<P> A study of pregnant women suggests those taking any type or amount of NSAIDs (including ibuprofen, diclofenac and naproxen) were 2.4 times more likely to miscarry than those not taking the drugs . However, an Israeli study found no increased risk of miscarriage in the group of mothers using NSAIDs . </P> <P> NSAIDs such as ibuprofen work by inhibiting the cyclooxygenase (COX) enzymes, which convert arachidonic acid to prostaglandin H (PGH). PGH, in turn, is converted by other enzymes to several other prostaglandins (which are mediators of pain, inflammation, and fever) and to thromboxane A (which stimulates platelet aggregation, leading to the formation of blood clots). </P> <P> Like aspirin and indomethacin, ibuprofen is a nonselective COX inhibitor, in that it inhibits two isoforms of cyclooxygenase, COX - 1 and COX - 2 . The analgesic, antipyretic, and anti-inflammatory activity of NSAIDs appears to operate mainly through inhibition of COX - 2, which decreases the synthesis of prostaglandins involved in mediating inflammation, pain, fever, and swelling . Antipyretic effects may be due to action on the hypothalamus, resulting in an increased peripheral blood flow, vasodilation, and subsequent heat dissipation . Inhibition of COX - 1 instead would be responsible for unwanted effects on the gastrointestinal tract . However, the role of the individual COX isoforms in the analgesic, anti-inflammatory, and gastric damage effects of NSAIDs is uncertain and different compounds cause different degrees of analgesia and gastric damage . </P> <P> Ibuprofen is administered as a racemic mixture . The R - enantiomer undergoes extensive interconversion to the S - enantiomer in vivo . The S - enantiomer is believed to be the more pharmacologically active enantiomer . The R - enantiomer is converted through a series of three main enzymes . These enzymes include acyl - CoA - synthetase, which converts the R - enantiomer to (-) - R - ibuprofen I - CoA; 2 - arylpropionyl - CoA epimerase, which converts (-) - R - ibuprofen I - CoA to (+) - S - Ibuprofen I - CoA; and hydrolase, which converts (+) - S - ibuprofen I - CoA to the S - enantiomer . In addition to the conversion of ibuprofen to the S - enantiomer, the body can metabolize ibuprofen to several other compounds, including numerous hydroxyl, carboxyl and glucuronyl metabolites . Virtually all of these have no pharmacological effects . </P>

How does ibuprofen inhibit the action of the cox enzyme
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