Ibuprofen

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

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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

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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.

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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

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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 Oral

Onset 30 min

Peak 1–2 hr

Duration 4–6 hr

Metabolism: Hepatic; T1/2: 1.8–2.5 hr Distribution: Crosses placenta; may enter breast milk Excretion: Urine Adverse effects

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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

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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

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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

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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.