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IBUPROFEN (Motrin, Advil, Genpril, IBU, Midol, Nuprin)

Ibuprofen is a non-steroidal anti-inflammatory, anti-pyretic (fever reducer); analgesic that exerts its pharmaceutical effects through prostaglandin synthesis inhibition. Indications for the medication include headache, toothache, back pain, arthritic disorders, menstrual cramps, tendonitis, and minor injuries.

Ibuprofen is available OTC (over the counter) in 200mg tablets and may be dosed up to 3200mg orally daily with food depending upon the severity of inflammation. The OTC 200mg dose recommendation of 1-2 tablets every 4-6 hours with food may be sufficient for minor aches and pains with doses on upward to 800mg orally 4 times daily for more serious pain and inflammation. Doses of ibuprofen should be taken following meals, generally directly after or within 30-60 minutes to minimize possible gastric irritation or damage. Patients who are taking aspirin as prevention for stroke or heart attack should generally avoid taking ibuprofen as the medication competes for protein binding sites rendering the aspirin less active in its role to protect the heart and blood vessels. If necessary to take both medications, for short term therapy, the ibuprofen should be taken either 8 hours prior to or 30 minutes after the aspirin. Patients should be aware that many OTC cold products also contain ibuprofen or other NSAIDs such as naproxen or ketoprofen.

DOSING



The usual adult dose for rheumatoid and osteoarthritis is 400-800 mg orally every 6-8 hours with maintenance increased up to 3200mg pending patient response and tolerance. The IV dose for pain is 400-800mg IV over 30 minutes every 6 hours IN WELL HYDRATED PATIENTS.

Ibuprofen is available in suspension (100mg/5cc), oral drops (40mg/cc) and chewable tablets (50mg or 100mg) and caplets (100mg) form for pediatric use for fever, pain, juvenile rheumatoid arthritis, cystic fibrosis and patent ductus arteriosus- congenital malformation heart defect pathology. Doses for fever from 2 months to 11 years is 5mg/kg for temperatures of less than 102.5 degrees F orally every 6-8 hours and 10mg/kg for those temperatures of greater than 102.5 degrees F, up to 40mg/kg maximum daily dose. Treatment for pain relief is also maxed at 40mg/kg per day with doses of 10mg/kg orally every 6-8 hours for 6 months to 11years of age. Pediatric rheumatoid arthritis requires higher doses of 30-40mg/kg in 3 or 4 doses daily up to 2400mg/.day. Patients treated for cystic fibrosis older than 4 years of age are dosed twice daily with ibuprofen to achieve and maintain blood levels of 50-100mg/cc which will slow the progress of the milder cases of this lung disease. Ibuprofen treatment of patent ductus arteriosus is administered as ibuprofen lysine for a gestational age of less than 33 weeks with weight off .5 to 1.5 kg at 10mg/kg IV initially, then two doses of 5mg/kg at both 24 hours and 48 hours.

SIDE EFFECTS



Allergic reactions include hives, breathing difficulties, edema(swelling) of the face, tongue, lips, and throat and may require emergency medical intervention. Side effects include chest pain, weakness, shortness of breath, slurring of the speech, balance or vision disturbances. Stools may be tarry, black or bloody with the coughing up of blood or vomit that resembles coffee grounds. Reduced, dark ,or total lack of urination, fever sore throat, red skin rash and blistering and peeling of the skin may occur. Neurological effects including severe tingling, ringing in ears, severe headaches, neck stiffness, chills, light sensitivity, seizure or convulsion

Drugs may interact with ibuprofen causing bruising or bleeding such as the antidepressants citalopram( celexa), escitalopram(Lexapro),fluxoetine (Prozac, Sarafem, Symbyax) fluvoxamine(Luvox) paroxetine (Paxil) and sertraline(Zoloft). Ibuprofen may reduce the diuretic effects of loop diuretics (furosemide) and the thiazides. Lithium levels can be elevated due to reduced clearance renally when taken with ibuprofen, to produce possible toxic lithium levels, which should be monitored closely. The antihypertensive effects of ACE-inhibitors may be reduced when dosed with ibuprofen.

References

PDR edition 59, Physicians Desk Reference, 2005

The Rx Consultant, “Pain Management" vol IX, Number 5, May 2000.

Drugs.com, Drug Information Online ‘IBUPROFEN’

COMMENTS

My personal practice with ibuprofen is very good, I find some patients reluctant to take prescription medicine, yet have a good history with the OTC 200mg tablets of ibuprofen. I explain to the patient who presents with pain and inflammation that ibuprofen is a good choice but must be dosed higher at the anti-inflammation regiment of 600mg taken 3 times daily, or simply taking the 200mg tablets - 3 , 3 times daily with food. Ibuprofen is available in pediatric form for my younger patients presenting with overuse tendonitis or various osseous growth plate inflammations. When additional analgesia is necessary, adding semi synthetic codeine such as hydrocodone provides relief for the patient.



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