Do You Know Your Ibuprofen?

 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.

Anticoagulants: Risk 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

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