Formulary
Ibuprofen: Indications, Dosing, Side Effects and Interactions
Ibuprofen clinical drug profile including indications, dosing, side effects, cautions and interactions.
MedNext Academy | 14 min read
Ibuprofen: Indications, Dosing, Side Effects and Interactions
Ibuprofen clinical drug profile including indications, dosing, side effects, cautions and interactions.
Indications and dose
**Pain and inflammation in rheumatic disease and other musculoskeletal disorders,Mild to moderate pain including dysmenorrhoea,Postoperative analgesia,Dental pain**
- **Adult** (By Mouth Using Immediate-Release Medicines): Initially 300-400 mg 3-4 times a day; maintenance 200-400 mg 3 times a day, increased if necessary up to 600 mg 4 times a day.
- **Adult** (By Mouth Using Modified-Release Medicines): 1.6 g once daily, dose to be taken in the early evening, increased if necessary to 2.4 g daily in 2 divided doses, dose to be increased only in severe cases.
**Acute migraine**
- **Adult** (By Mouth Using Immediate-Release Medicines): 400-600 mg for 1 dose, to be taken as soon as migraine symptoms develop.
**Mild to moderate pain,Pain and inflammation of soft-tissue injuries,Pyrexia with discomfort**
- **Child** (By Mouth Using Immediate-Release Medicines): 12-17 years Initially 300-400 mg 3-4 times a day; maintenance 200-400 mg 3 times a day, increased if necessary up to 600 mg 4 times a day.
**Pain and inflammation**
- **Child** (By Mouth Using Modified-Release Medicines): 12-17 years 1.6 g once daily, dose preferably taken in the early evening, increased to 2.4 g daily in 2 divided doses, dose to be increased only in severe cases.
**Pain and inflammation in rheumatic disease including juvenile idiopathic arthritis**
- **Child** (By Mouth Using Immediate-Release Medicines): 3 months-17 years 30-40 mg/kg daily in 3 divided doses (max. per dose 800 mg), alternatively 30-40 mg/kg daily in 4 divided doses (max. per dose 600 mg).
**Pain and inflammation in systemic juvenile idiopathic arthritis**
- **Child** (By Mouth Using Immediate-Release Medicines): 3 months-17 years (body-weight 40 kg and above) Up to 2.4 g daily in 4-6 divided doses.
**Post-immunisation pyrexia in infants (on doctor's advice only)**
- **Child** (By Mouth Using Immediate-Release Medicines): 2-3 months 50 mg for 1 dose, followed by 50 mg for 1 dose, to be given 6 hours after first dose if required.
**Pain relief in musculoskeletal conditions,Treatment in knee or hand osteoarthritis (adjunct)**
- **Adult** (To The Skin): Apply up to 3 times a day.
**Pain and inflammation in rheumatic disease and other musculoskeletal disorders (dose approved**
- **Child** (By Mouth Using Immediate-Release Medicines): for use by community practitioner nurse prescribers), Mild to moderate pain including dysmenorrhoea (dose approved for use by community practitioner nurse prescribers), Migraine (dose approved for use by community practitioner nurse prescribers), Dental pain (dose approved for use by community practitioner nurse prescribers), Headache (dose approved for use by community practitioner nurse prescribers), Fever (dose approved for use by community practitioner nurse prescribers), Symptoms of colds and influenza (dose approved for use by community practitioner nurse prescribers), Neuralgia (dose approved for use by community practitioner nurse prescribers) 12-17 years 200-400 mg 3 times a day, if symptoms worsen or persist for more than 3 days refer to doctor.
- **Adult** (By Mouth Using Immediate-Release Medicines): 200-400 mg 3 times a day, if symptoms worsen or persist for more than 10 days refer to doctor.
**Mild to moderate pain (dose approved**
- **Child** (By Mouth Using Immediate-Release Medicines): 10-11 years 300 mg 3 times a day, refer to doctor if symptoms persist for more than 3 days.
