Ibuprofen
Author: Dr. Wamiq Ansari
Last Updated:
Classification
1. Class: Non-Steroidal Anti-inflammatory Drug (NSAID).
2. Sub-class: Propionic Acid derivate.
Mechanism of Action
1. Analgesic Effect:
Inhibits COX-1 and COX-2 enzymes , leading to decreased production of Prostglandins.
2. Antipyretic Effect:
a. Inhibits COX-1 and COX-2 enzymes , leading to decreased production of Prostglandins (same as analgesic effect).
b. Inhibits Prostaglandin-2 in hypothalamaus , lowring the temperature set-point.
3. Anti-Inflammatory Effect:
Inhibits COX-1 and COX-2 enzymes , leading to decreased production of Prostglandins (same as analgesic effect).
Pharmacokinetics
1. Half Life: 2 hours.
2. Cross Barrier: Placenta.
3. Metabolism: Liver.
4. Excretion: Mainly urine.
Indications
1. Fever (especially when associated with obvious inflammation).
2. Moderate to Severe Pain.
3. Inflammation-Associated Conditions like Juvenile Idiopathic Arthritis.
Contraindications
1. On going or Past history of Gstrointestinal Bleeding.
2. Thrombocytopenia or Agranulocytopenia.
3. Coagulation Defects.
4. Severe Hepatic Impairement.
5. Known Hypersensitivity.
6. Neonatal : all of the above plus;
- a. Untreated Infections.
- b. Congenital Heart Disease requiring patency of Ductus Arteriosus.
- c. Necrotizing Enterocolitis.
- d. Hyperbilirubinemia.
Dosage
Oral
| Analgesic and Antipyretic | 5-10 mg/kg/dose x every 6-8 hour. |
| Juvenile Idiopathic Arthirits | 30-50 mg/kg/day x every 6 hour. |
Parenteral
| Analgesic and Antipyretic | 10 mg/kg/dose x every 4-6 hour. |
| Closure of Ductus Arteriosus (Neonate with weight 0.5-1.5 kg and Gestational Age less than 32 weeks). | a. DOSE 1 = 10 mg/kg IV. b. DOSE 2 (after 24 hours of Dose 1) = 5 mg/kg IV. b. DOSE 3 (after 48 hours of Dose 1) = 5 mg/kg IV. (If Urine Output is less than 0.6mL/kg/min after DOSE 1 , then do not give DOSE 2 and DOSE 3. |
Maximum Dosage
Oral
| Analgesic and Antipyretic | 40 mg/kg/day OR 400 mg/day. |
| Juvenile Idiopathic Arthritis | 800 mg/dose OR 2400 mg/day. |
Parenteral
| All ages and scenarios | less than 40 mg/kg/day or 400mg/day. |
Method of IV Preparation
1. Dilute every 3mg of dose in 1 mL of 0.9% Normal Saline, Dextrose 5%, Dextrose 10% or Ringer Lactate.
2. Infuse over more than 10 minuted.
3. Avoid rapid rate of infusion.
Renal Adjustment Dosage
Use lowest effective doses (after pharmacologist consultation)
Hepatic Adjustment Dosage
| Mild to Moderate Hepatic Impairment | lowest effective doses (after pharmacologist consultation). |
| Severe Hepatic Impairment | Contraindicated. |
Adverse Effects
1. Gastrointestinal upset.
2. Agranulocytopenia.
2. Acute Kidney Injury.
2. Thrombotic Events.
2. Hypersensitivty.
Toxicity
1. Toxic Doses :
- a. Mild Toxicity : 100-200 mg/kg/day.
- b. Moderate to Severe Toxicity : 200-400 mg/kg/day.
- c. Potential Life threatening Toxicity : More than 400 mg/kg/day.
2. Findings :
- a. Gastrointestinal : Nausea, Vomiting and Abdominal Pain.
- b. Central Nervous System : Altered Conscious level and Seizures.
- a. Cardiovascular : Hypotension, tachycardia and Heart failure.
- a. Respiratory : Depression.
- a. Metabolic : Metabolic Acidosis and Acute Kidney Injury.
2. Management :
| Mild Toxicity | Supportive Care (Reassurance, symptomatic treatment and wait and watch). |
| Moderate to Severe Toxicity | a. Nil-per-mouth for few hours. b. Activated Charcoal (if presents within 1-2 hours). c. Strict monitoring of vitals and symptoms. |
| Potential life threatening Toxicity | a. Nil-per-mouth until condition improves. b. Activated Charcoal (if presents within 1-2 hours). c. Fluid Resuscitation. d. Electrolyte Correction. e. Strict monitoring of vitals and symptoms. |
References
1. Vanderah, Todd W. Basic and Clinical Pharmacology 16th Edition. McGraw Hill Professional, 3 Nov. 2023.
2. Tripathi, K D. Essentials of Medical Pharmacology. New Delhi, Jaypee Brothers Medical Publishers (P) Ltd, 2015
3. The, et al. The Harriet Lane Handbook, 23 Edition: South Asia Edition - E-Book. Elsevier Health Sciences, 20 June 2023.
4. Ershad M, Ameer MA, Chen RJ, et al. Ibuprofen Toxicity. [Updated 2024 Apr 30]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan.
5. “Clinical Practice Guidelines : Nonsteroidal Anti-Inflammatory Drug NSAID Poisoning.” Www.rch.org.au.