Ibuprofen (Advil, Motrin)

Ibuprofen is a pain reliever and fever reducer used to temporarily relieve minor aches and pains due to: headache, toothache, backache, menstrual cramps, the common cold, muscular aches, and minor pain of arthritis. Ibuprofen is also used to temporarily reduce fever.

• Ibuprofen is available under the following different brand names: Advil, Motrin, PediaCare Children's Pain Reliever/Fever Reducer IB, and PediaCare Infant's Pain Reliever/Fever Reducer IB.

Adult and Pediatric Dosage Forms & Strengths

Tablet

• 100mg
• 200mg
• 400mg (Rx)
• 600mg (Rx)
• 800mg (Rx)

Capsule

• 200mg

Tablet, chewable

• 50mg
• 100mg

Oral suspension

• 100mg/5mL
• 40mg/mL

Pain/Fever/Dysmenorrhea

• Over-the-counter (OTC): 200-400 mg taken orally once every 4-6 hours; not to exceed 1.2 g unless directed by a physician
• Prescription: 400-800 mg taken orally or intravenously (IV) once every 6 hours

Inflammatory Disease

• 400-800 mg taken orally once every 6-8 hours; not to exceed 3.2 g/day

Osteoarthritis

• 300 mg, 400 mg, 600 mg, or 800 mg taken orally once every 6-8 hours; not to exceed 3.2 g/day
• Monitor for gastrointestinal (GI) risks

Rheumatoid Arthritis

• 300 mg, 400 mg, 600 mg, or 800 mg taken orally once every 6-8 hours; not to exceed 3200 mg/day
• Monitor for GI risks

• Significantly impaired renal function: Monitor closely; consider reduced dosage if warranted
• Severe hepatic impairment: Avoid use

Pediatric Dose

Fever

• Children 6 months to 12 years: 5-10 mg/kg/dose taken orally once every 6-8 hours; not to exceed 40 mg/kg/day 

Pain

• 4-10 mg/kg/dose taken orally once every 6-8 hours; not to exceed 40 mg/kg/day

Juvenile Idiopathic Arthritis

• 30-50 mg/kg/24hr taken orally once every 8 hours; not to exceed 2.4 g/day

Patent Ductus Arteriosus

• See ibuprofen IV drug monograph

Cystic Fibrosis (Off-label)

• Younger than 4 years: Safety and efficacy not established
• 4 years of age and older: taken orally once every 12 hours, adjusted to maintain serum levels of 50-100 mcg/mL; may slow disease progression in younger patients with mild lung disease

• The potential toxic dose in children younger than 6 years: 200 mg/kg

Common side effects of ibuprofen include:

• Dizziness 
• Stomach and abdominal pain
• Heartburn
• Constipation
• Nausea
• Rash
• Ringing in the ears
• Swelling (edema)
• Fluid retention
• Headache
• Vomiting
• Skin peeling
• Sun sensitivity (photosensitivity reactions)

Serious side effects of ibuprofen include:

• Acute renal failure
• Agranulocytosis
• Aplastic anemia
• Erythematous macular rashes
• Hemolytic anemia (with or without positive direct antiglobulin test results)
• Neutropenia
• Thrombocytopenia (with or without rash)
• Toxic epidermal necrolysis (Lyell syndrome)

This document does not contain all possible side effects and others may occur. Check with your physician for additional information about side effects.

If your doctor has directed you to use this medication, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider, or pharmacist first.

Severe Interactions of ibuprofen include: None

Serious Interactions of ibuprofen include:

• apixaban
• aspirin
• aspirin rectal
• aspirin/citric acid/sodium bicarbonate
• benazepril
• captopril
• enalapril
• fosinopril
• ketorolac
• ketorolac intranasal
• lisinopril
• methotrexate
• moexipril
• pemetrexed
• perindopril
• quinapril ramipril
• tacrolimus
• trandolapril

Ibuprofen has moderate interactions with at least 239 different drugs.

Ibuprofen has mild interactions with at least 116 different drugs.

This document does not contain all possible interactions. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you, and share the list with your doctor and pharmacist. Check with your physician if you have health questions or concerns.

