ibuprofen

Absorption: Oral formulation is well absorbed (80%) from the GI tract; IV administration results in complete bioavailability.

Distribution: Well distributed to tissues.

Protein Binding: 99%.

Metabolism/Excretion: Mostly metabolized by the liver; small amounts (1%) excreted unchanged by the kidneys.

Half-Life: Neonates: 26–43 hr; Children: 1–2 hr; Adults: 2–4 hr.

Time/Action Profile ⬆ ⬇

ROUTE	ONSET	PEAK	DURATION
PO (antipyretic)	0.5–2.5 hr	2–4 hr	6–8 hr
PO (analgesic)	30 min	1–2 hr	4–6 hr
PO (anti-inflammatory)	≤7 days	1–2 wk	unknown
IV (analgesic)	unknown	unknown	6 hr
IV (antipyretic)	within 2 hr	10–12 hr‡	4–6 hr

‡With repeated dosing.

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Hypersensitivity (cross-sensitivity may exist with other NSAIDs, including aspirin);
Active GI bleeding or ulcer disease;
Chewable tablets contain aspartame and should not be used in patients with phenylketonuria;
Coronary artery bypass graft surgery;
History of recent MI;
Severe HF;
OB: Avoid use after 30 wk gestation;
Pedi: Ibuprofen lysine: Preterm neonates with untreated infection, congenital heart disease where patency of PDA is necessary for pulmonary or systemic blood flow, bleeding, thrombocytopenia, coagulation defects, necrotizing enterocolitis, significant renal dysfunction.

Use Cautiously in:

Cardiovascular disease or risk factors for cardiovascular disease (may ↑ risk of serious cardiovascular thrombotic events, MI, and stroke, especially with prolonged use or use of higher doses); avoid use in patients with recent MI or HF;
Renal or hepatic disease, dehydration, or patients on nephrotoxic drugs (may ↑ risk of renal toxicity);
Aspirin triad patients (asthma, nasal polyps, and aspirin intolerance); can cause fatal anaphylactoid reactions;
Chronic alcohol use/abuse;
Coagulation disorders;
OB: Use at or after 20 wk gestation may cause fetal or neonatal renal impairment; if treatment is necessary between 20 wk and 30 wk gestation, limit use to the lowest effective dose and shortest duration possible;
Lactation: Use while breastfeeding only if potential maternal benefit justifies potential risk to infant;
Pedi: Safety and effectiveness not established for children 6 mo (oral) or 3 mo (IV Caldolor); hyperbilirubinemia in neonates (may displace bilirubin from albumin-binding sites); safety and effectiveness of ibuprofen lysine only established in premature infants;
Geri: Appears on Beers list. risk GI bleeding or peptic ulcer disease in older adults. Avoid chronic use unless other alternatives are not effective and the patient can take a gastroprotective agent; avoid short-term use in combination with oral or parenteral corticosteroids, anticoagulants, or antiplatelet agents unless other alternatives are not effective and the patient can take a gastroprotective agent.

History of GI bleeding or GI ulcer disease.

Adv. Reactions/Side Effects ⬆ ⬇

CV: arrhythmias, edema, HF, hypertension, MI

Derm: ACUTE GENERALIZED EXANTHEMATOUS PUSTULOSIS (AGEP), DRUG REACTION WITH EOSINOPHILIA AND SYSTEMIC SYMPTOMS (DRESS), EXFOLIATIVE DERMATITIS, rash, STEVENS-JOHNSON SYNDROME (SJS), TOXIC EPIDERMAL NECROLYSIS (TEN)

EENT: amblyopia, blurred vision, tinnitus

F and E: hyperkalemia

GI: constipation, dyspepsia, nausea, vomiting, abdominal discomfort, GI BLEEDING, HEPATITIS, necrotizing enterocolitis (ibuprofen lysine)

GU: cystitis, hematuria, renal failure

Hemat: anemia, blood dyscrasias, prolonged bleeding time

Local: injection site reaction

Neuro: headache, dizziness, drowsiness, intraventricular hemorrhage (ibuprofen lysine), psychic disturbances, STROKE

Misc: HYPERSENSITIVITY REACTIONS (INCLUDING ANAPHYLAXIS)

Interactions ⬆ ⬇

Drug-drug:

May limit the cardioprotective (antiplatelet) effects of low-dose aspirin.
Aspirin may ↓ effectiveness of ibuprofen.
Additive adverse GI side effects with aspirin, oral potassium, other NSAIDs, corticosteroids, or alcohol.
Chronic use with acetaminophen may ↑ risk of adverse renal reactions.
May ↓ effectiveness of diuretics, ACE inhibitors, or other antihypertensives.
May ↑ hypoglycemic effects of insulin or oral hypoglycemic agents.
May ↑ serum lithium levels and risk of toxicity.
↑risk of toxicity from methotrexate.
Probenecid↑ risk of toxicity from ibuprofen.
↑risk of bleeding with cefotetan, corticosteroids, valproic acid, thrombolytics, warfarin, and drugs affecting platelet function, including clopidogrel, eptifibatide, or tirofiban.
↑risk of adverse hematologic reactions with antineoplastics or radiation therapy.
↑risk of nephrotoxicity with cyclosporine.
May ↑ levels and the risk of toxicity of amikacin.

