ibuprofen: clinical use

Prescribing considerations

• Consider gastrointestinal, renal, cardiovascular, hepatic, respiratory and bleeding risks, particularly in older people.
• Avoid concurrent NSAIDs and review relevant interacting therapies.
• Maintain adequate hydration where renal hypoperfusion is a concern. Ibuprofen may mask fever and pain associated with infection.
• Adult intravenous ibuprofen is reserved for hospital use when other routes are unsuitable.
• Pedea requires echocardiographic confirmation and neonatologist supervision.

Contraindications and cautions

• Hypersensitivity to ibuprofen or an NSAID-associated history of asthma, rhinitis, angioedema or urticaria.
• Active or recurrent peptic ulcer or haemorrhage, or previous NSAID-related gastrointestinal bleeding or perforation.
• Severe renal, hepatic or heart failure for selected systemic products.
• Last trimester of pregnancy for systemic products.
• Topical gel must not be applied to broken or damaged skin; the selected gel is contraindicated in pregnancy and lactation.
• Pedea: life-threatening infection, active bleeding, thrombocytopenia or coagulation defects, significant renal impairment, duct-dependent congenital heart disease, or suspected necrotising enterocolitis.

Monitoring

• Assess for gastrointestinal bleeding, renal deterioration, fluid retention, blood-pressure change and hypersensitivity where clinically indicated.
• Consider renal function monitoring with renin–angiotensin system inhibitors or diuretics, especially in older or dehydrated patients.
• Monitor infection progression when used for infection-associated pain or fever.
• For Pedea, monitor renal and gastrointestinal function, urine output, bleeding, oxygenation and interacting aminoglycoside concentrations.

Clinical pharmacology

Ibuprofen is a non-selective cyclo-oxygenase inhibitor that reduces prostaglandin synthesis. It has analgesic, anti-inflammatory and antipyretic effects and reversibly inhibits platelet aggregation. Oral ibuprofen is rapidly absorbed and has an elimination half-life of about two hours.

Formulation and product differences

• Selected tablets and caplets are sugar-coated and contain sucrose and sodium.
• Calprofen is a sugar-free, colour-free, strawberry-flavoured oral suspension containing maltitol and preservatives; shake before measurement.
• Ibuleve Maximum Strength Gel is intended for local use on intact skin and has lower systemic exposure than oral ibuprofen.
• The adult infusion is hospital-only, used when other routes are unsuitable, and contains a clinically relevant sodium load.
• Pedea is a distinct neonatal intravenous formulation for significant patent ductus arteriosus in preterm newborns.

Gel

Route: Cutaneous

Strengths: 5%, 5% w/w, 10%, 10% w/w

Solution for infusion

Route: Intravenous

Strengths: 200 mg, 400 mg