Ibuprofen

Action

Unknown. Thought to inhibit cyclooxygenase, an enzyme needed for prostaglandin synthesis.

Availability

Capsules (liquigels): 200 mg

Injection: 400 mg/4-ml, 800 mg/8-ml vials

Oral suspension: 100 mg/5 ml

Pediatric drops: 50 mg/1.25 ml

Tablets: 100 mg, 200 mg, 400 mg, 600 mg, 800 mg

Tablets (chewable): 50 mg, 100 mg

Indications and dosages

➣ Rheumatoid arthritis; osteoarthritis

Adults: 1.2 to 3.2 g/day P.O. in three to four divided doses

➣ Mild to moderate pain

Adults: 400 mg P.O. q 4 to 6 hours p.r.n. or 400 to 800 mg I.V. over 30 minutes q 6 hours, as necessary

➣ Moderate to severe pain as adjunct to opioid analgesics

Adults: 400 to 800 mg I.V. over 30 minutes q 6 hours, as necessary

➣ Fever reduction

Adults: 400 mg I.V. over 30 minutes, followed by 400 mg P.O. q 4 to 6 hours or 100 to 200 mg P.O. q 4 hours as necessary

➣ Primary dysmenorrhea

Adults: 400 mg P.O. q 4 hours p.r.n.

➣ Juvenile arthritis

Children: 30 to 40 mg/kg/day P.O. in three or four divided doses. Daily dosages above 50 mg/kg aren't recommended.

➣ Fever reduction; pain relief

Children ages 6 to 12: 5 mg/kg P.O. if temperature is below 102.5 °F (39.2 °C) or 10 mg/kg if temperature is above 102.5 °F. Maximum daily dosage is 40 mg/kg.

Off-label uses

• Migraine and tension headaches

Contraindications

• Hypersensitivity to drug or other NSAIDs

• Perioperative use in coronary artery bypass graft surgery

Precautions

Use cautiously in:

• severe cardiovascular, renal, or hepatic disease; GI disease; asthma; chronic alcohol use

• elderly patients

• pregnant (avoid use after 30 weeks' gestation) or breastfeeding patients

• children younger than age 17 (safety and efficacy not established).

Administration

• Ideally, give oral form 1 hour before or 2 hours after meal. If GI upset occurs, give with meals.

• Be aware that patients must be well hydrated before I.V. form is administered.

• Dilute injection form before administering.

Adverse reactions

CNS: headache, dizziness, drowsiness, nervousness, aseptic meningitis

CV: hypertension, arrhythmias

EENT: amblyopia, blurred vision, tinnitus

GI: nausea, vomiting, constipation, dyspepsia, abdominal discomfort, GI bleeding

GU: cystitis, hematuria, azotemia, renal failure

Hematologic: anemia, prolonged bleeding time, aplastic anemia, neutropenia, pancytopenia, thrombocytopenia, leukopenia, agranulocytosis

Hepatic: hepatitis

Metabolic: hyperglycemia, hypoglycemia

Respiratory: bronchospasm

Skin: rash, pruritus, urticaria, Stevens-Johnson syndrome

Other: edema, allergic reactions including anaphylaxis

Interactions

Drug-drug. Antihypertensives, diuretics: decreased efficacy of these drugs

Aspirin and other NSAIDs, corticosteroids: additive adverse GI effects

Cefamandole, cefoperazone, cefotetan, drugs affecting platelet function (including abciximab, clopidogrel, eptifibatide, ticlopidine, tirofiban), plicamycin, thrombolytics, valproic acid, warfarin: increased risk of bleeding

Cyclosporine: increased risk of nephrotoxicity

Digoxin: slightly increased digoxin blood level

Lithium: increased lithium blood level, greater risk of lithium toxicity

Methotrexate: increased risk of methotrexate toxicity

Probenecid: increased risk of ibuprofen toxicity

Drug-diagnostic tests. Alanine aminotransferase, alkaline phosphatase, aspartate aminotransferase, blood urea nitrogen, creatinine, lactate dehydrogenase, potassium: increased values

Bleeding time: prolonged

Creatinine clearance, glucose, hematocrit, hemoglobin, platelets, white blood cells: decreased values

Drug-herbs. Anise, arnica, chamomile, clove, dong quai, fenugreek, feverfew, garlic, ginger, ginkgo, ginseng, licorice: increased risk of bleeding

White willow: additive adverse GI effects

Drug-behaviors. Alcohol use: additive adverse GI effects

Sun exposure: phototoxicity

Patient monitoring

• Monitor for desired effect.

• Watch for GI upset, adverse CNS effects (such as headache and drowsiness), and hypersensitivity reaction.

• Stay alert for GI bleeding and ulcers, especially in long-term therapy.

• In long-term therapy, assess renal and hepatic function regularly.

• Monitor blood pressure closely during treatment.

Patient teaching

• Tell patient to take oral drug with full glass of water, with food, or after meals to minimize GI upset.

• To help prevent esophageal irritation, instruct patient to avoid lying down for 30 to 60 minutes after taking dose.

☞ Instruct patient to immediately report irregular heartbeats, black tarry stools, vision changes, unusual tiredness, yellowing of skin or eyes, change in urination pattern, difficulty breathing, finger or ankle swelling, weight gain, itching, rash, fever, or sore throat.

• Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration, alertness, and balance.

• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, herbs, and behaviors mentioned above.