**Post-immunisation pyrexia in infants (dose approved**
- **Child** (By Mouth Using Immediate-Release Medicines): for use by community practitioner nurse prescribers) (on doctor's advice only) 3 months 50 mg for 1 dose, followed by 50 mg for 1 dose, to be given 6 hours after first dose if required, if pyrexia persists refer to doctor.
**Acute moderate pain,Pyrexia**
- **Child** (By Intravenous Infusion): 6-17 years (body-weight 40 kg and above) 200-400 mg 3 times a day as required for maximum 3 days, doses to be given at intervals of at least 6 hours; maximum 1.2 g per day.
**Acute moderate pain**
- **Adult** (By Intravenous Infusion): 400 mg 3 times a day as required for maximum 3 days, doses to be given at intervals of at least 6 hours, alternatively 600 mg twice daily as required for maximum 3 days, doses to be given at intervals of at least 6 hours; maximum 1.2 g per day.
**Pyrexia**
- **Adult** (By Intravenous Infusion): 400 mg 3 times a day as required for maximum 3 days, doses to be given at intervals of at least 6 hours; maximum 1.2 g per day.
**Mild to moderate pain, Pain and inflammation of soft-tissue injuries, Pyrexia with discomfort for ibuprofen**
- **Child 1-2 months** (By mouth using immediate-release medicines): 5 mg/kg 3-4 times a day.
- **Child 3-5 months** (By mouth using immediate-release medicines): 50 mg 3 times a day, maximum daily dose to be given in 3-4 divided doses; maximum 30 mg/kg per day.
- **Child 6-11 months** (By mouth using immediate-release medicines): 50 mg 3-4 times a day, maximum daily dose to be given in 3-4 divided doses; maximum 30 mg/kg per day.
- **Child 1-3 years** (By mouth using immediate-release medicines): 100 mg 3 times a day, maximum daily dose to be given in 3-4 divided doses; maximum 30 mg/kg per day.
- **Child 4-6 years** (By mouth using immediate-release medicines): 150 mg 3 times a day, maximum daily dose to be given in 3-4 divided doses; maximum 30 mg/kg per day.
- **Child 7-9 years** (By mouth using immediate-release medicines): 200 mg 3 times a day, maximum daily dose to be given in 3-4 divided doses; maximum 30 mg/kg per day; maximum 2.4 g per day.
- **Child 10-11 years** (By mouth using immediate-release medicines): 300 mg 3 times a day, maximum daily dose to be given in 3-4 divided doses; maximum 30 mg/kg per day; maximum 2.4 g per day.
- **Child 12-17 years** (By mouth using immediate-release medicines): Initially 300-400 mg 3-4 times a day; maintenance 200-400 mg 3 times a day, increased if necessary up to 600 mg 4 times a day.
**Pain and inflammation for ibuprofen**
- **Child 12-17 years** (By mouth using modified-release medicines): 1.6 g once daily, dose preferably taken in the early evening, increased to 2.4 g daily in 2 divided doses, dose to be increased only in severe cases.
**Pain and inflammation in rheumatic disease including juvenile idiopathic arthritis for ibuprofen**
- **Child 3 months-17 years** (By mouth using immediate-release medicines): 30-40 mg/kg daily in 3 divided doses (max. per dose 800 mg), alternatively 30-40 mg/kg daily in 4 divided doses (max. per dose 600 mg).
**Pain and inflammation in systemic juvenile idiopathic arthritis for ibuprofen**
- **Child 3 months-17 years (body-weight up to 40 kg)** (By mouth using immediate-release medicines): Up to 60 mg/kg daily in 4-6 divided doses.
- **Child 3 months-17 years (body-weight 40 kg and above)** (By mouth using immediate-release medicines): Up to 2.4 g daily in 4-6 divided doses.
