IBUPROFEN (eye-byoo'proe-fen) Advil, Amersol , Children's Motrin, Ibuprin, Junior Strength Motrin Caplets, Motrin, Nuprin, Pediaprofen, Pamprin-IB, Rufen, Trendar Classifications: analgesic, nonsteroidal antiinflammatory drug (nsaid) (cox-1 and cox-2 inhibitor); antipyretic; Therapeutic:nsaid, analgesic; antipyretic Pregnancy Category: B
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Availability
100 mg, 200 mg, 400 mg, 600 mg, 800 mg tablets; 50 mg, 100 mg chewable tablets; 100 mg/5 mL, 100 mg/2.5 mL suspension; 40 mg/mL drops
Action
Prototype of the propionic acid NSAIDs (COX-1 and COX-2) inhibitor with nonsteroidal antiinflammatory activity and significant antipyretic and analgesic properties.
It blocks prostaglandin synthesis. Ibuprofen activity also includes modulation of T-cell function, inhibition of inflammatory
cell chemotaxis, decreased release of superoxide radicals, or increased scavenging of these compounds at inflammatory sites.
Therapeutic Effect
Has nonsteroidal antiinflammatory, analgesic, and antipyretic effects. Inhibits platelet aggregation and prolongs bleeding
time but does not affect prothrombin or whole blood clotting times.
Uses
Chronic, symptomatic rheumatoid arthritis and osteoarthritis; relief of mild to moderate pain; primary dysmenorrhea; reduction
of fever.
Unlabeled Uses
Gout, juvenile rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, vascular headache.
Contraindications
Patient in whom urticaria, severe rhinitis, bronchospasm, angioedema, nasal polyps are precipitated by aspirin or other
NSAIDs; active peptic ulcer, bleeding abnormalities; perioperative pain related to CABG. Safe use in children <6 mo is not established.
Cautious Use
Hypertension, history of GI ulceration; diabetes mellitus, impaired hepatic or renal function, history of coronary artery
disease, angina, MI cardiac decompensation; chronic renal failure, patients with SLE; pregnancy (category B).
Route & Dosage
Inflammatory Disease Adult: PO 400800 mg t.i.d. or q.i.d. (max: 3200 mg/d) Child: PO <20 kg, up to 400 mg/d in divided doses; 2030 kg, up to 600 mg/d in divided doses; 3040 kg, up to 800 mg/d in divided doses
Mild to Moderate Pain, Dysmenorrhea Adult: PO 400 mg q46h up to 1200 mg/d
Fever Adult: PO 200400 mg t.i.d. or q.i.d. (max: 1200 mg/d) Child (6 mo12 y): PO 510 mg/kg q46h up to 40 mg/kg/d
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Administration
Oral
- Give on an empty stomach, 1 h before or 2 h after meals. May be taken with meals or milk if GI intolerance occurs.
- Ensure that chewable tablets are chewed or crushed before being swallowed.
- Note: Tablet may be crushed if patient is unable to swallow it whole and mixed with food or liquid before swallowing.
- Store in tightly closed, light-resistant container unless otherwise directed by manufacturer.
Adverse Effects (≥1%)
CNS: Headache, dizziness, light-headedness, anxiety, emotional lability,
fatigue, malaise, drowsiness, anxiety, confusion,
depression,
aseptic meningitis.
CV: Hypertension, palpitation, congestive heart failure (patient with marginal cardiac function); peripheral edema.
Special Senses: Amblyopia (blurred vision, decreased visual acuity, scotomas, changes in color vision); nystagmus, visual-field defects;
tinnitus, impaired hearing.
GI: Dry mouth, gingival ulcerations, dyspepsia,
heartburn, nausea, vomiting, anorexia, diarrhea,
constipation, bloating, flatulence, epigastric or abdominal discomfort or pain, GI ulceration,
occult blood loss. Hematologic: Thrombocytopenia, neutropenia, hemolytic or
aplastic anemia, leukopenia; decreased Hgb, Hct; transitory rise in AST, ALT, serum alkaline phosphatase; rise in (Ivy) bleeding time.
GU: Acute renal failure, polyuria, azotemia,
cystitis, hematuria, nephrotoxicity, decreased creatinine clearance.
Skin: Maculopapular and vesicobullous skin eruptions, erythema multiforme, pruritus, rectal itching,
acne.
Body as a Whole: Fluid retention with edema, Stevens-Johnson syndrome,
toxic hepatitis, hypersensitivity reactions,
anaphylaxis, bronchospasm, serum sickness, SLE, angioedema.
Interactions
Drug: oral anticoagulants,
heparin may prolong bleeding time; may increase
lithium and
methotrexate toxicity.
Herbal: Feverfew, garlic, ginger, ginkgo may increase bleeding potential.
Pharmacokinetics
Absorption: 80% from GI tract.
Onset: 1 h (antipyretic).
Peak: 12 h.
Duration: 68 h.
Metabolism: In liver.
Elimination: Primarily in urine; some biliary excretion.
Half-Life: 24 h.
Nursing Implications
Assessment & Drug Effects
- Monitor for therapeutic effectiveness. Optimum response generally occurs within 2 wk (e.g., relief of pain, stiffness, or
swelling; or improved joint flexion and strength).
- Observe patients with history of cardiac decompensation closely for evidence of fluid retention and edema.
- Lab tests: Baseline and periodic evaluations of Hgb, renal and hepatic function, and auditory and ophthalmologic examinations
are recommended in patients receiving prolonged or high-dose therapy.
- Monitor for GI distress and S&S of GI bleeding.
- Note: Symptoms of acute toxicity in children include apnea, cyanosis, response only to painful stimuli, dizziness, and nystagmus.
Patient & Family Education
- Notify physician immediately of passage of dark tarry stools, "coffee ground" emesis, frankly bloody emesis, or
other GI distress, as well as blood or protein in urine, and onset of skin rash, pruritus, jaundice.
- Do not drive or engage in other potentially hazardous activities until response to the drug is known.
- Do not self-medicate with ibuprofen if taking prescribed drugs or being treated for a serious condition without consulting
physician.
- Do not give to children <3 mo or for longer than 2 d without consulting physician.
- Do not take aspirin concurrently with ibuprofen.
- Avoid alcohol and NSAIDs unless otherwise advised by physician. Concurrent use may increase risk of GI ulceration and bleeding tendencies.