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
;
Recent MI
;
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, or 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)
;
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;
History of long duration of NSAID use, smoking, alcohol use, advanced liver disease, coagulopathy, or poor general health (↑ risk of GI bleeding)
;
History of peptic ulcer disease and/or GI bleeding
;
Bleeding tendency or concurrent anticoagulant therapy
;
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;
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
.

Exercise Extreme Caution in:

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, GENERALIZED BULLOUS FIXED DRUG ERUPTION, 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, GI PERFORATION, GI ULCERATION, 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 AND SERIOUS SKIN REACTIONS)

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 ↑ levels and risk of toxicity of lithium.
↑risk of toxicity from methotrexate.
Probenecid may ↑ risk of toxicity.
↑risk of GI bleeding with anticoagulants, aspirin, clopidogrel, ticagrelor, prasugrel, corticosteroids, fibrinolytics, SNRIs, or SSRIs
.
↑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 tablets fruit, grape, orange, and citrus flavor: 100 mg^OTC
Oral solution berry flavor: 50 mg/1.25 mL^OTC
Oral suspension fruit, 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 ⬆ ⬇

Monitor for hypersensitivity reactions, including anaphylaxis. Patients who have asthma, aspirin-induced allergy, and nasal polyps are at ↑ risk.
Assess for signs and symptoms of GI bleeding (tarry stools, dizziness, hypotension), renal impairment (↑ BUN and serum creatinine, ↓ urine output), and hepatic impairment (↑ liver enzymes, jaundice) periodically during therapy. Geri: Older adults have higher risk for poor outcomes or death from GI bleeding. Age-related renal impairment ↑ risk of hepatic and renal toxicity.
Assess patient for rash (SJS, TEN, generalized bullous fixed drug eruption) frequently during therapy. At first sign of rash, discontinue ibuprofen and treat as indicated; may recur once therapy 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. If PDA closes or size significantly ↓, 2nd and 3rd doses are unnecessary.

Lab Test Considerations:

Monitor BUN, serum creatinine, CBC, and liver function tests periodically during prolonged therapy.
- May ↑ potassium, BUN, serum creatinine, alkaline phosphatase, LDH, AST, and ALT. May ↓ blood glucose, hemoglobin, hematocrit, leukocytes, platelets, and CCr.
- May cause prolonged bleeding time.
- 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.
- Ensure appropriate hydration before initiation and during therapy to prevent renal toxicity.
- Use lowest effective dose for shortest period of time, especially in older adults, to minimize risk of cardiovascular thrombotic events.
- Coadministration with opioid analgesics may have additive analgesic effects, permitting lower opioid doses.
PO: For rapid initial effect, administer 30 min before or 2 hr after food. 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.

IV Administration:

Intermittent Infusion: Ibuprofen injection: Diluent: Dilute 800-mg dose in 200 mL and 100-mg, 200-mg, and 400-mg doses in 100 mL of 0.9% NaCl, D5W, or LR. Concentration: 4 mg/mL. 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 particulates. Stable for up to 24 hr at room temperature. Discard remaining solution.
Rate: Infuse Ibuprofen injection over ≥30 min for adults and ≥10 min for children for Caldolor or over 15 min for NeoProfen. Infuse Ibuprofen lysine over 15 min.

Ibuprofen

Y-Site Compatibility:
- hydrocortisone
- metoprolol
Y-Site Incompatibility:
- caffeine citrate
- esmolol
- labetalol
- sildenafil

Ibuprofen Lysine

Y-Site Compatibility:
- ceftazidime
- epinephrine
- furosemide
- heparin
- insulin, regular
- phenobarbital
- potassium chloride
- sodium bicarbonate
Y-Site Incompatibility:
- amikacin
- caffeine citrate
- dobutamine
- dopamine
- isoproterenol
- midazolam
- vancomycin
- vecuronium

Patient/Family Teaching ⬆ ⬇

Explain purpose and side effects of medication. Advise patient to read Patient Information before starting therapy.
Advise patients to take ibuprofen with a full glass of water and to remain upright for 15–30 min after administration.
Pedi: Teach 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 provider.
Advise patient to notify health care provider of all Rx or OTC medications, vitamins, or herbal products being taken and to consult health care provider before taking other medications or undergoing surgery.
Instruct patient not to take OTC ibuprofen preparations >10 days for pain or >3 days for fever and to consult health care provider if symptoms persist or worsen. Many OTC products contain ibuprofen; avoid duplication.
Caution patient that use of ibuprofen with ≥3 glasses of alcohol per day may ↑ the risk of GI bleeding.
Inform patient of ↑ risk of MI and stroke. Use lowest effective dose for shortest time. Advise patient to notify health care provider immediately if signs and symptoms (shortness of breath or trouble breathing, chest pain, weakness in one part or side of body, slurred speech, swelling of the face or throat) occur.
Advise patient to notify health care provider promptly if signs or symptoms of GI toxicity (abdominal pain, black stools) occur.
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 women of reproductive potential to notify health care provider 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 for NSAID therapy >48 hr. Discontinue ibuprofen if oligohydramnios occurs and follow up with infant. Use during labor or delivery may delay birth and ↑ risk of stillbirth. Advise patient to notify health care provider 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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