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Ibuprofen (Advil, Motrin)

  • Medical Editor: John P. Cunha, DO, FACOEP
    John P. Cunha, DO, FACOEP

    John P. Cunha, DO, FACOEP

    John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.

Brand Name: Advil, Motrin, PediaCare Children's Pain Reliever/Fever Reducer IB, PediaCare Infant's Pain Reliever/Fever Reducer IB

Generic Name: Ibuprofen

Drug Class: NSAIDs; Patent Ductus Arteriosus Agents

What Is Ibuprofen Used For?

Ibuprofen is a pain reliever and fever reducer used to temporarily relieve minor aches and pains due to: headache, toothache, backache, menstrual cramps, the common cold, muscular aches, and minor pain of arthritis. Ibuprofen is also used to temporarily reduce fever.

Ibuprofen is available under the following different brand names: Advil, Motrin, PediaCare Children's Pain Reliever/Fever Reducer IB, and PediaCare Infant's Pain Reliever/Fever Reducer IB.

Dosages of Ibuprofen

Adult and Pediatric Dosage Forms & Strengths

Tablet

  • 100mg
  • 200mg
  • 400mg (Rx)
  • 600mg (Rx)
  • 800mg (Rx)

Capsule

  • 200mg

Tablet, chewable

  • 50mg
  • 100mg

Oral suspension

  • 100mg/5mL
  • 40mg/mL

Dosage Considerations – Should be Given as Follows:

Pain/Fever/Dysmenorrhea

Over-the-counter (OTC): 200-400 mg taken orally once every 4-6 hours; not to exceed 1.2 g unless directed by physician

Prescription: 400-800 mg taken orally or intravenously (IV) once every 6 hours

Inflammatory Disease

400-800 mg taken orally once every 6-8 hours; not to exceed 3.2 g/day

Osteoarthritis

300 mg, 400 mg, 600 mg, or 800 mg taken orally once every 6-8 hours; not to exceed 3.2 g/day

Monitor for gastrointestinal (GI) risks

Rheumatoid Arthritis

300 mg, 400 mg, 600 mg, or 800 mg taken orally once every 6-8 hours; not to exceed 3200 mg/day

Monitor for GI risks

Dosage Modifications

Significantly impaired renal function: Monitor closely; consider reduced dosage if warranted

Severe hepatic impairment: Avoid use

Pediatric Dose

Fever

Children 6 months to 12 years: 5-10 mg/kg/dose taken orally once every 6-8 hours; not to exceed 40 mg/kg/day 

Pain

4-10 mg/kg/dose taken orally once every 6-8 hours; not to exceed 40 mg/kg/day

Juvenile Idiopathic Arthritis

30-50 mg/kg/24hr taken orally once every 8 hours; not to exceed 2.4 g/day

Patent Ductus Arteriosus

See ibuprofen IV drug monograph

Cystic Fibrosis (Off-label)

Younger than 4 years: Safety and efficacy not established

4 years of age and older: taken orally once every 12 hours, adjusted to maintain serum levels of 50-100 mcg/mL; may slow disease progression in younger patients with mild lung disease

Dosing Considerations

Potential toxic dose in children younger than 6 years: 200 mg/kg

What Are Side Effects Associated with Using Ibuprofen?

Common side effects of ibuprofen include:

Serious side effects of ibuprofen include:

This document does not contain all possible side effects and others may occur. Check with your physician for additional information about side effects.

What Other Drugs Interact with Ibuprofen?

If your doctor has directed you to use this medication, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider or pharmacist first.

Severe Interactions of ibuprofen include: None

Serious Interactions of ibuprofen include:

Ibuprofen has moderate interactions with at least 239 different drugs.

Ibuprofen has mild interactions with at least 116 different drugs.

This document does not contain all possible interactions. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you, and share the list with your doctor and pharmacist. Check with your physician if you have health questions or concerns.

What Are Warnings and Precautions for Ibuprofen?

