Ibuprofen : Indications | Dose | Side Effects

Trade Names: Brufen, Nurofen, Motril, Advil

Class: Nonsteroidal Anti-inflammatory Drugs (NSAIDs)

Ibuprofen indications

• Analgesia for mild to moderate pain
• Inflammatory conditions e.g. infections, Arthritis, autoimmune diseases & Injuries
• Fever

Contraindications:

• Active Peptic ulcer Disease
• Hypersensitivity to Aspirin and other NSAIDs
• Third trimester pregnancy
• Severe renal impairment
• Severe hepatic impairment
• Hypercoagulability

Dose and Preparations

Adult dose

Preparations: tablets, capsules, rectal tabs

• For Pain: 400-800mg oral 8 hourly. Maximum dose is 2400mg per day in divided doses for acute phase (short duration) and 1200mg per day in divided doses for maintenance phase (chronic use such as in Rheumatoid arthritis).
• Inflammation and Fever: 400 to 800mg 6 to 8 oral hourly. Maximum dose is 1200mg/day.
• Rectal dose: given as 1600mg single dose at night. It is contraindicated in the presence of hemorrhoids and rectal bleeding. Dose frequency can be increased to twice daily (maximum 2400mg/day).

Always take ibuprofen with or after meals, never on an empty stomach.

Ibuprofen children dose

Preparations: suspension (sus)

Ibuprofen should not be used in children below 3 months of age unless for patent ductus arteriosus. Only use in line with local guidelines.

Dose: usually 5 to 10mg/kg/dose 6 to 8 hourly. Do not exceed more than 30mg/kg/day. It should be taken after food.

Ibuprofen paediatric dosing table for quick reference:

Age	Weight	Dose
3-6 Months	5-7.6kg	50mg 8 hourly
6-12 months	7.7-9kg	50mg 6-8 hourly
1-3 years	10-16kg	100mg 8 hourly
4-6 years	17-20kg	150mg 8 hourly
7-9 years	21-30kg	200mg 8 hourly
10-12 years	31-40kg	300mg 8 hourly
Above 12 years		Adult dose

Special Population

Pregnancy: NSAIDs like Ibuprofen are not recommended in pregnancy but can be used with caution during first and second trimester. It is contraindicated in third trimester as it leads to early closure of ductus arteriosus and pulmonary hypertension.

Breastfeeding: Use with caution (shortest duration, with clear indication and no safer alternative available) and avoid if possible.

Renal Impairment: Reduce dose of ibuprofen by 50% in mild to moderate renal impairment. Do not use in severe renal impairment.

Elderly: Geriatrics are prone to side effects associated with using NSAIDs such as ibuprofen. Use the lowest effective dose and warn the patient about side effects to expect and when to seek medical care.

Ibuprofen Side Effects

• Gastrointestinal Bleeding
• Peptic ulcer formation or exacerbation of an existing ulcer
• Gastritis
• Renal impairment
• Hepatic impairment
• Abdominal cramps
• Nausea and vomiting
• Hematemesis
• Bronchospasm
• Skin rash
• Angioedema
• Increased bleeding tendency (antiplatelet effect)
• Headaches, dizziness, vertigo

Mechanism of Action

Ibuprofen is a propionic acid derivative that belongs to a class of drugs called nonsteroidal anti-inflammatory drugs (NSAIDs). It produces an anti-inflammatory effect through inhibition of Cyclooxygenase, an enzyme responsible for prostaglandin synthesis. Ibuprofen is a non-selective NSAID, meaning it inhibits both Cyclo-Oxygenase-1 (COX-1) and Cyclo-Oxygenase-2 (COX-2).

Prostaglandins are hormone-like chemicals that contribute in the inflammation process and fever.

 Ibuprofen also exerts reversible antiplatelet aggregation effect in the blood.

Tips and Warnings

Low dose PPI such as Lansoprazole helps gastrointestinal symptoms associated with ibuprofen use.

Ibuprofen use is not recommended in persons with severe heart failure. Long term use of NSAIDs is associated with increased risk of cardiovascular events. The risk is dose and duration dependent.

Ibuprofen works better for analgesic and antipyretic effect if it’s combined with paracetamol.

Shops to Buy Ibuprofen

You can buy Ibuprofen at registered online stores in South Africa such as:

• Clicks
• Dis-Chem