**Post-immunisation pyrexia in infants (on doctor's advice only) for ibuprofen**
- **Child 2-3 months** (By mouth using immediate-release medicines): 50 mg for 1 dose, followed by 50 mg for 1 dose, to be given 6 hours after first dose if required.
**Pain and inflammation in rheumatic disease and other musculoskeletal disorders (dose approved for use by community practitioner nurse prescribers), Mild to moderate pain including dysmenorrhoea (dose approved for use by community practitioner nurse prescribers), Migraine (dose approved for use by community practitioner nurse prescribers), Dental pain (dose approved for use by community practitioner nurse prescribers), Headache (dose approved for use by community practitioner nurse prescribers), Fever (dose approved for use by community practitioner nurse prescribers), Symptoms of colds and influenza (dose approved for use by community practitioner nurse prescribers), Neuralgia (dose approved for use by community practitioner nurse prescribers) for ibuprofen**
- **Child 12-17 years** (By mouth using immediate-release medicines): 200-400 mg 3 times a day, if symptoms worsen or persist for more than 3 days refer to doctor.
**Mild to moderate pain (dose approved for use by community practitioner nurse prescribers), Pain and inflammation of soft-tissue injuries (dose approved for use by community practitioner nurse prescribers), Pyrexia with discomfort (dose approved for use by community practitioner nurse prescribers) for ibuprofen**
- **Child 3-5 months (body-weight 5 kg and above)** (By mouth using immediate-release medicines): 20-30 mg/kg daily in divided doses, alternatively 50 mg 3 times a day for maximum of 24 hours, refer to doctor if symptoms persist for more than 24 hours.
- **Child 6-11 months** (By mouth using immediate-release medicines): 50 mg 3-4 times a day, refer to doctor if symptoms persist for more than 3 days.
- **Child 1-3 years** (By mouth using immediate-release medicines): 100 mg 3 times a day, refer to doctor if symptoms persist for more than 3 days.
- **Child 4-6 years** (By mouth using immediate-release medicines): 150 mg 3 times a day, refer to doctor if symptoms persist for more than 3 days.
- **Child 7-9 years** (By mouth using immediate-release medicines): 200 mg 3 times a day, refer to doctor if symptoms persist for more than 3 days.
- **Child 10-11 years** (By mouth using immediate-release medicines): 300 mg 3 times a day, refer to doctor if symptoms persist for more than 3 days.
**Post-immunisation pyrexia in infants (dose approved for use by community practitioner nurse prescribers) (on doctor's advice only) for ibuprofen**
- **Child 3 months** (By mouth using immediate-release medicines): 50 mg for 1 dose, followed by 50 mg for 1 dose, to be given 6 hours after first dose if required, if pyrexia persists refer to doctor.
**Acute moderate pain, Pyrexia for ibuprofen**
- **Child 6-17 years (body-weight 20-29 kg)** (By intravenous infusion): 200 mg 3 times a day as required for maximum 3 days, doses to be given at intervals of at least 6 hours; maximum 600 mg per day.
- **Child 6-17 years (body-weight 30-39 kg)** (By intravenous infusion): 200 mg 4 times a day as required for maximum 3 days, doses to be given at intervals of at least 6 hours; maximum 800 mg per day.
- **Child 6-17 years (body-weight 40 kg and above)** (By intravenous infusion): 200-400 mg 3 times a day as required for maximum 3 days, doses to be given at intervals of at least 6 hours; maximum 1.2 g per day.
**Closure of ductus arteriosus (under expert supervision) for Pedea**
- **Neonate up to 34 weeks corrected gestational age** (By slow intravenous injection): Initially 10 mg/kg for 1 dose, to be given after the first 6 hours of life, then 5 mg/kg every 24 hours for 2 doses but see also Monitoring requirements, the course may be repeated after 48 hours if necessary.