Warnings

Cardiovascular risk

Nonsteroidal anti-inflammatory drugs (NSAIDs) may increase risk of serious cardiovascular thrombotic events, myocardial infarction (MI), and stroke, which can be fatal Risk may increase with duration of use Patients with existing cardiovascular disease or risk factors for such disease may be at greater risk NSAIDs are contraindicated for perioperative pain in setting of coronary artery bypass graft (CABG) surgery

Gastrointestinal risk

NSAIDs increase risk of serious GI adverse events, including bleeding, ulceration, and gastric or intestinal perforation, which can be fatal GI adverse events may occur at any time during use and without warning symptoms Elderly patients are at greater risk for serious GI events

This medication contains ibuprofen. Do not take Advil, Motrin, PediaCare Children's Pain Reliever/Fever Reducer IB, or PediaCare Infant's Pain Reliever/Fever Reducer IB if you are allergic to ibuprofen or any ingredients contained in this drug.

Keep out of reach of children. In case of overdose, get medical help or contact a Poison Control Center immediately.

Contraindications

Absolute

Effects of Drug Abuse

None.

Short-Term Effects

  • See "What Are Side Effects Associated with Using Ibuprofen?"

Long-Term Effects

Long-term opioid use may cause secondary hypogonadism, which may lead to sexual dysfunction, infertility, mood disorders, and osteoporosis.

  • See "What Are Side Effects Associated with Using Ibuprofen?"

Cautions

Use caution in asthma (bronchial), cardiac disease, congestive heart failure (CHF), hepatic or renal impairment, hypertension. bleeding disorders, duodenal/gastric/peptic ulcer, stomatitis, systemic lupus erythematosus (SLE), ulcerative colitis, upper GI disease, late pregnancy (may cause premature closure of ductus arteriosus).

Long-term administration of NSAIDs may result in renal papillary necrosis and other renal injury; patients at greatest risk include elderly individuals; those with impaired renal function, hypovolemia, heart failure, liver dysfunction, or salt depletion; and those taking diuretics, angiotensin-converting enzyme (ACE) inhibitors, or angiotensin receptor blockers.

Junior Advil (100 mg): Doses higher than recommended may cause stomach bleeding.

May cause serious adverse reactions, including exfoliative dermatitis, toxic epidermal necrolysis, Steven's Johnson syndrome reported.

Children's and Junior Advil (50 mg, 100 mg): May cause severe and persistent sore throat.

Fever, rash, abdominal pain, nausea, liver dysfunction, and meningitis have occurred in patients with collagen-vascular disease, especially SLE.

Blurred vision, scotomata, and changes in color vision reported; discontinue therapy if symptoms occur.

Platelet aggregation and adhesion may be decreased; monitor patients with coagulation disorders receiving the therapy.

Risk of hyperkalemia may increase in patients with diabetes, the elderly, renal disease, or with concomitant use of agents that can induce hyperkalemia including ACE inhibitors; monitor potassium closely.

May cause drowsiness and dizziness; may impair physical or mental abilities to operate heavy machinery or driving.

Not for use right before or after heart surgery.

Heart Failure (HF) risk

  • NSAIDs have the potential to trigger HF by prostaglandin inhibition that leads to sodium and water retention, increased systemic vascular resistance, and blunted response to diuretics
  • NSAIDs should be avoided or withdrawn whenever possible
  • AHA/ACC Heart Failure Guidelines; Circulation. 2016; 134

Pregnancy and Lactation

At or after 30 weeks' gestation: Ibuprofen may cause premature closure of ductus arteriosus; avoid during 1st and 3rd trimesters.

Quebec Pregnancy Registry identified 4705 women who had spontaneous abortions by 20 weeks' gestation; each case was matched to 10 control subjects (n=47,050) who had not had spontaneous abortions; exposure to non-aspirin NSAIDs during pregnancy was documented in approximately 7.5% of cases of spontaneous abortions and in approximately 2.6% of controls.

Ibuprofen is excreted into human breast milk in extremely low levels. Ibuprofen has a short half-life and is considered safe in infants in doses much higher than those excreted in breast milk. Ibuprofen is considered the preferred choice for analgesia or inflammation in breastfeeding women (LactMed from NIH).

Reviewed on 1/11/2018

SOURCE:
https://reference.medscape.com/drug/advil-motrin-ibuprofen-343289
https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=1a665e64-9f30-be37-4a83-38789f1f1e89

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