II. Indications

  1. See NSAID
  2. FDA approved indications in Adults
    1. Rheumatoid Arthritis
    2. Osteoarthritis
    3. Acute Gouty Arthritis
    4. Mild to moderate pain
    5. Primary Dysmenorrhea
    6. Migraine Headache
    7. Fever
  3. FDA approved indications in Children (age >6 months except in PDA)
    1. Juvenile Rheumatoid Arthritis
    2. Mild to moderate pain
    3. Fever
    4. Patent Ductus Arteriosus (PDA) in premature newborns (NeoProfen)

III. Contraindications

  1. See NSAID
  2. Avoid in age under 6 months old

IV. Mechanism

  1. NSAID in Propionic Acid class
  2. Strong Analgesic action
  3. Moderate anti-inflammatory action (Dose >= 600 mg)

V. Medications

  1. Ibuprofen
    1. Suspension: 100 mg/5ml
    2. Chewables: 50 mg, 100 mg
    3. Oral drops: 40 mg/ml
    4. Tablets: 100 mg, 200 mg, 300 mg, 400 mg, 600 mg, 800 mg
    5. Intravenous (Caldolor)
      1. Adults: 400 to 800 mg IV infused over 30 minutes every 6 hours as needed
  2. Combinations
    1. Duexis (Ibuprofen 800 mg and Famotidine 26.6 mg)
      1. Take one tablet orally up to three times daily (swallowed whole and not cut)
      2. FDA approved for Osteoarthritis and Rheumatoid Arthritis

VI. Dosing: Children older than age 6 months

  1. Dose: 5-10 mg/kg orally every 6 to 8 hours
  2. Maximum: 40 mg/kg/day up to 2400 mg/day
  3. See other references for NeoProfen in Patent Ductus Arteriosus (PDA)

VII. Dosing: Adult

  1. See Caldolor IV dosing above
  2. Dose: 400 to 800 mg orally three to four times daily
    1. See efficacy below regarding Analgesic ceiling dose of 400 mg
    2. Arthritis (RA,OA, gout) dose: 600 to 800 mg orally every 6 to 8 hours as needed
    3. Analgesic and antipyretic dose: 200 to 400 mg orally every 4 to 6 hours as needed
  3. Maximum: 3200 mg/day

IX. Safety

  1. See NSAID
  2. Considered safe in Lactation
  3. Avoid NSAIDs in pregnancy outside the first part of the second trimester (13 to 20 weeks)
    1. Teratogenic in first trimester
    2. Risk of premature ductus arteriosus closure in the fetus in third trimester
    3. Most NSAIDs carry a legacy system Pregnancy Category B or C designation (aside from third trimester)
      1. However, many obstetricians avoid NSAIDs entirely in pregnancy (even in second trimester)

X. Drug Interactions

  1. Aspirin
    1. Ibuprofen counters Aspirin antiplatelet effects
    2. Take Aspirin at least 2 hours before Ibuprofen dose

XI. Efficacy

  1. Ibuprofen Analgesic ceiling is 400 mg
    1. Doses 600 mg and 800 mg offer little additional Analgesic benefit above the 400 mg dose
    2. Motov (2019) Ann Emerg Med 74(4): 530-7 +PMID:31383385 [PubMed]

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Related Studies

Cost: Medications

ibuprofen (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
IBUPROFEN 100 MG/5 ML SUSP Generic $0.03 per ml
IBUPROFEN 200 MG CAPLET Generic OTC $0.03 each
IBUPROFEN 200 MG CAPSULE Generic OTC $0.09 each
IBUPROFEN 200 MG SOFTGEL Generic OTC $0.09 each
IBUPROFEN 200 MG TABLET Generic OTC $0.03 each
IBUPROFEN 400 MG TABLET Generic $0.05 each
IBUPROFEN 600 MG TABLET Generic $0.05 each
IBUPROFEN 800 MG TABLET Generic $0.07 each
IBUPROFEN COLD-SINUS CPLT Generic OTC $0.15 each
IBUPROFEN JR STR 100 MG TB CHW Generic OTC $0.14 each
IBUPROFEN PM CAPLET Generic OTC $0.13 each
IBUPROFEN-FAMOTIDIN 800-26.6 MG Generic $4.05 each
duexis (on 7/20/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
DUEXIS 800-26.6 MG TABLET Generic $4.05 each

Ontology: Ibuprofen (C0020740)