Drug-Natural Products:

↑bleeding risk with arnica, chamomile, feverfew, garlic, ginger, ginkgo, Panax ginseng, and others.

Route/Dosage ⬆ ⬇

Analgesia/Anti-inflammatory/Antipyretic

PO (Adults ): Anti-inflammatory: 400–800 mg 3–4 times daily (not to exceed 3200 mg/day). Analgesic/antidysmenorrheal/antipyretic: 200–400 mg every 4–6 hr (not to exceed 1200 mg/day).
PO (Children 6 mo–12 yr): Anti-inflammatory: 30–50 mg/kg/day in 3–4 divided doses (maximum dose: 2.4 g/day). Antipyretic: 5 mg/kg for temperature <102.5°F or 10 mg/kg for higher temperatures (not to exceed 40 mg/kg/day); may be repeated every 4–6 hr.
PO (Infants and Children): Analgesic: 4–10 mg/kg/dose every 6–8 hr.
IV (Adults ): Analgesic (Caldolor): 400–800 mg every 6 hr as needed (not to exceed 3200 mg/day); Antipyretic (Caldolor): 400 mg initially, then 400 mg every 4–6 hr or 100–200 mg every 4 hr as needed (not to exceed 3200 mg/day).
IV (Children 12–17 yr): Analgesic and antipyretic (Caldolor): 400 mg every 4–6 hr as needed (not to exceed 2400 mg/day).
IV (Children 6 mo–12 yr): Analgesic and antipyretic (Caldolor): 10 mg/kg (not to exceed 400 mg) every 4–6 hr as needed (not to exceed 40 mg/kg/day or 2400 mg/day, whichever is less).
IV (Children 3–<6 mo): Analgesic and antipyretic (Caldolor): 10 mg/kg (not to exceed 100 mg) as a single dose.

Pediatric OTC Dosing

PO (Children 11 yr/72–95 lb): 300 mg every 6–8 hr.
PO (Children 9–10 yr/60–71 lb): 250 mg every 6–8 hr.
PO (Children 6–8 yr/48–59 lb): 200 mg every 6–8 hr.
PO (Children 4–5 yr/36–47 lb): 150 mg every 6–8 hr.
PO (Children 2–3 yr/24–35 lb): 100 mg every 6–8 hr.
PO (Children 12–23 mo/18–23 lb): 75 mg every 6–8 hr.
PO (Infants 6–11 mo/12–17 lb): 50 mg every 6–8 hr.

Patent Ductus Arteriosus Closure

IV (Neonates Gestational age ≤32 wk, 500–1500 g): Neoprofen: 10 mg/kg followed by two doses of 5 mg/kg at 24 and 48 hr after initial dose.

Availability ⬆ ⬇

(Generic available)

Tablets: 200 mg^OTC; 400 mg; 600 mg; 800 mg
Capsules (liquigels): 200 mg^OTC
Chewable tabletsfruit, grape, orange, and citrus flavor: 100 mg^OTC
Oral solutionberry flavor: 50 mg/1.25 mL^OTC
Oral suspensionfruit, berry, grape flavor: 100 mg/5 mL^OTC
Solution for injection: 10 mg/mL (NeoProfen); 100 mg/mL (Caldolor)
Premixed infusion (Caldolor): 800 mg/200 mL
In combination with: decongestantsOTC, hydrocodone.

Assessment ⬆ ⬇

Patients who have asthma, aspirin-induced allergy, and nasal polyps are at increased risk for developing hypersensitivity reactions. Assess for rhinitis, asthma, and urticaria.
Assess for signs and symptoms of GI bleeding (tarry stools, light-headedness, hypotension), renal impairment (↑ BUN and serum creatinine levels, ↓ urine output), and hepatic impairment (↑ liver enzymes, jaundice) periodically during therapy. Geri: Higher risk for poor outcomes or death from GI bleeding. Age-related renal impairment risk of hepatic and renal toxicity.
Assess patient for skin rash frequently during therapy. Discontinue ibuprofen at first sign of rash; may be life-threatening. SJS, TEN, or AGEP may develop. Treat symptomatically; may recur once treatment is stopped.
Monitor for signs and symptoms of DRESS (fever, rash, lymphadenopathy, facial swelling, eosinophilia) periodically during therapy. If symptoms occur discontinue ibuprofen.
Pain: Assess pain (note type, location, and intensity) prior to and 1–2 hr following administration.
Arthritis: Assess pain and range of motion prior to and 1–2 hr following administration.
Fever: Monitor temperature; note signs associated with fever (diaphoresis, tachycardia, malaise).
PDA Closure: Monitor preterm neonates for signs of bleeding, infection, and ↓ urine output. Monitor IV site for signs of extravasation; ibuprofen lysine is an irritant. If PDA closes or size significantly ↓, 2nd and 3rd doses are unnecessary.

