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ibuprofen

(eye byoo' proe fen)


Actiprofen (CAN), Advil, Advil Liqui-Gels, Advil Migraine, Alti-Ibuprofen
(CAN), Apo-Ibuprofen (CAN), Children's Advil, Children's Motrin, Genpril,
Haltran, Infants' Motrin, Junior Strength Advil, Junior Strength Motrin,
Menadol, Midol, Midol Maximum Strength Cramp Formula, Motrin, Motrin
IB, Motrin Migraine Pain, Novo-Profen (CAN), Nuprin, PediaCare Fever,
Pediatric Advil Drops

Pregnancy Category B
Pregnancy Category D (third trimester)

Drug classes
NSAID
Analgesic (nonopioid)
Propionic acid derivative

Therapeutic actions
Anti-inflammatory, analgesic, and antipyretic activities largely related to inhibition of
prostaglandin synthesis; exact mechanisms of action are not known. Inhibits both
cyclooxygenase (COX) 1 and 2. Ibuprofen is slightly more selective for COX-1.

Indications
• Relief of signs and symptoms of rheumatoid arthritis and osteoarthritis
• Relief of mild to moderate pain
• Treatment of primary dysmenorrhea
• Fever reduction
• Unlabeled uses: Prophylactic for migraine; abortive treatment for migraine

Contraindications and cautions


• Contraindicated with allergy to ibuprofen, salicylates, or other NSAIDs (more
common in patients with rhinitis, asthma, chronic urticaria, nasal polyps).
• Use cautiously with CV dysfunction, hypertension; peptic ulceration, GI bleeding;
pregnancy; lactation; impaired hepatic or renal function.

Available forms
Tablets—100, 200, 400, 600, 800 mg; chewable tablets—50, 100 mg; capsules—200 mg;
suspension—100 mg/2.5 mL, 100 mg/5 mL; oral drops—40 mg/mL
Dosages
ADULTS
Do not exceed 3,200 mg/day.
• Mild to moderate pain: 400 mg q 4–6 hr PO.
• Osteoarthritis or rheumatoid arthritis: 1,200–3,200 mg/day PO (300 mg qid or
400, 600, 800 mg tid or qid; individualize dosage. Therapeutic response may
occur in a few days, but often takes 2 wk).
• Primary dysmenorrhea: 400 mg q 4 hr PO.
• OTC use: 200–400 mg q 4–6 hr PO while symptoms persist; do not exceed
1,200 mg/day. Do not take for more than 10 days for pain or 3 days for fever,
unless so directed by health care provider.
PEDIATRIC PATIENTS
• Juvenile arthritis: 30–40 mg/kg/day PO in three to four divided doses;
20 mg/kg/day for milder disease.
• Fever (6 mo–12 yr): 5–10 mg/kg PO q 6–8 hr; do not exceed 40 mg/kg/day.

Pharmacokinetics
Route Onset Peak Duration
Oral 30 min 1–2 hr 4–6 hr

Metabolism: Hepatic; T1/2: 1.8–2.5 hr


Distribution: Crosses placenta; may enter breast milk
Excretion: Urine

Adverse effects
• CNS: Headache, dizziness, somnolence, insomnia, fatigue, tiredness, dizziness,
tinnitus, ophthalmologic effects
• CV: Hypertension, palpitations, arrhythmia
• Dermatologic: Rash, pruritus, sweating, dry mucous membranes, stomatitis
• GI: Nausea, dyspepsia, GI pain, diarrhea, vomiting, constipation, flatulence, GI
bleeding
• GU: Dysuria, renal impairment, menorrhagia
• Hematologic: Bleeding, platelet inhibition with higher doses, neutropenia,
eosinophilia, leukopenia, pancytopenia, thrombocytopenia, agranulocytosis,
granulocytopenia, aplastic anemia, decreased Hgb or Hct, bone marrow
depression
• Respiratory: Dyspnea, hemoptysis, pharyngitis, bronchospasm, rhinitis
• Other: Peripheral edema, anaphylactoid reactions to anaphylactic shock

Interactions
Drug-drug
• Increased toxic effects of lithium with ibuprofen
• Decreased diuretic effect with loop diuretics—bumetanide, furosemide,
ethacrynic acid
• Potential decrease in antihypertensive effect of beta-adrenergic blocking agents
and angiotensin-converting enzyme inhibitors
• Increased risk of gastric ulceration with bisphosphates
• Increased risk of bleeding with anticoagulants

Nursing considerations
Assessment
• History: Allergy to ibuprofen, salicylates or other NSAIDs; CV dysfunction,
hypertension; peptic ulceration, GI bleeding; impaired hepatic or renal function;
pregnancy; lactation
• Physical: Skin color, lesions; T; orientation, reflexes, ophthalmologic evaluation,
audiometric evaluation, peripheral sensation; P, BP, edema; R, adventitious
sounds; liver evaluation, bowel sounds; CBC, clotting times, urinalysis, renal and
liver function tests, serum electrolytes, stool guaiac

Interventions
• Administer drug with food or after meals if GI upset occurs.
• Arrange for periodic ophthalmologic examination during long-term therapy.
• Discontinue drug if eye changes, symptoms of liver dysfunction, or renal
impairment occur.
• Institute emergency procedures if overdose occurs: Gastric lavage, induction of
emesis, supportive therapy.

Teaching points
• Use drug only as suggested; avoid overdose. Take the drug with food or after
meals if GI upset occurs. Do not exceed the prescribed dosage.
• Avoid over-the-counter drugs. Many of these drugs contain similar medications,
and serious overdosage can occur.
• These side effects may occur: Nausea, GI upset, dyspepsia (take drug with food);
diarrhea or constipation; drowsiness, dizziness, vertigo, insomnia (use caution
when driving or operating dangerous machinery).
• Report sore throat, fever, rash, itching, weight gain, swelling in ankles or fingers,
changes in vision, black or tarry stools.

Adverse effects in Italic are most common; those in Bold are life-threatening.