ibuprofen
Advil, Children’s Advil, Medipren, Motrin, Motrin IB, Nuprin, Pediacare Fever, Rufen, Trendar

Available forms
Available by prescription only
Tablets: 300 mg, 400 mg, 600 mg, 800 mg
Oral drops: 40 mg/ml
Oral suspension: 100 mg/5 ml, 100 mg/2.5 ml
Tablets: 100 mg, 200 mg
Tablets (chewable): 50 mg, 100 mg

Indications and dosages
 Arthritis, gout, and postextraction dental pain. Adults: 300 to 800 mg P.O. t.i.d. or q.i.d. Don’t exceed 3,200 mg daily.
 Primary dysmenorrhea. Adults: 400 mg P.O. q 4 to 6 hours.
 Mild to moderate pain, headache, backache and minor aches associated with the common cold. Adults: 400 mg P.O. q 4 to 6 hours.
Children: 10 mg/kg P.O. q 6 to 8 hours; maximum dose is 40 mg/kg.
 Juvenile arthritis. Children: 20 to 40 mg/kg P.O. daily, divided into three or four doses. For mild disease, 20 mg/kg daily in divided doses.
 Fever reduction. Adults: 200 to 400 mg P.O. q 4 to 6 hours, p.r.n. Don’t exceed 1,200 mg daily or take for longer than 3 days.
Children ages 6 months to 12 years: 5 mg/kg P.O. q 6 to 8 hours, p.r.n., if baseline temperature is 39.2° C (102.5° F) or below; 10 mg/kg P.O. q 6 to 8 hours, p.r.n., if baseline temperature is more than 39.2° C. Recommended daily maximum dose is 40 mg/kg.

Pharmacodynamics
Analgesic, antipyretic, and anti-inflammatory actions: Mechanisms of action are unknown; ibuprofen is thought to inhibit prostaglandin synthesis.

Pharmacokinetics
Absorption: 80% of oral dose is absorbed from GI tract.
Distribution: Highly protein-bound.
Metabolism: Undergoes biotransformation in the liver.
Excretion: Excreted mainly in urine, with some biliary excretion. Plasma half-life ranges from 2 to 4 hours.

Contraindications and precautions
Contraindicated in patients hypersensitive to drug or in those who have the syndrome of nasal polyps, angioedema, and bronchospastic reaction to aspirin or other NSAIDs. Contraindicated during the last trimester of pregnancy because it may cause problems with the fetus or complications during delivery.
  Use cautiously in patients with impaired renal or hepatic function, GI disorders, peptic ulcer disease, cardiac decompensation, hypertension, or coagulation defects. Because chewable tablets contain aspartame, use cautiously in patients with phenylketonuria.

Interactions
Drug-drug. ACE inhibitors: Reduces response when used together; may result in acute reduction in renal function. Monitor patient closely.
Acetaminophen, gold compounds, other anti-inflammatories: May increase nephrotoxicity. Use cautiously.
Antacids: May decrease absorption of ibuprofen. Patient should take drugs at separate times.
Anticoagulants, thrombolytics (coumarin derivatives, heparin, streptokinase, urokinase): Increase anticoagulant effects. Monitor coagulation studies. Dosage adjustment may be needed.
Antihypertensives, diuretics: May decrease effectiveness of these drugs; diuretics may increase nephrotoxicity. Monitor patient closely.
Aspirin, carbenicillin, cefamandole, cefoperazone, corticosteroids, dextran, dipyridamole, mezlocillin, piperacillin, plicamycin, salicylates, sulfinpyrazone, ticarcillin, valproic acid, other anti-inflammatories: Increases risk of bleeding or adverse GI reactions. Avoid use together.
Aspirin: May decrease bioavailability of ibuprofen. Monitor patient for drug effect.
Insulin, oral antidiabetics: May potentiate hypoglycemic effects. Dosage adjustment may be needed.
Lithium, methotrexate: Decreases renal clearance of these drugs. Use together cautiously.
Nifedipine, phenytoin, verapamil: Toxicity may occur. Avoid use together.
Drug-herb. Feverfew: Decreases effectiveness of ibuprofen. Discourage use together.
Ginkgo biloba: Increases risk of bleeding from decreased platelet aggregation. Discourage use together.

Adverse reactions
CNS: headache, dizziness, nervousness, aseptic meningitis.
CV: peripheral edema, fluid retention, edema.
EENT: tinnitus.
GI: epigastric distress, nausea, occult blood loss, peptic ulceration, diarrhea, constipation, dyspepsia, flatulence, heartburn, decreased appetite.
GU: acute renal failure, azotemia, cystitis, hematuria.
Hematologic: prolonged bleeding time, anemia, neutropenia, pancytopenia, thrombocytopenia, aplastic anemia, leukopenia, agranulocytosis.
Respiratory: bronchospasm.
Skin: pruritus, rash, urticaria, Stevens-Johnson syndrome.

Effects on lab test results
• May increase BUN, creatinine, ALT, AST, and potassium levels. May decrease glucose level.
• May decrease hemoglobin, hematocrit, and neutrophil, WBC, RBC, platelet, and granulocyte counts.

Overdose and treatment
Signs and symptoms of overdose include dizziness, drowsiness, paresthesia, vomiting, nausea, abdominal pain, headache, sweating, nystagmus, apnea, and cyanosis.
 To treat drug overdose, empty stomach immediately by inducing emesis with ipecac syrup or by gastric lavage. Administer activated charcoal via nasogastric tube. Provide symptomatic and supportive measures (respiratory support and correction of fluid and electrolyte imbalances). Monitor laboratory parameters and vital signs closely. Alkaline diuresis may enhance renal excretion. Dialysis is of minimal value because ibuprofen is strongly protein-bound.

Special considerations
• Maximum results in arthritis may require 1 to 2 weeks of continuous therapy with ibuprofen. Improvement may be seen, however, within 7 days.
• Give drug on an empty stomach, 1 hour before or 2 hours after meals, for maximum absorption. However, it may be administered with meals to lessen GI upset.
• Monitor auditory and ophthalmic functions periodically during ibuprofen therapy.
• Monitor cardiopulmonary status closely; monitor vital signs, especially heart rate and blood pressure.
• Observe patient for possible fluid retention.
Pregnant patients
• Use not recommended during pregnancy. Don’t use drug in third trimester unless absolutely necessary.
Breast-feeding patients
• Drug doesn’t enter breast milk in significant quantities. However, manufacturer doesn’t recommend use in breast-feeding women.
Pediatric patients
• Safety and efficacy in children younger than age 6 months haven’t been established.
Geriatric patients
• Patients older than age 60 may be more susceptible to the toxic effects of ibuprofen, especially adverse GI reactions. Use lowest possible effective dose. The effect of drug on renal prostaglandins may cause fluid retention and edema, a significant drawback for elderly patients, especially those with heart failure.

Patient education
• Instruct patient to seek medical approval before taking OTC drugs.
• Advise patient not to take ibuprofen for longer than 10 days for analgesic use and not to exceed maximum dose of six tablets (1.2 g) daily. Caution patient not to take drug if fever lasts longer than 3 days, unless prescribed.
• Tell patient to report adverse reactions; they’re usually dose-related.
• Instruct patient in safety measures to prevent injury. Caution him to avoid hazardous activities that require mental alertness until CNS effects of drug are known.
• Encourage patient to adhere to prescribed drug regimen and stress importance of medical follow-up care.

Reactions may be common, uncommon, life-threatening, or COMMON AND LIFE THREATENING.
◆ Canada only
◇ Unlabeled clinical use