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Pharmacology

Do You Know Your Ibuprofen?

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bigstock-Ibuprofen-Pills-4889950 This Prescription Drug Consult is presented by the JCDA Oasis Team. It is also available in JCDA Oasis Mobile

Ibuprofen 

Addaprin [OTC]; Advil® [OTC]; Caldolor®; I-Prin [OTC]; Ibu®; Midol® Cramps & Body Aches [OTC]; Motrin® Infants’ [OTC]; NeoProfen

Presentation

Ibuprofen is a Non-Steroidal Anti-Inflammatory Drug (NSAID) which could be administered orally and through I.V.

Ibuprofen is prescribed for inflammatory diseases, analgesia, dysmenorrhea, and as an antipyretic.

Dosage

Analgesic

  • Children: < 4-10 mg/kg/dose every 6-8 hrs.
  • Adults: 200-400 mg/dose every 4-6 hrs (maximum daily dose: 1.2 g, unless directed by physician).

Analgesic, antipyretic: (Consult physician if treatment for > 10 days is required)

  • Children 6 months to 11 years: Use of weight to select dose is preferred; doses may be repeated every 6-8 hrs (maximum: 4 doses/day).
  • Children ≥ 12 years and Adults: 200 mg every 4-6 hrs as needed (maximum: 1200 mg/24 hrs)

 Find detailed dosage tables here

Avoid

Analgesics: NSAIDs (e.g., floctafenine): Risk of adverse/toxic effects. 

Loop Diuretics: Risk of diminishing the diuretic effect of loop diuretics.

Immunosuppressant Agent: Methotrexate: risk of decreasing the excretion of methotrexate.

Vitamin K Antagonists (warfarin): Risk of NSAIDs (nonselective) enhancing the anticoagulant effect of Vitamin K antagonists.

Use With Caution

NSAIDs: Risk of adverse/toxic effect of Antiplatelet Agents (decreased wound healing), increased risk of bleeding, and ofadverse/toxic effect of other NSAIDs.

Antibiotics: Quinolones: Risk of increasing the neuroexcitatory and/or seizure-potentiating effect of quinolone antibiotics and increasing the serum concentration of quinolone antibiotics.

ACE Inhibitors: Risk of adverse/toxic effect of NSAID agents: the combination may result in significantly decreasing renal function and of NSAIDs diminishing the antihypertensive effect of ACE Inhibitors.

AnticoagulantsRisk of antiplatelet agents enhancing the effect of anticoagulants.  

Antidepressants (Tricyclic, Tertiary Amine): Risk of enhancing the antiplatelet effect of NSAIDs (nonselective).

Beta-Blockers: Risk of NDSAIDs diminishing the antihypertensive effect of beta-blockers (Exceptions: levobunolol, metipranolol).

Bisphosphonates: Risk of NSAIDs enhancing the adverse/toxic effect of bisphosphonates and increased risk of gastrointestinal ulceration and nephrotoxicity.

Corticosteroids (Systemic): Risk of adverse/toxic effect of NSAID (nonselective).

Digoxin: Risk of increasing the serum concentration of digoxin.

Antipsychotic Agent, Typical: Haloperidol: Risk of adverse/toxic effect of haloperidol, including drowsiness and confusion.

Clinical Implications

1. Consider the increased risk of excessive bleeding and delayed wound healing.

2. Cardiovascular effects:

  • Blood pressure
  • Risk of cardiovascular events, such as heart failure
  • Decrease in the cardioprotective effect of aspirin

3. Use extreme caution or avoid concurrent use with nephrotoxic agents.

4. Avoid ethanol: risk of gastric mucosal irritation.

5. Pregnancy and Lactation:

  • Studies have not demonstrated evidence of developmental abnormalities. However, because of the known effects of NSAIDs on the fetal cardiovascular system, use of ibuprofen during pregnancy should be avoided.
  • Only very small amounts of ibuprofen are found in breast milk.

 

Follow-up: What further information would you like on this topic? Email us at jcdaoasis@cda-adc.ca

Readers are invited to comment on this initial response and provide further insights by posting in the comment box which you will find by clicking on “Leave a reply“ below. You are welcome to remain anonymous and your email address will not be posted.

3 Comments

  1. Sheena March 13, 2013

    Alerts/ caution: could also add
    1) on patients with Asthma
    2) pts with gastric ulcers, GERD pts, pts on antacids?

    Reply
  2. Marie-Claude Lepage March 13, 2013

    The latest conferences I attended about dealing with pain said we could prescribe up to 600 mg doses of Ibuprofen, with a maximum of 2400 mg daily. Your article mention max doses of 1200 mg. Has there been recent changes and the maximum level has lowered?

    Reply
  3. James Noble March 20, 2013

    That must be a typo because my understanding is 2400mg for adults and 1200 mg for children.

    Reply

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