Clinical beta

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Drug Monograph

Ibuprofen

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USE IF: Inflammatory pain (MSK, dysmenorrhea, gout, arthritis), fever

AVOID IF: CKD eGFR <30, GI bleed risk, HF, pregnancy β‰₯20 wk, aspirin-dependent cardioprotection

Ibuprofen

Non-selective NSAID

AdultPediatricHigh-yield

Indication

Inflammatory pain Β· Fever

At a glance

INDICATION β†’ Inflammatory pain / fever (first-line when appropriate)

ADULT DOSE β†’ 200–400 mg q4–6h (OTC)

MAX DOSE β†’ 1,200 mg OTC Β· up to 2,400–3,200 mg Rx (short-term, supervised)

CONTRA β†’ CKD, GI bleeding, HF, pregnancy β‰₯20 weeks

ANTIDOTE β†’ None (supportive only)

Quick facts

Onset

30–60 min (PO); 5–15 min (IV).

Duration

4–6 h effect Β· Tmax 1–2 h Β· tΒ½ ~2 h.

Routes

PO, IV, topical.

Pregnancy

Avoid β‰₯20 weeks; contraindicated 3rd trimester.

Renal

Avoid if eGFR <30.

Hepatic

Caution mild/moderate disease; avoid severe impairment.

Do not miss

Severe overdose toxicity usually declares itself within 4 hours

Max dose

  • OTC β†’ 1,200 mg/day.
  • Rx β†’ up to 3,200 mg/day (short-term, supervised).

Black box risks

  • CV events (MI, stroke) can occur early β€” dose- and duration-dependent.
  • GI bleeding / perforation can occur without warning.
  • Contraindicated peri-CABG.
  • β€œTriple whammy” = NSAID + ACEi/ARB + diuretic β†’ AKI.

Aspirin interaction

  • Ibuprofen can block aspirin’s antiplatelet effect β€” separate dosing per cardiology reference.

Hidden NSAIDs / combos

  • Widely OTC in Middle East β€” duplicate NSAID use is common; reconcile all sources.

Warfarin

  • Warfarin β†’ ↑ bleeding risk.
  • SSRIs / corticosteroids β†’ ↑ GI bleed risk with NSAID.

Indications

Primary

  • Headache / migraine
  • Musculoskeletal pain
  • Dental pain
  • Dysmenorrhea
  • Fever
  • Post-operative pain
  • Osteoarthritis
  • Rheumatoid arthritis

Secondary

  • Acute gout
  • Ankylosing spondylitis
  • Juvenile idiopathic arthritis
  • Renal colic
  • Acute pericarditis
  • PDA closure in premature neonates (IV ibuprofen lysine / Neoprofen)

Other

  • Selected off-label inflammatory uses (avoid speculative prominence).

Dosing

Standard: 200β€”400 mg q4β€”6h PRN (max 1,200 mg OTC) β€” lower dose/short course if elderly or high risk

Max daily dose

  • Standard OTC framing: 200–400 mg q4–6h PRN; max 1,200 mg/day OTC.
  • Rx: up to 2,400–3,200 mg/day short-term, supervised β€” follow label.

Adult β€” PO

  • 400–800 mg every 6–8 hours when prescribed.
  • Max 2,400–3,200 mg/day, short-term and supervised.

Adult β€” IV

  • 400–800 mg every 6 hours.
  • Infuse over β‰₯30 minutes.
  • Max 3,200 mg/day.
  • Ensure adequate hydration before IV ibuprofen.
  • Avoid in hypovolemia or unstable renal function.
  • Monitor renal function if repeated dosing.

Pediatric

  • 5–10 mg/kg every 6–8 hours.
  • Max 40 mg/kg/day.
  • Weight-based only β€” verify mg/mL on liquids.

Renal adjustment

  • eGFR <30 β†’ contraindicated.
  • eGFR 30–60 β†’ short course only; monitor renal function.

Hepatic adjustment

  • Avoid severe hepatic disease.
  • Caution in mild/moderate liver disease.

Warnings

Clinical warnings

  • CV risk (MI, stroke) is dose- and duration-dependent.
  • GI bleeding can occur at any time.
  • AKI risk ↑ with dehydration, CKD, HF, ACEi/ARB, and diuretics.
  • Can worsen HF through fluid retention.
  • May mask infection by suppressing fever.

Adverse effects

  • Common: dyspepsia, nausea, dizziness.
  • Serious: GI bleed, renal impairment, CV events, hypersensitivity.

Contraindications / caution

Do not use

  • eGFR <30.
  • Active GI bleed / ulcer.
  • 3rd-trimester pregnancy.
  • Severe heart failure.
  • NSAID hypersensitivity / aspirin-sensitive asthma.

Use caution / avoid high doses

  • Elderly.
  • Hypertension.
  • CKD stage 3.
  • Anticoagulants / SSRIs.
  • ACEi + diuretic users.
  • Prior peptic ulcer disease.