Definition (CHV) a chemical substance
Definition (CHV) a chemical substance
Definition (NCI) A propionic acid derivate and nonsteroidal anti-inflammatory drug (NSAID) with anti-inflammatory, analgesic, and antipyretic effects. Ibuprofen inhibits the activity of cyclo-oxygenase I and II, resulting in a decreased formation of precursors of prostaglandins and thromboxanes. This leads to decreased prostaglandin synthesis, by prostaglandin synthase, the main physiologic effect of ibuprofen. Ibuprofen also causes a decrease in the formation of thromboxane A2 synthesis, by thromboxane synthase, thereby inhibiting platelet aggregation. (NCI05)
Definition (NCI_NCI-GLOSS) A drug used to treat fever, swelling, pain, and redness by preventing the body from making a substance that causes inflammation. It is a type of nonsteroidal anti-inflammatory drug (NSAID).
Definition (MSH) A nonsteroidal anti-inflammatory agent with analgesic properties used in the therapy of rheumatism and arthritis.
Definition (CSP) nonsteroidal analgesic, antipyretic and anti-inflammatory agent that is a propionic acid derivative.
Definition (PDQ) A propionic acid derivate and nonsteroidal anti-inflammatory drug (NSAID) with anti-inflammatory, analgesic, and antipyretic effects. Ibuprofen inhibits the activity of cyclo-oxygenase I and II, resulting in a decreased formation of precursors of prostaglandins and thromboxanes. This leads to decreased prostaglandin synthesis, by prostaglandin synthase, the main physiologic effect of ibuprofen. Ibuprofen also causes a decrease in the formation of thromboxane A2 synthesis, by thromboxane synthase, thereby inhibiting platelet aggregation. Check for "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=40475&idtype=1" active clinical trials or "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=40475&idtype=1&closed=1" closed clinical trials using this agent. ("http://nciterms.nci.nih.gov:80/NCIBrowser/ConceptReport.jsp?dictionary=NCI_Thesaurus&code=C561" NCI Thesaurus)
Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH D007052
SnomedCT 329955004, 329651005, 363606004, 322295006, 38268001, 387207008
LNC LP16165-0, MTHU004262, LA14347-1
English Ibuprofen, alpha-Methyl-4-(2-methylpropyl)benzeneacetic Acid, Benzeneacetic acid, alpha-methyl-4-(2-methylpropyl)-, Ibuprofen [cns analgesic], Ibuprofen [cns analgesic] [see j28..], Ibuprofen [musc-skel], Benzeneacetic Acid, Alpha-methyl-4-(2-methylpropyl)-, p-Isobutylhydratropic Acid, ibuprofen, Ibuprofen [musculoskeletal use], Ibuprofen product, ibuprofen (OTC), ibuprofen (medication), Ibuprofen PMR, Ibuprofen [musc-skel use 2], Ibuprofen [musculoskeletal use 2], non-prescription ibuprofen, non-prescription ibuprofen (medication), IBUPROFEN, Ibuprofen [Chemical/Ingredient], ibuprofen products, Ibuprofen product (substance), Ibuprofen [cns analgesic] [see j28..] (product), Ibuprofen [musculoskeletal use] (product), Ibuprofen [musculoskeletal use 2] (product), (.+ -.)-p-Isobutylhydratropic acid, Propionic acid-ibuprofen, p-Isobutylhydratropic acid, Ibuprofen (product), Ibuprofen (substance), Ibuprofen [cns analgesic] [see j28..] (substance), Ibuprofen [musculoskeletal use 2] (substance), Ibuprofen [musculoskeletal use] (substance)
Swedish Ibuprofen
Czech ibuprofen
Finnish Ibuprofeeni
Russian IBUPROFEN, ИБУПРОФЕН
Japanese イブプロフェン
Polish Ibuprofen, Brufen
Norwegian Ibuprofen
Spanish ibuprofeno [uso musculoesquelético], ibuprofeno [uso musculoesquelético 2], ibuprofeno [analgésico de acción central] [véase j28..] (producto), ibuprofeno [analgésico de acción central] [véase j28..], ibuprofeno [uso musculoesquelético 2] (producto), ibuprofeno [uso musculoesquelético] (producto), ibuprofeno (producto), ibuprofeno (sustancia), ibuprofeno, ácido p-isobutilhidratrópico, Ibuprofeno
French Ibuprofène
German Ibuprofen
Italian Ibuprofene
Portuguese Ibuprofeno

Ontology: Advil (C0593507)

Definition (CHV) brand name of a pain killer drug
Definition (CHV) brand name of a pain killer drug
Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
English Advil, advil [brand name], advil

Ontology: Motrin (C0699203)

Definition (CHV) brand name of ibuprofen
Definition (CHV) brand name of ibuprofen
Definition (CHV) brand name of ibuprofen
Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH D007052
English Motrin IB, motrin [brand name], motrin ib, motrin, Motrin

Ontology: Nuprin (C0699205)

Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH D007052
English nuprin, Nuprin