ADMINISTRATION ROUTES:
PO, NG
ALTERNATIVE NAMES:
Ibuprofen, Brufen, I-Profen, Nurofen, Panafen, ACT-3, Fenpaed
ICU INDICATIONS:
- Analgesia
PRESENTATION AND ADMINISTRATION:
PO:
Tablets:
Apo-ibuprofen 200 mg (yellow), Brufen 400 mg (white), I-Profen 200 mg, Ibuprofen 200 mg (white), Nurofen 200 mg (white), Panafen 200 mg
Sustained Release Tablets:
Brufen Retard 800 mg
Capsules:
ACT-3 200 mg (green), Nurofen liquid capsules 200 mg
Oral Suspension:
Fenpaed oral suspension 100 mg/5 mL, Nurofen for children 100 mg/5 mL
DOSAGE:
PO/NG:
200 - 400 mg QID
DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY:
Dose in renal impairment
| GFR (ml/min) | DOSE |
|---|---|
| <10 | dose as in normal renal function but avoid unless ESRF |
| 10-20 | dose as in normal renal function but avoid if possible |
| >20-50 | dose as in normal renal function but avoid if possible |
Dose in renal replacement therapy
| MODALITY | DOSE |
|---|---|
| CAPD | dose as in normal renal function |
| HD | dose as in normal renal function |
| CVVHDF | dose as in normal renal function but avoid unless ESRF on long-term dialysis |
DOSAGE IN PAEDIATRICS:
PO:
5-10 mg/kg QID
CLINICAL PHARMACOLOGY:
Ibuprofen is a non-steroidal anti-inflammatory drug
CONTRAINDICATIONS:
- Hypersensitivity to ibuprofen
- The syndrome of nasal polyps, angioedema, and bronchospastic reactivity to aspirin or other nonsteroidal anti-inflammatory agents.
WARNINGS:
Risk of GI Ulceration, Bleeding and Perforation:
Serious gastrointestinal toxicity such as bleeding, ulceration, and perforation, can occur at any time, with or without warning symptoms, in patients treated with nonsteroidal anti- inflammatory drugs.
Bleeding Risk:
Ibuprofen, like other nonsteroidal anti-inflammatory agents, can inhibit platelet aggregation but the effect is quantitatively less and of shorter duration than that seen with aspirin. Ibuprofen has been shown to prolong bleeding time (but within the normal range) in normal subjects. Because this prolonged bleeding effect may be exaggerated in patients with underlying haemostatic defects, ibuprofen should be used with caution in persons with intrinsic coagulation defects and those on anticoagulant therapy.
Renal Effects:
As with other nonsteroidal anti-inflammatory drugs, long-term administration of ibuprofen to animals has resulted in renal papillary necrosis and other abnormal renal pathology. In humans, there have been reports of acute interstitial nephritis with haematuria, proteinuria, and occasionally nephrotic syndrome.
A second form of renal toxicity has been seen in patients with prerenal conditions leading to a reduction in renal blood flow or blood volume, where the renal prostaglandins have a supportive role in the maintenance of renal perfusion. In these patients administration of a nonsteroidal anti-inflammatory drug may cause a dose dependent reduction in prostaglandin formation and may precipitate overt renal decompensation. Patients at greatest risk of this reaction are those with impaired renal function, heart failure, liver dysfunction, those taking diuretics and the elderly.
PRECAUTIONS:
General:
Liver effects
As with other nonsteroidal anti-inflammatory drugs, borderline elevations of one or more liver function tests may occur in up to 15% of patients. These abnormalities may progress, may remain essentially unchanged, or may be transient with continued therapy. Severe hepatic reactions, including jaundice and cases of fatal hepatitis, have been reported with ibuprofen as with other nonsteroidal anti-inflammatory drugs. Although such reactions are rare, if abnormal liver tests persist or worsen, if clinical signs and symptoms consistent with liver disease develop, or if systemic manifestations occur (e.g., eosinophilia, rash, etc.), ibuprofen should be discontinued.
Aseptic Meningitis
Aseptic meningitis with fever and coma has been observed on rare occasions in patients on ibuprofen therapy. Although it is probably more likely to occur in patients with systemic lupus erythematosus and related connective tissue diseases, it has been reported in patients who do not have an underlying chronic disease.
Laboratory Tests:
No tests additional to routine ICU tests are indicated
Drug/Laboratory Test Interactions:
None known
IMPORTANT DRUG INTERACTIONS IN ICU:
Diuretics:
Clinical studies have shown that ibuprofen can reduce the natriuretic effect of furosemide and thiazides in some patients. This response has been attributed to inhibition of renal prostaglandin synthesis. During concomitant therapy with ibuprofen, the patient should be observed closely for signs of renal failure, as well as to assure diuretic efficacy.
Lithium:
Ibuprofen produces an elevation of plasma lithium levels and a reduction in renal lithium clearance in patients on concomitant therapy.
Anticoagulants:
Risk of bleeding is additive with other anticoagulant drugs.
ADVERSE REACTIONS:
Haematologic:
Neutropaenia, agranulocytosis, aplastic anaemia, haemolytic anaemia (sometimes Coombs positive), thrombocytopaenia with or without purpura, eosinophilia
Cardiovascular:
Oedema, palpitations, arrhythmias (sinus tachycardia, sinus bradycardia)
Renal:
Acute renal failure, decreased creatinine clearance, polyuria, azotaemia, cystitis, haematuria, renal papillary necrosis
Gastrointestinal:
Nausea, epigastric pain , heartburn , diarrhoea, abdominal distress, nausea and vomiting, indigestion, constipation, abdominal cramps or pain, fullness of GI tract (bloating and flatulence). Gastric or duodenal ulcer with bleeding and/or perforation, gastritis, hepatitis, jaundice, abnormal liver function tests, pancreatitis
Central Nervous System:
Dizziness, headache, nervousness, depression, insomnia, confusion, emotional lability, somnolence, aseptic meningitis with fever and coma, paraesthesias, hallucinations, dream abnormalities, pseudotumour cerebri
Dermatologic:
Rash (including maculopapular type), pruritus, vesiculobullous eruptions, urticaria, erythema multiform, Stevens-Johnson syndrome, allopecia Toxic epidermal necrolysis, photoallergic skin reactions
Special Senses:
Tinnitus, hearing loss, amblyopia (blurred and/or diminished vision, scotomata and/or changes in colour vision), conjunctivitis, diplopia, optic neuritis, cataracts