Analgesic

Ibuprofen

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Ibuprofen, Motrin, Advil, Nuprin, NeoProfen, Caldolor, Rufen, Duexis

  • See Also
  1. Nonsteroidal Anti-inflammatory
  • Indications
  1. See NSAID
  2. FDA approved indications in Adults
    1. Rheumatoid Arthritis
    2. Osteoarthritis
    3. Acute Gouty Arthritis
    4. Mild to moderate pain
    5. Primary Dysmenorrhea
    6. Migraine Headache
    7. Fever
  3. FDA approved indications in Children (age >6 months except in PDA)
    1. Juvenile Rheumatoid Arthritis
    2. Mild to moderate pain
    3. Fever
    4. Patent Ductus Arteriosus (PDA) in premature newborns (NeoProfen)
  • Contraindications
  1. See NSAID
  2. Avoid in age under 6 months old
  • Mechanism
  1. NSAID in Propionic Acid class
  2. Strong Analgesic action
  3. Moderate anti-inflammatory action (Dose >= 600 mg)
  • Medications
  1. Ibuprofen
    1. Suspension: 100 mg/5ml
    2. Chewables: 50 mg, 100 mg
    3. Oral drops: 40 mg/ml
    4. Tablets: 100 mg, 200 mg, 300 mg, 400 mg, 600 mg, 800 mg
    5. Intravenous (Caldolor)
      1. Adults: 400 to 800 mg IV infused over 30 minutes every 6 hours as needed
  2. Combinations
    1. Duexis (Ibuprofen 800 mg and Famotidine 26.6 mg)
      1. Take one tablet orally up to three times daily (swallowed whole and not cut)
      2. FDA approved for Osteoarthritis and Rheumatoid Arthritis
  • Dosing
  • Children older than age 6 months
  1. Dose: 5-10 mg/kg orally every 6 to 8 hours
  2. Maximum: 40 mg/kg/day up to 2400 mg/day
  3. See other references for NeoProfen in Patent Ductus Arteriosus (PDA)
  • Dosing
  • Adult
  1. See Caldolor IV dosing above
  2. Dose: 400 to 800 mg orally three to four times daily
    1. See efficacy below regarding Analgesic ceiling dose of 400 mg
    2. Arthritis (RA,OA, gout) dose: 600 to 800 mg orally every 6 to 8 hours as needed
    3. Analgesic and antipyretic dose: 200 to 400 mg orally every 4 to 6 hours as needed
  3. Maximum: 3200 mg/day
  • Adverse Effects
  1. See NSAID Gastrointestinal Adverse Effects
  2. See NSAID Renal Adverse Effects
  • Safety
  1. See NSAID
  2. Considered safe in Lactation
  3. Avoid NSAIDs in pregnancy outside the first part of the second trimester (13 to 20 weeks)
    1. Teratogenic in first trimester
    2. Risk of premature ductus arteriosus closure in the fetus in third trimester
    3. Most NSAIDs carry a legacy system Pregnancy Category B or C designation (aside from third trimester)
      1. However, many obstetricians avoid NSAIDs entirely in pregnancy (even in second trimester)
  • Drug Interactions
  1. Aspirin
    1. Ibuprofen counters Aspirin antiplatelet effects
    2. Take Aspirin at least 2 hours before Ibuprofen dose
  • Efficacy
  1. Ibuprofen Analgesic ceiling is 400 mg
    1. Doses 600 mg and 800 mg offer little additional Analgesic benefit above the 400 mg dose
    2. Motov (2019) Ann Emerg Med 74(4): 530-7 +PMID:31383385 [PubMed]
  • Resources
  1. Ibuprofen (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=8ea0e303-3967-4d71-8255-ac42a841ce28
  2. Ibuprofen (StatPearls)
    1. https://www.ncbi.nlm.nih.gov/books/NBK542299/