ibuprofen

ibuprofen

(eye byoo' proe fen)

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

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; T_1/2: 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 ACE 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, LFTs, renal 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.

·        WARNING: 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.

·        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.

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