What is the recommended dosing for ibuprofen (Nonsteroidal Anti-Inflammatory Drug (NSAID))?

Ibuprofen Dosing Recommendations

The recommended dosing for ibuprofen in adults is 400 to 800 mg every 6 hours with a maximum daily dose of 2400 mg. 1

Adult Dosing Guidelines

Standard Dosing

• Initial dose: 400-600 mg orally every 4-6 hours 1, 2
• Maximum single dose: 800 mg 1
• Maximum daily dose: 2400 mg (do not exceed without medical supervision) 1, 2
• Minimum effective dose: 200 mg (for mild pain) 3

Dosing by Pain Severity

1. Mild pain (NRS 1-4):

   • 200-400 mg every 4-6 hours 1, 3
   • Duration of action: 4-6 hours for 200 mg dose 3

2. Moderate pain (NRS 5-7):

   • 400-600 mg every 6 hours 1
   • Duration of action: at least 6 hours for 400 mg dose 3

3. Severe pain:

   • 800 mg per dose 1
   • Consider alternative or additional analgesics if inadequate relief 1

Special Considerations

Risk Factors Requiring Dose Adjustment

• Elderly patients: Use lowest effective dose due to increased risk of adverse effects 1
• Renal impairment: Avoid or use with caution 1
• Cardiovascular disease: Use lowest effective dose for shortest duration 1
• History of GI bleeding: Consider alternative analgesics or add gastroprotective agents 1

Concomitant Medications

• Aspirin: If taking low-dose aspirin for cardioprotection, take ibuprofen at least 30 minutes after or 8 hours before aspirin to avoid interference with aspirin's antiplatelet effect 1
• Anticoagulants: Avoid combination due to increased bleeding risk 1

Formulation Considerations

• Standard tablets: 200 mg, 400 mg, 600 mg, 800 mg 1
• Solubilized formulations and certain salts (lysine, arginine, potassium) may provide faster onset of action 3

Monitoring and Safety

Common Adverse Effects

• Gastrointestinal: Dyspepsia, abdominal pain (10-20% prevalence) 1
• Cardiovascular: Potential for increased blood pressure and cardiovascular events 1
• Renal: Decreased renal function, especially with prolonged use 1

Risk Mitigation

• Use for shortest duration necessary at lowest effective dose 1
• Consider gastroprotective agents (PPIs or H2 blockers) for patients at high risk of GI complications 1
• Monitor renal function and blood pressure in patients on long-term therapy 1
• Avoid in late pregnancy (6-8 weeks before term) 1

Clinical Pearls

• Ibuprofen has been shown to be more effective than acetaminophen for inflammatory conditions 1
• For acute pain, a 400 mg dose provides better and longer-lasting analgesia than 200 mg 3, 4
• In postoperative pain, the NNT (number needed to treat) for at least 50% pain relief is 2.5 for 400 mg and 2.7 for 200 mg 4
• Short-term use of ibuprofen has a safety profile comparable to acetaminophen at OTC doses 5

Remember that the smallest effective dose should be used for the shortest duration necessary to control symptoms, particularly in patients with risk factors for adverse effects.