Drug interactions

  • Aspirin β†’ reduced antiplatelet cardioprotection (ibuprofen can block effect).
  • Warfarin β†’ increased bleeding risk.
  • Lithium β†’ increased lithium levels.
  • Methotrexate β†’ increased toxicity.
  • ACEi/ARB + diuretics β†’ AKI risk (β€œtriple whammy”).
  • SSRIs / corticosteroids β†’ GI bleed risk with NSAID.

Special populations

Pediatrics

5–10 mg/kg q6–8h; max 40 mg/kg/day β€” weight-based only; follow pediatric NSAID guidance in dehydration/viral illness.

Pregnancy

Avoid from 20 weeks onward; contraindicated 3rd trimester; paracetamol often preferred.

Breastfeeding

Compatible; preferred NSAID in lactation for many references β€” confirm locally.

Elderly

↑ GI, renal, CV risk β€” lowest dose, shortest duration; consider PPI gastroprotection.

Liver disease

Caution in stable disease; avoid severe hepatic impairment.

Renal impairment

Avoid if eGFR <30; monitor if eGFR 30–60.

Administration

  • PO: take with food or milk; lowest effective dose.
  • IV: dilute to final concentration ≀4 mg/mL if needed; infuse β‰₯30 min (adults); hydrate before and during.
  • Topical: localized OA where appropriate.

Infusion / dilution

  • IV: ensure hydration before use per hospital protocol.
  • Infuse over at least 30 minutes in adults.

Monitoring

  • Renal function in high-risk patients.
  • Blood pressure.
  • GI bleeding symptoms.
  • LFTs if prolonged use.
  • INR if interacting anticoagulation context.
  • Reassess need regularly.

Overdose / toxicity

IF SUSPECTED OVERDOSE β†’ SUPPORTIVE CARE IMMEDIATELY (NO SPECIFIC ANTIDOTE)

Recognition

  • Toxic dose: <100 mg/kg β†’ usually minimal toxicity.
  • Toxic dose: >400 mg/kg β†’ high risk of severe toxicity.
  • Early: nausea, vomiting, abdominal pain, dizziness, drowsiness.
  • Severe: seizures, severe metabolic acidosis, coma, renal failure.

Immediate actions

  • ABCs, supportive care, early poison center if significant ingestion.
  • IV fluids.
  • Sodium bicarbonate for severe acidosis.

Antidote

  • No specific antidote β€” supportive care only.

Decontamination

  • Activated charcoal within 1–2 hours if appropriate and airway protected.

Escalation

  • Dialysis may support refractory acidosis; ibuprofen poorly dialyzable (>99% protein binding).
  • ICU support if CNS depression, acidosis, or seizures

Clinical pearls

Common mistakes, resistance logic, and bedside traps

vs paracetamol

  • Better than paracetamol for inflammatory pain.

When APAP wins

  • Paracetamol preferred in CKD, HF, pregnancy, and high GI risk.
  • Prefer paracetamol in CKD, HF, and elderly.

Triple whammy

  • NSAID + ACEi/ARB + diuretic is a major AKI risk.
  • Avoid NSAIDs in dehydrated patients -> AKI risk.
  • Always check ACEi/ARB + diuretic combination before prescribing NSAIDs.

Aspirin

  • Aspirin–ibuprofen interaction is clinically important.

CV risk

  • Duration matters for CV risk, not just dose.

Elderly

  • Lowest dose; consider PPI cover with prolonged use or risk factors.

Pharmacy Tool

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Ibuprofen 20 mg/mL oral suspension

suspension Β· oral

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Pharmacokinetics

  • Bioavailability ~80–90%.
  • Tmax 1–2 h.
  • Protein binding >99%.
  • tΒ½ ~2 h.
  • Metabolism: hepatic (mainly CYP2C9).
  • Elimination: renal.

Mechanism of action

  • Reversible non-selective COX-1 / COX-2 inhibition.
  • ↓ Prostaglandin synthesis β†’ analgesic, antipyretic, anti-inflammatory effect.
  • Reversible platelet inhibition (unlike aspirin).

Common brand names

Saudi Arabia

Brufen Β· Profinal Β· Sapofen Β· Sarixell Β· Ambafen IV

Global

Advil Β· Nurofen Β· Motrin Β· Caldolor Β· Neoprofen

Common trade names are curated examples only β€” formulations and availability vary. Verify the exact product name with your local pharmacy and national regulator before prescribing or dispensing.

Country practice notes

  • Often second-line after paracetamol for pain/fever in Gulf practice.
  • Widely OTC in Middle East β€” duplicate NSAID use is common.
  • IV ibuprofen used in hospitals under strict hydration protocols.
  • Pediatric dosing must remain weight-based.
  • PPI co-prescription is common in elderly or prolonged use.

Saudi Arabia β€” confirm with local formulary.