ibuprofen

Drug Name
  • Generic Name : ibuprofen
  • Brand Name: Advil, Advil Liqui-Gels, Advil Migraine, Apo-Ibuprofen (CAN), Children’s Advil, Children’s Motrin, Genpril, 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 
  • Classification: NSAID, Analgesic (nonopioid), Propionic acid derivative
    • Pregnancy Category B
    • Pregnancy Category D (third trimester) 
Dosage & Route
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.
Therapeutic actions
  • Ibuprofen exhibits anti-inflammatory, analgesic and antipyretic activities. Its analgesic effect is independent of anti-inflammatory activity and has both central and peripheral effects. It potently inhibits the enzyme cyclooxygenase resulting in the blockage of prostaglandin synthesis. It also prevents formation of thromboxane A2 by platelet aggregation.
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
Adverse effects
  • Oral: Dyspepsia, vomiting, abdominal pain, heartburn, nausea, diarrhoea, epigastric pain, oedema, fluid retention, dizziness, rash, tinnitus. Parenteral: Intraventricular haemorrhage, skin irritation, hypocalcaemia, hypoglycaemia, GI disorders, anaemia, apnoea, respiratory infection, sepsis.
  • Potentially Fatal: Severe CV thrombotic events. Severe GI bleeding, ulceration and perforation.
Contraindications
  • Active peptic ulcer; hypersensitivity. Neonates with congenital heart disease, suspected necrotising enterocolitis and active bleeding (parenteral).
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, LFTs, renal function tests, serum electrolytes, stool guaiac
Interventions
  • BLACK BOX WARNING: Be aware that patient may be at increased risk of CV event, GI bleeding, monitor accordingly.
  • 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 hepatic impairment, or renal impairment occur.
  • WARNING: Institute emergency procedures if overdose occurs: Gastric lavage, induction of emesis, and 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.
  • You may experience these side effects: 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.