What is the recommended dosing for ibuprofen (nonsteroidal anti-inflammatory drug) for pain relief?

Ibuprofen Dosing for Pain Relief

For pain relief in adults, ibuprofen should be dosed at 400 mg every 4-6 hours as needed, not exceeding 2400 mg per day. 1

Standard Dosing Recommendations

Adult Dosing

• For mild to moderate pain:
  • 400 mg every 4-6 hours as needed 1
  • Maximum daily dose: 2400 mg (FDA recommended) 1
  • Maximum FDA-approved daily dose: 3200 mg (for severe conditions like rheumatoid arthritis) 1

Formulations

• Available as tablets: 200 mg, 400 mg, 600 mg, 800 mg 2
• Also available as modified-release tablets and topical gels 2

Pain-Specific Dosing

Acute Pain Management

• Mild pain (NRS 1-4): Ibuprofen 400-600 mg orally every 4-6 hours 2
• Moderate pain: 400-800 mg every 6 hours 2
• Postoperative pain: 400 mg provides better pain relief than 200 mg with longer duration of action (6 hours vs 4-6 hours) 3

Migraine Pain

• For mild to moderate migraine attacks: 400-800 mg every 6 hours 2
• Maximum initial dose: 800 mg 2
• Avoid taking more than 2400 mg per day 2

Clinical Efficacy Considerations

• The smallest clinically effective dose is 200 mg 4
• 400 mg dose provides superior efficacy compared to 200 mg:
  • 54% of patients achieve at least 50% pain relief with 400 mg vs 46% with 200 mg 3
  • Median time to remedication: 5.4 hours with 400 mg vs 4.7 hours with 200 mg 3
• Clear dose-response relationship exists between 50-400 mg doses 4

Special Considerations

Cautions and Contraindications

• GI and renal toxicity: Use with caution in patients with history of GI bleeding or renal impairment 2
• Contraindicated in: Aspirin/NSAID-induced asthma 2
• Cardiovascular risk: Slightly higher risk of CV events with long-term use compared to some other analgesics 5

Combination Therapy

• Combining ibuprofen with acetaminophen (paracetamol) provides better analgesia than either drug alone 6
  • Ibuprofen 400 mg + acetaminophen 1000 mg is particularly effective 6
• For moderate to severe pain, may be combined with WHO level I medications 2

Pediatric Dosing

• 10 mg/kg every 8 hours orally 2
• 10-15 mg/kg every 6-8 hours (for postoperative pain) 2

Common Pitfalls to Avoid

1. Exceeding maximum daily dose: Never exceed 3200 mg daily, with 2400 mg being the recommended maximum for most pain conditions 1

2. Prolonged use without GI protection: For extended use, consider gastric protection, especially in high-risk patients 2

3. Aspirin interaction: May interfere with the antiplatelet effects of aspirin in patients taking it for cardiovascular protection 5

4. Inadequate dosing: The 400 mg dose is generally more effective than 200 mg for most pain conditions 3

5. Failure to consider formulation: Soluble formulations and certain salts (lysine, arginine, potassium) may provide faster onset of action 4

Remember to use the lowest effective dose for the shortest duration consistent with individual treatment goals to minimize potential adverse effects.