Cautions
With systemic use Allergic disorders; cardiac impairment (NSAIDs may impair renal function); cerebrovascular disease; coagulation defects; connective-tissue disorders; dehydration (risk of renal impairment); elderly (risk of serious side-effects and fatalities) (in adults); heart failure; history of gastro-intestinal disorders (e.g. ulcerative colitis, Crohn's disease); ischaemic heart disease; may mask symptoms of infection; peripheral arterial disease; risk factors for cardiovascular events; uncontrolled hypertension With topical use Avoid contact with eyes (in adults); avoid contact with inflamed or broken skin (in adults); avoid contact with mucous membranes (in adults); not for use with occlusive dressings (in adults); topical application of large amounts can result in systemic effects, including hypersensitivity and asthma (renal disease has also been reported) (in adults) Cautions, further information High-dose ibuprofen With oral use: A small increase in cardiovascular risk, similar to the risk associated with cyclo-oxygenase-2 inhibitors and diclofenac, has been reported with high-dose ibuprofen ( 2.4 g daily); use should be avoided in patients with established ischaemic heart disease, peripheral arterial disease, cerebrovascular disease, congestive heart failure (New York Heart Association classification II-III), and uncontrolled hypertension. Masking of symptoms of underlying infections With systemic use: Ibuprofen can mask symptoms of infection, which may lead to delayed initiation of appropriate treatment and thereby worsen infection outcome. This has been observed in bacterial community-acquired pneumonia and bacterial complications to varicella. When administered for fever or pain relief in relation to infection, monitoring of infection is advised.
Contraindications
With intravenous use Active bleeding (especially intracranial or gastro-intestinal); thrombocytopenia With systemic use Active gastro-intestinal bleeding; active gastro-intestinal ulceration; history of gastro-intestinal bleeding related to previous NSAID therapy; history of gastro-intestinal perforation related to previous NSAID therapy; history of recurrent gastro-intestinal haemorrhage (two or more distinct episodes); history of recurrent gastro-intestinal ulceration (two or more distinct episodes); severe heart failure; varicella infection
Side effects
General side-effects: Common or very common Gastrointestinal discomfort; skin reactions Uncommon Asthma; hypersensitivity Rare or very rare Dyspnoea Specific side-effects: Common or very common With intravenous use Constipation; diarrhoea; dizziness; fatigue; gastrointestinal disorders; haemorrhage; headache; inflammatory bowel disease; insomnia; nausea; oral disorders; vertigo; vomiting Uncommon With intravenous use Acute kidney injury; anxiety; irritability; nephritis tubulointerstitial; nephrotic syndrome; oedema; tinnitus; vasculitis; vision disorders With oral use Headache; nausea; rash (discontinue) Rare or very rare With intravenous use Agranulocytosis; alopecia; anaemia; auditory disorder; confusion; depression; heart failure; hepatic disorders; hypertension; hypotension; infection exacerbated; leucopenia; meningitis aseptic (patients with connective-tissue disorders such as systemic lupus erythematosus may be especially susceptible); myocardial infarction; neck stiffness; palpitations; pancreatitis; pancytopenia; photosensitivity reaction; psychotic disorder; renal papillary necrosis; respiratory disorders; severe cutaneous adverse reactions (SCARs); shock; systemic lupus erythematosus (SLE); thrombocytopenia With oral use Acute kidney injury; agranulocytosis; anaemia; angioedema; constipation; diarrhoea; gastrointestinal disorders; haemorrhage; leucopenia; liver disorder; meningitis aseptic (patients with connective-tissue disorders such as systemic lupus erythematosus may be especially susceptible); oedema; oral ulceration; pancytopenia; renal papillary necrosis; severe cutaneous adverse reactions (SCARs); shock; thrombocytopenia; vomiting Frequency not known With intravenous use Increased risk of arterial thromboembolism With oral use Crohn's disease; fertility decreased female; fluid retention; heart failure; hypertension; increased risk of arterial thromboembolism; renal failure (more common in patients with pre-existing renal impairment); respiratory disorders; respiratory tract reaction With topical use Angioedema (in adults); bronchospasm (in adults); rash (discontinue) (in adults); renal impairment (in adults); toxic epidermal necrolysis (in adults) Side-effects, further information For information about cardiovascular and gastrointestinal side-effects, and a possible exacerbation of symptoms in asthma, see Non-steroidal anti-inflammatory drugs With topical use Topical application of large amounts can result in systemic effects, including hypersensitivity and asthma (renal disease has also been reported). Overdose Overdosage with ibuprofen may cause nausea, vomiting, epigastric pain, and tinnitus, but more serious toxicity is very uncommon. Activated charcoal followed by symptomatic measures are indicated if more than 100 mg/kg has been ingested within the preceding hour. For details on the management of poisoning, see Emergency treatment of poisoning .
