What is the dose of prescription ibuprofen (Nonsteroidal Anti-Inflammatory Drug, NSAID)?

Prescription Ibuprofen Dosing Guidelines

The standard prescription dose of ibuprofen is 400 to 800 mg every 6 hours, with a maximum initial dose of 800 mg and a maximum daily dose of 2400 mg. 1

Dosing Algorithm for Prescription Ibuprofen

Standard Adult Dosing

• Rheumatoid arthritis and osteoarthritis:

  • 1200 mg to 3200 mg daily (400 mg, 600 mg, or 800 mg three or four times daily)
  • Maximum daily dose: 3200 mg 2
  • Note: While 3200 mg is FDA-approved, clinical guidelines typically recommend not exceeding 2400 mg daily for safety 1

• Mild to moderate pain:

  • 400 mg every 4 to 6 hours as necessary
  • Higher doses (600-800 mg) may be used but show no greater efficacy than 400 mg in controlled analgesic trials 2

• Dysmenorrhea:

  • 400 mg every 4 hours as needed, beginning with earliest onset of pain 2

Acute Pain Management

• For acute pain in emergency settings, 400 mg, 600 mg, and 800 mg doses have shown similar analgesic efficacy, suggesting that the 400 mg dose may be sufficient for most acute pain scenarios 3

Special Considerations

Migraine Treatment

• For migraine headaches: 400 to 800 mg every six hours
• Maximum initial dose: 800 mg
• Avoid exceeding 2.4 g per day 1

Acute Gouty Arthritis

• Higher doses (2400 mg daily) have shown effectiveness with complete resolution within 72 hours 4

Safety Considerations

Administration Guidelines

• Administer with meals or milk if gastrointestinal complaints occur 2
• Use the lowest effective dose for the shortest duration consistent with treatment goals 2
• After initial response, adjust dose and frequency to suit individual patient needs 2

Contraindications

• Aspirin/NSAID-induced asthma 1
• History of GI bleeding or ulceration
• Severe heart failure
• Third trimester of pregnancy

Common Adverse Effects

• Dizziness
• Rash
• Gastrointestinal upset 1

Cardiovascular Risk

• Ibuprofen may slightly increase cardiovascular risk with long-term use, though generally lower than with some COX-2 inhibitors and diclofenac 5
• May potentially interfere with the antiplatelet effects of aspirin, requiring caution in patients taking aspirin for cardiovascular protection 5

Comparative Efficacy

• Ibuprofen 400 mg has been shown to be as effective as aspirin 600 or 900 mg in moderate pain models
• Duration of action for ibuprofen 400 mg is at least 6 hours compared to 4-6 hours for ibuprofen 200 mg or paracetamol 6
• In emergency department settings, there is no significant difference in pain reduction between 400 mg, 600 mg, and 800 mg doses at 60 minutes 3

Practical Prescribing Tips

• For most acute pain conditions, starting with 400 mg is reasonable as higher doses do not necessarily provide better analgesia 3
• For chronic inflammatory conditions like rheumatoid arthritis, higher doses (600-800 mg three to four times daily) may be needed 2
• When transitioning from OTC to prescription strength, remember that prescription ibuprofen typically starts at 400 mg per dose (compared to OTC 200 mg tablets)