Warnings

Cardiovascular risk

Nonsteroidal anti-inflammatory drugs (NSAIDs) may increase the risk of serious cardiovascular thrombotic events, myocardial infarction (MI), and stroke, which can be fatal Risk may increase with duration of use Patients with existing cardiovascular disease or risk factors for such disease may be at greater risk NSAIDs are contraindicated for perioperative pain in the setting of coronary artery bypass graft (CABG) surgery

Gastrointestinal risk

NSAIDs increase the risk of serious GI adverse events, including bleeding, ulceration, and gastric or intestinal perforation, which can be fatal GI adverse events may occur at any time during use and without warning symptoms, Elderly patients are at greater risk for serious GI events

This medication contains ibuprofen. Do not take Advil, Motrin, PediaCare Children's Pain Reliever/Fever Reducer IB, or PediaCare Infant's Pain Reliever/Fever Reducer IB if you are allergic to ibuprofen or any ingredients contained in this drug.

Keep out of reach of children. In case of overdose, get medical help or contact a Poison Control Center immediately.

Contraindications

Absolute

• Aspirin allergy
• Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery
• Preterm infants with untreated proven or suspected infection; bleeding with active intracranial hemorrhage or GI bleed; thrombocytopenia, coagulation defects, proven or necrotizing enterocolitis, significant renal impairment, congenital heart disease where patency or the PDA is necessary for pulmonary or systemic blood flow

Effects of Drug Abuse

None.

Short-Term Effects

• See "What Are Side Effects Associated with Using Ibuprofen?"

Long-Term Effects

• Long-term opioid use may cause secondary hypogonadism, which may lead to sexual dysfunction, infertility, mood disorders, and osteoporosis.
• See "What Are Side Effects Associated with Using Ibuprofen?"

Cautions

Use caution in asthma (bronchial), cardiac disease, congestive heart failure (CHF), hepatic or renal impairment, hypertension. bleeding disorders, duodenal/gastric/peptic ulcer, stomatitis, systemic lupus erythematosus (SLE), ulcerative colitis, upper GI disease, late pregnancy (may cause premature closure of ductus arteriosus).

Long-term administration of NSAIDs may result in renal papillary necrosis and another renal injury; patients at greatest risk include elderly individuals; those with impaired renal function, hypovolemia, heart failure, liver dysfunction, or salt depletion; and those taking diuretics, angiotensin-converting enzyme (ACE) inhibitors, or angiotensin receptor blockers.

• Junior Advil (100 mg): Doses higher than recommended may cause stomach bleeding.
• May cause serious adverse reactions, including exfoliative dermatitis, toxic epidermal necrolysis, Steven's Johnson syndrome reported.
• Children's and Junior Advil (50 mg, 100 mg): May cause severe and persistent sore throat.
• Fever, rash, abdominal pain, nausea, liver dysfunction, and meningitis have occurred in patients with collagen-vascular disease, especially SLE.
• Blurred vision, scotomata, and changes in color vision were reported; discontinue therapy if symptoms occur.
• Platelet aggregation and adhesion may be decreased; monitor patients with coagulation disorders receiving the therapy.
• The risk of hyperkalemia may increase in patients with diabetes, the elderly, renal disease, or with concomitant use of agents that can induce hyperkalemia including ACE inhibitors; monitor potassium closely.
• May cause drowsiness and dizziness; may impair physical or mental abilities to operate heavy machinery or driving.
• Not for use right before or after heart surgery.

Heart Failure (HF) risk

• NSAIDs have the potential to trigger HF by prostaglandin inhibition that leads to sodium and water retention, increased systemic vascular resistance, and blunted response to diuretics
• NSAIDs should be avoided or withdrawn whenever possible
• AHA/ACC Heart Failure Guidelines; Circulation. 2016; 134

Pregnancy and Lactation

• At or after 30 weeks gestation: Ibuprofen may cause premature closure of ductus arteriosus; avoid during 1st and 3rd trimesters.
• Quebec Pregnancy Registry identified 4705 women who had spontaneous abortions by 20 weeks gestation; each case was matched to 10 control subjects (n=47,050) who had not had spontaneous abortions; exposure to non-aspirin NSAIDs during pregnancy was documented in approximately 7.5% of cases of spontaneous abortions and approximately 2.6% of controls.
• Ibuprofen is excreted into human breast milk at extremely low levels. Ibuprofen has a short half-life and is considered safe in infants in doses much higher than those excreted in breast milk. Ibuprofen is considered the preferred choice for analgesia or inflammation in breastfeeding women (LactMed from NIH).