Ibuprofen
Mechanism :
Ibuprofen possesses analgesic and antipyretic activities. Its mode of action, like that of other NSAIDs, is not completely understood, but may be related to prostaglandin synthetase inhibition.
Indication :
- Fever
- Pain
- Juvenile idiopathic arthritis (JIA)
- PDA closure in neonate
Contraindications :
Contraindicated in patients with known hypersensitivity to Ibuprofen, in patients who have experienced asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs, in the treatment of peri-operative pain in the setting of coronary artery bypass graft (CABG) surgery, in active peptic ulceration. Use with caution in renal, cardiac or hepatic impairment.
Dosing :
Pain/fever: Oral
6 months-12 years:
5-10 mg/kg/dose 3-4 times daily; Max: 40 mg/kg/day.
>12 years:
200-400 mg every 4-6 hourly; Max: 1200 mg/day. In severe pain: 2400 mg/day.
Juvenile idiopathic arthritis and other rheumatic disorders: Oral
30-50 mg/kg/24 hour in 3-4 divided doses; Max: 2400 mg/day.
Closure of PDA in newborn:
First dose 10 mg/kg IV, 2nd and 3rd dose 5 mg/kg IV after 24 and 48 hours. If PDA dose not close 48 hours after last dose or reopens, a 2nd course of 3 doses may be given.
Adverse Effect :
Gastrointestinal discomfort, diarrhea, nausea, heartburn, constipation, bleeding and ulceration, dizziness, headache, vertigo, tinnitus, confusion, fluid retention and hypersensitivity reactions.
Interaction :
ACE-inhibitors: NSAIDs may diminish the antihypertensive effect of ACE-inhibitors. This interaction should be given consideration in patients taking NSAIDs concomitantly with ACE-inhibitors.
Diuretics: Can reduce the natriuretic effect-of furosemide and thiazides in some patients. This response has been attributed to inhibition of renal prostaglandin synthesis.
Lithium: When ibuprofen and lithium are administered concurrently, subjects should be observed carefully for signs of lithium toxicity.
Methotrexate: Enhances the toxicity of methotrexate. Caution should be used when NSAIDs are administered concomitantly with methotrexate.
Warfarin: Effects of warfarin and NSAIDs on GI bleeding are synergistic, such that the users of both drugs together have a risk of serious GI bleeding higher than users of either drug alone.
Renal Dose :
Dose in Renal Impairment GFR (mL/min)
| 20-50 | Dose as in normal renal function, but avoid if possible |
| 10-20 | Dose as in normal renal function, but avoid if possible |
| <10 | Dose as in normal renal function, but only use if on dialysis |
Dose in Patients undergoing Renal Replacement Therapies
| CAPD | Not dialysed. Dose as in normal renal function. |
| HD | Not dialysed. Dose as in normal renal function. |
| HDF/High flux | Not dialysed. Dose as in normal renal function. |
| CAV/VVHD | Not dialysed. Dose as in GFR=10– 20 mL/min |
Hepatic Dose :
Ibuprofen is metabolized in the liver, and its elimination half-life is significantly prolonged in patients with moderate to severe cirrhosis.
Mild hepatic impairment: Use with caution.
Moderate hepatic impairment: Reduce dose or initiate at the lower end of the usual dosage range.
Severe hepatic impairment: Use is contraindicated.