Interactions
**Other interactions (20):**
- Ibuprofen should be avoided in combination with: Acetylsalicylic acid (Aspirin): As with other products containing NSAIDs, concomitant administration of ibuprofen and acetylsalicylic acid is not...
- Experimental data suggest that ibuprofen may competitively inhibit the effect of low dose acetylsalicylic acid on platelet aggregation when they are dosed concomitantly.
- Although there are uncertainties regarding extrapolation of these data to the clinical situation, the possibility that regular, long-term use of ibuprofen may reduce the cardioprotective effect of...
- No clinically relevant effect is considered to be likely for occasional ibuprofen use.
- Other NSAIDs including cyclooxygenase-2 selective inhibitors: avoid concomitant use of two or more NSAIDs as this may increase the risk of adverse effects (see section 4.4) Methotrexate: NSAIDs may...
- Ibuprofen should be used with caution in combination with: Anticoagulants: NSAIDs may enhance the effects of anticoagulants, such as warfarin (see section 4.4).
Pregnancy
Important safety information For ibuprofen MHRA/CHM advice: NSAIDs: potential risks following prolonged use after 20 weeks of pregnancy (June 2023) With systemic use: See Non-steroidal anti-inflammatory drugs .
Breast feeding
Specialist sources indicate suitable for use in breast-feeding-negligible amounts present in milk.
Hepatic impairment
With systemic use for indications relating to Pain or Pyrexia: Caution in mild to moderate impairment; avoid in severe impairment. M Dose adjustments With systemic use for indications relating to Pain or Pyrexia: The lowest effective dose should be used for the shortest possible duration. M
Renal impairment
With systemic use for indications relating to Pain or Pyrexia: In general, for NSAIDs the MHRA advises to avoid where possible; if necessary, use with caution (risk of fluid retention and further renal impairment, including renal failure). For ibuprofen , avoid in severe impairment. M With topical use in adults: Caution (deterioration in renal function has also been reported after topical use). M Dose adjustments With systemic use for indications relating to Pain or Pyrexia: The lowest effective dose should be used for the shortest possible duration. M
Medicinal forms
Suspension,Tablet,Tablet,Tablet,Capsule,Capsule,Capsule,Granules,Suspension,Solution,Gel
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
Inside MedNext for this topic
- 411 MedNext-authored chapters
- 80,000+ MCQ bank
- 15 study modes
- Growing visual cheat sheets
Study modes
- Notes
- MCQ
- Audio
- Video
- Visual
- 3D Anatomy
- Trace
- Flashcards
- Mnemonics
- Image Bank
- Clinical
- Microscopy
- Audio QBank
- Cadaver
- Book Match
Continue reading
Subject HubPharmacology Hub
All pharmacology resources in one place.
Drug SchedulesIndian Drug Schedules
Schedule H, H1, X and G classifications.
FormularyBrowse all drugs
Search 1,850+ drug profiles.
Study Ibuprofen in the MedNext app
Challenge yourself with targeted pharmacology MCQs on this drug class. Every explanation links back to the chapter that teaches the concept.
Start drug challengeExplore the full formulary