDs originally introduced into the United Kingdom in 1969. Chemically quite distinct from its forerunners it was the first of the propionic acid derivatives to be used in rheumatic practice. The propionics have since become the largest, single and most important group of NSAIDs accounting for 50% of NSAID prescriptions in the United Kingdom. It is estimated that over 100 million patients worldwide have received ibuprofen which is now available in over 100 countries throughout the world including all the major markets. Ibuprofen was developed directly as a result of the problems associated with the use of corticosteroids in the treatment of rheumatoid arthritis and also because of the gastro-intestinal irritation and general intolerability of the established NSAIDs, at that time. Ibuprofen was readily accepted because, unlike the previous drugs, its therapeutic efficacy was easily seen to outweigh the severity of its side-effects. Ibuprofen was the first new drug with the potency of aspirin but without its major disadvantages.