Ibuprofen

Oral
Intravenous
Class
Nonsteroidal anti-inflammatory drugs
Subclass
Propionates
Substance name
Ibuprofen
Brand names
Advil®
Common formulations
Tablet, Capsule
Dosage and administration
Adults patients
Symptomatic relief
Fever
•
Maintenance: 200 mg PO q4-6h PRN
•
Maximum: 1,200 mg per day
Headache
•
Maintenance: 200 mg PO q4-6h PRN
•
Maximum: 1,200 mg per day
Musculoskeletal pain in patients with osteoarthritis
•
400-800 mg PO q6-8h
Musculoskeletal pain in patients with rheumatoid arthritis
•
400-800 mg PO q6-8h
Pain • Mild-to-moderate
•
400 mg PO q4-6h PRN
Primary dysmenorrhea
•
Maintenance: 200 mg PO q4-6h PRN
•
Maximum: 1,200 mg per day
Treatment
Migraine attacks
•
400 mg PO daily
Acute pericarditis • Off-label
•
600 mg PO TID for 1-2 weeks
Decrease by 200-400 mg every 1-2 weeks.
Cystic fibrosis • Off-label
•
Maintenance: 20-30 mg/kg PO BID
•
Maximum: 1,600 mg per day
Gout • Acute flare • Off-label
•
800 mg PO q6-8h
Recurrent pericarditis • Off-label
•
600 mg PO q6-12h for several weeks to months
Taper daily dose by 200-400 mg every 1-2 weeks until discontinuation.
Prevention
Prevention of acute mountain sickness • Off-label
•
600 mg PO TID
Other off-label uses
•
Treatment of cystic fibrosis in patients with CFTR mutation
•
Treatment of recurrent pericarditis
Indications for use
Labeled indications
Adults
•
Symptomatic relief of fever
•
Symptomatic relief of headache
•
Symptomatic relief of musculoskeletal pain in patients with osteoarthritis
•
Symptomatic relief of musculoskeletal pain in patients with rheumatoid arthritis
•
Symptomatic relief of pain (mild-to-moderate)
•
Symptomatic relief of primary dysmenorrhea
•
Treatment of migraine attacks
Children
•
Symptomatic relief of fever
Off-label indications
Adults
•
Treatment of acute pericarditis
•
Treatment of cystic fibrosis
•
Treatment of gout (acute flare)
•
Treatment of recurrent pericarditis
•
Prevention of acute mountain sickness
Children
•
Treatment of cystic fibrosis in patients with CFTR mutation
•
Treatment of recurrent pericarditis
Safety risks
Boxed warnings
Cardiovascular thrombotic events
•
Do not use in patients undergoing CABG.
Gastrointestinal bleeding, peptic ulcer disease, gastric perforation
•
Use extreme caution in elderly patients and patients with a history of peptic ulcer disease and/or gastrointestinal bleeding.
Contraindications
Hypersensitivity to ibuprofen or its components
Aspirin-exacerbated respiratory disease
Post-myocardial infarction period
Warnings and precautions
Anemia
•
Use caution in patients taking the drug for a prolonged period.
Aseptic meningitis
•
Use caution in all patients, especially with connective tissue diseases.
Blurred vision, color vision impairment, visual field defect, vision loss
•
Maintain a high level of suspicion, as ibuprofen has been associated with an increased risk for these adverse events.
Edema, myocardial infarction, cardiovascular mortality
•
Use extreme caution in patients with HF. Avoid use in patients with severe HF.
Exacerbation of asthma
•
Use caution in patients with asthma.
Exacerbation of hypertension
•
Use caution in patients with hypertension. Monitor BP closely during the initiation period and throughout treatment.
Hepatotoxicity
•
Maintain a high level of suspicion, as ibuprofen has been associated with an increased risk of hepatotoxicity, including severe hepatic injury, fulminant hepatitis, liver necrosis, and liver failure.
Renal papillary necrosis, AKI
•
Use caution in elderly patients or patients with impaired renal function, HF, liver dysfunction, or taking diuretics or ACEis.
