What is the recommended dose and usage of ibuprofen (Non-Steroidal Anti-Inflammatory Drug) for pain management?

Recommended Dosage and Usage of Ibuprofen for Pain Management

For adults with pain, ibuprofen should be dosed at 400-800 mg every 6-8 hours, with a maximum daily dose of 2400-3200 mg, using the lowest effective dose for the shortest duration necessary. 1

Dosing Guidelines by Pain Type

Mild to Moderate Pain

• Initial dose: 400 mg every 4-6 hours as needed 1
• Higher doses (600-800 mg) provide no additional benefit for mild to moderate pain 1

Moderate to Severe Pain (Chronic Conditions)

• Rheumatoid arthritis/osteoarthritis: 1200-3200 mg daily divided into 3-4 doses 1
• Typically administered as 400-800 mg three times daily 2
• Response usually observed within 1-2 weeks for chronic conditions 1

Specific Pain Conditions

• Dysmenorrhea: 400 mg every 4 hours at earliest onset of pain 1
• Postoperative pain: 400-800 mg every 6 hours, often as adjunct to opioids 3

Administration Recommendations

Timing and Administration

• Take with meals or milk if gastrointestinal complaints occur 1
• For regular pain control, administer at regular intervals rather than "as needed" 4
• For breakthrough pain, immediate-release formulations should be used 4

Duration of Treatment

• Use for shortest duration consistent with treatment goals 1
• Reassess after 3-5 days; if no improvement after 7 days, consider alternative treatments 2

Safety Considerations

Contraindications

• Absolute contraindications: Active peptic ulcer disease, chronic kidney disease, heart failure 4
• Relative contraindications: Hypertension, history of peptic ulcer disease, concomitant use of corticosteroids or SSRIs 4

Risk Mitigation

• Patients taking NSAIDs should use a proton pump inhibitor for gastrointestinal protection 4
• Monitor for gastrointestinal and renal toxicity, hypertension, and heart failure 4
• Avoid using multiple NSAIDs simultaneously 2
• Patients taking aspirin for cardioprotection should be cautious as ibuprofen may interfere with aspirin's cardioprotective effects 2

Monitoring

• Baseline and periodic monitoring of blood pressure, renal function, and liver function 4
• For long-term use, monitor complete blood count and fecal occult blood 4

Special Populations

Elderly Patients

• Use lower doses and monitor more frequently for adverse effects 4
• Consider gastroprotection with proton pump inhibitor 2

Patients with Hepatic Impairment

• Use with caution in patients with hepatic insufficiency or chronic alcohol abuse 4
• Maximum daily dose should not exceed 4g including "hidden sources" from combination medications 4

Alternative NSAIDs When Ibuprofen Is Not Suitable

• Naproxen: 500 mg twice daily, may be preferred for patients with cardiovascular risk factors 2
• Selective COX-2 inhibitors: Consider for patients at high risk of gastrointestinal complications 2

Comparative Efficacy

• Ibuprofen 400 mg has been shown to be more effective than aspirin or paracetamol in sensitive pain models such as dental pain 5
• Duration of action for ibuprofen 400 mg is at least 6 hours compared to 4-6 hours for ibuprofen 200 mg or paracetamol 5
• At OTC doses (800-1200 mg/day), ibuprofen has a safety profile comparable to paracetamol 6

Remember that ibuprofen's analgesic effects are linked to its anti-inflammatory properties through inhibition of cyclooxygenase enzymes. The optimal dose should balance efficacy with the risk of adverse effects, particularly for long-term use.