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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Alerts/ caution: could also add
1) on patients with Asthma
2) pts with gastric ulcers, GERD pts, pts on antacids?
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?
That must be a typo because my understanding is 2400mg for adults and 1200 mg for children.