Lab Test Considerations:

BUN, serum creatinine, CBC, and liver function tests should be evaluated periodically in patients receiving prolonged therapy.
- May ↑ serum potassium, BUN, serum creatinine, alkaline phosphatase, LDH, AST, and ALT. May ↓ blood glucose, hemoglobin, and hematocrit concentrations, leukocyte and platelet counts, and CCr.
- May cause prolonged bleeding time; may persist for <1 day following discontinuation.
- PDA Closure: If urinary output <0.6 mL/kg/hr at time of 2nd or 3rd dose, hold dose until renal function has returned to normal.

Implementation ⬆ ⬇

Do not confuse Motrin with Neurontin.
Administration of higher than recommended doses does not provide ↑ pain relief but may ↑ incidence of side effects.
- Patient should be well hydrated before administration to prevent renal adverse reactions. Do not give to neonates with urine output <0.6 mL/kg/hr
- Use lowest effective dose for shortest period of time, especially in the elderly, to minimize risk of cardiovascular thrombotic events.
- Coadministration with opioid analgesics may have additive analgesic effects and may permit lower opioid doses.
PO: For rapid initial effect, administer 30 min before or 2 hr after meals. May be administered with food, milk, or antacids to ↓ GI irritation. Tablets may be crushed and mixed with fluids or food; 800-mg tablet can be dissolved in water.
Dysmenorrhea: Administer as soon as possible after the onset of menses. Prophylactic treatment has not been shown to be effective.

IV Administration:

Intermittent Infusion: Ibuprofen injection: Diluent: 0.9% NaCl, D5W, or LR.Concentration: Dilute the 800-mg dose in at least 200 mL and the 100-mg, 200-mg, and 400-mg doses in at least 100 mL for a concentration of 4 mg/mL or less. Ibuprofen lysine Dilute in appropriate volume of D5W or 0.9% NaCl. Administer within 30 min of dilution. Do not administer solutions that are discolored or contain particulate matter. Stable for up to 24 hr at room temperature. Discard remaining solution; does not contain preservatives.
Rate: Infuse Ibuprofen injection: over at least 30 min for adults and at least 10 min for children for Caldolor or over 15 min for NeoProfen. Infuse Ibuprofen lysine: over 15 min.

Ibuprofen

Ibuprofen Lysine

Patient/Family Teaching ⬆ ⬇

Advise patients to take ibuprofen with a full glass of water and to remain in an upright position for 15–30 min after administration.
Instruct patient to take medication as directed. Take missed doses as soon as remembered but not if almost time for next dose. Do not double doses. Pedi: Teach parents and caregivers to calculate and measure doses accurately and to use measuring device supplied with product.
May cause drowsiness or dizziness. Advise patient to avoid driving or other activities requiring alertness until response to medication is known.
Caution patient to avoid the concurrent use of alcohol, aspirin (including low-dose aspirin), acetaminophen, and other OTC or herbal products without consulting health care professional.
Advise patient to inform health care professional of medication regimen prior to treatment or surgery.
Instruct patient not to take OTC ibuprofen preparations for more than 10 days for pain or more than 3 days for fever and to consult health care professional if symptoms persist or worsen. Many OTC products contain ibuprofen; avoid duplication.
Caution patient that use of ibuprofen with 3 or more glasses of alcohol per day may ↑ the risk of GI bleeding.
Advise patient to consult health care professional if rash, itching, visual disturbances, tinnitus, weight gain, edema, epigastric pain, dyspepsia, black stools, hematemesis, persistent headache, influenza-like syndrome (chills, fever, muscle aches, pain), or cardiovascular events (chest pain, shortness of breath, weakness, slurring of speech) occurs.
Pedi: Advise parents or caregivers not to administer ibuprofen to children who may be dehydrated (can occur with vomiting, diarrhea, or poor fluid intake); dehydration risk of renal impairment.
Rep: May cause fetal harm. Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected and to avoid ibuprofen starting at 20 wk gestation due to risk of oligohydramnios and 30 wk gestation because of risk of premature closing of the fetal ductus arteriosus. If NSAIDs are necessary between 20 and 30 wk gestation, limit use to the lowest effective dose and shortest duration possible. Consider ultrasound monitoring of amniotic fluid if NSAID therapy extends beyond 48 hr. Discontinue ibuprofen if oligohydramnios occurs and follow up with infant. Advise women to avoid ibuprofen in the 3rd trimester of pregnancy (after 29 wk); may cause premature closure of the fetal ductus arteriosus. Use during labor or delivery may delay birth and risk of stillbirth. Advise patient to notify health care professional if breastfeeding. May cause temporary infertility in women.

section name header

Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇

Pharmacokinetics ⬆ ⬇

Time/Action Profile ⬆ ⬇

Contraind./Precautions ⬆ ⬇

Adv. Reactions/Side Effects ⬆ ⬇

Interactions ⬆ ⬇

Route/Dosage ⬆ ⬇

Availability ⬆ ⬇

Assessment ⬆ ⬇

Implementation ⬆ ⬇

Patient/Family Teaching ⬆ ⬇

Evaluation/Desired Outcomes ⬆ ⬇

US Brand Names ⬆ ⬇

Canadian Brand Names ⬆ ⬇

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