Description of Ibuprofen
Ibuprofen, a propionic acid derivative, is a traditional non-steroidal anti-inflammatory drug (NSAID). Being an NSAID, it therefore has analgesic, anti-inflammatory and antipyretic activities.
It acts primarily through non-selective, reversible inhibition of the cyclooxygenase enzymes COX-1 and COX-2. COX inhibition results in a marked reduction in prostaglandin synthesis. Furthermore, ibuprofen reversibly inhibits platelet aggregation.
Uses of Ibuprofen
Ibuprofen is used in the following under listed conditions;
- Mild to moderate pain and inflammation, pyrexia, headache.
- Acute migraine attacks, tension headache.
- Pain and inflammation in rheumatic disease and other musculoskeletal disorders including juvenile arthritis.
Dosage of Ibuprofen
Mild to moderate pain, pyrexia, inflammatory musculoskeletal disorders, by mouth with or after food:
- 1.2-1.8 g daily in 3-4 divided doses, increased if necessary to a maximum of 2.4 g daily (3.2 g daily in inflammatory disease); maintenance dose of 0.6-1.2 g daily may be sufficient.
Treatment of acute migraine attack, by mouth preferably with or after food:
- 400-600 mg at first sign of attack, may be repeated every 6-8 hours if necessary, maximum of 2.4 g daily
- up to 2.4 g daily
- 200 mg daily up to 2.4 g daily in divided doses
- 400 – 800 mg by mouth every 12 hours
Sickle cell pain crises (Mild pain):
- 200 mg every 8 hours
Pain in child (not recommended for child <7 kg), by mouth with or after food:
- 20-40 mg/kg daily in divided doses
- 1-2 years, 50 mg 3-4 times daily;
- 3-7 years, 100 mg 3-4 times daily;
- 8-12 years, 200 mg 3-4 times daily.
Treatment of acute migraine attack, by mouth preferably with or after food, child 8-12 years:
- 200 mg at first sign of attack, may be repeated every 6-8 hours if necessary.
Juvenile arthritis, by mouth with or after food, child over 7 kg:
- 30-40 mg/kg daily in 3-4 divided doses
Sickle cell pain crises (Mild pain):
- Child: 5-10 mg/kg/dose by mouth every 6 – 8 hours (max. 40 – 60 mg/kg/24 hours)
- Child <16 years: not recommended
The following are notable side effects of Ibuprofen.
- Gastro intestinal disturbances including nausea, diarrhoea, dyspepsia,
- Gastro intestinal ulceration and haemorrhage.
- Hypersensitivity reactions including rash, angioedema, bronchospasm.
- Headache, dizziness, nervousness, depression, drowsiness, insomnia, vertigo, tinnitus, photosensitivity, haematuria.
- Fluid retention (rarely precipitating congestive heart failure in elderly), raised blood pressure, renal failure.
- Rarely, hepatic damage, alveolitis, pulmonary eosinophilia, pancreatitis, visual disturbances, erythema multiforme (Stevens-Johnson syndrome), toxic epidermal necrolysis (Lyell’s syndrome), colitis, aseptic meningitis.
- Very rarely, exfoliative dermatitis, purpura
Always report serious side effects of any medicine to your healthcare provider or to an emergency department.
How to administer Ibuprofen
Ibuprofen is for oral use only. It can come in different dosage forms such as Syrup, capsules and tablets.
It may be administered with food to minimize gastro intestinal upset.
Sustained-release products should be swallowed whole with plenty of fluid and not chewed, broken, crushed or sucked on to avoid dose dumping, gastro intestinal discomfort and throat irritation.
Contraindications of Ibuprofen
- Hypersensitivity (including asthma, angioedema, urticaria or rhinitis) to acetylsalicylic acid or any other NSAIDs.
- Active peptic ulceration
- Hepatic or renal impairment.
- Preferably avoid in history of peptic ulceration.
- Cardiac disease
- Coagulation defects.
- Allergic disorders
- Anticoagulants: NSAIDs may enhance the effects of anticoagulants, such as warfarin.
- Antihypertensives and diuretics: NSAIDS may diminish the effect of these drugs. Diuretics can increase the risk of nephrotoxicity associated with NSAIDs.
- Corticosteroids, antiplatelet agents and SSRIS: Concurrent use may increase the risk of gastrointestinal bleeding.
- Cardiac glycosides: NSAIDs may exacerbate cardiac failure, reduce GFR and increase plasma glycoside levels.
- Aspirin: As with other NSAIDs, co-administration of Ibuprofen with Aspirin is not generally recommended because of the increased risk of adverse effects.
- Lithium: Concurrent use may lead to increased plasma levels of lithium.
- Methotrexate: Concurrent use may lead to increased plasma levels of methotrexate.
- Cyclosporin: Increased risk of nephrotoxicity.
- Zidovudine: Increased risk of haematological toxicity when NSAIDs are given with zidovudine.