Severe cutaneous adverse reactions
•
Maintain a high level of suspicion, as ibuprofen has been associated with an increased risk of severe cutaneous adverse reactions, including exfoliative dermatitis, Stevens-Johnson Syndrome, toxic epidermal necrolysis, and DRESS syndrome.
Specific populations
Renal impairment
CrCl > 60 mL/min
•
Use acceptable. No dose adjustment required.
CrCl 30-60 mL/min
•
Avoid use.
CrCl < 30 mL/min
•
Do not use.
Renal replacement therapy
Continuous renal replacement
•
Avoid use as much as possible.
Intermittent hemodialysis
•
Use acceptable. No dose adjustment required.
Peritoneal dialysis
•
Use acceptable. No dose adjustment required.
Hepatic impairment
Any severity
•
No guidance available.
Pregnancy and breastfeeding
Pregnancy
< 20 weeks of gestation • Australia Category: C
•
Use only if benefits outweigh potential risks. Limit to shortest duration possible.
20-30 weeks of gestation • Australia Category: C
•
Use only if benefits outweigh potential risks. Limit to shortest duration possible.
> 30 weeks of gestation • Australia Category: C
•
Do not use. May cause premature closure of the ductus arteriosus.
Breastfeeding
Acceptable for use during breastfeeding.
Unknown drug levels in breastfed infants.
No overt adverse effects reported in breastfed infants.
Adverse reactions
Very common > 10%
•
Anemia
Common 1-10%
•
Fluid retention, ↑ platelet count, maculopapular rash, peripheral edema, photosensitivity of skin, abdominal cramps, abdominal pain, bloating, blurred vision, constipation, cough, diarrhea, dizziness, dyspepsia, epigastric pain, flatulence, headache, heartburn, loss of appetite, nausea, nervousness, pruritus, tinnitus, urinary retention, vomiting
Uncommon < 1%
•
Acute cystitis, acute pancreatitis, agranulocytosis, alopecia, amblyopia, angioedema, aplastic anemia, aseptic meningitis, bradycardia, bronchospasm, cardiac arrhythmias, cataract, congestive heart failure, conjunctivitis, ↓ blood glucose, ↓ blood neutrophil count, ↓ hematocrit, ↓ platelet count, ↓ serum pH, erythema multiforme, gastric perforation, gynecomastia, heart failure, hemolytic anemia, Henoch-Schönlein purpura, hepatitis, hypertension, ↑ BUN, ↑ ICP, ↑ blood eosinophil count, ↑ liver enzymes, ↑ serum creatinine, jaundice, large bowel perforation, optic neuritis, peptic ulcer disease, ↑bleeding time, purpura, renal failure, renal papillary necrosis, chills, confusion, depression, diplopia, drowsiness, dry mouth, emotional lability, fever, hair loss, hallucinations, hearing loss, heavy or prolonged menstrual bleeding, hematuria, insomnia, melena, nightmares, nosebleed, palpitations, paresthesia, polyuria, visual disturbances, rhinitis, systemic lupus erythematosus, serum sickness, sinus tachycardia, small bowel perforation, Stevens-Johnson syndrome, urticaria, xerophthalmia
Unknown frequency
•
Acute liver failure, anaphylactoid reactions, apnea, DRESS syndrome, ↓ serum potassium, esophageal stricture, exfoliative dermatitis, fulminant hepatic failure, gastrointestinal bleeding, hepatic necrosis, ↑ blood glucose, ↑ pulmonary artery pressure, ↑ serum potassium, ↑ urine protein, lymphadenopathy, myocardial infarction, nephrotic syndrome, renal tubular necrosis, dyspnea, hematemesis, low urine output, seizure, weight gain, stroke, tubulointerstitial nephritis
Interactions
Drug(s)
Check Interactions
Reset

What did you think about this content?

Create free account

Sign up for free to access the full drug resource