What is the recommended dosage and administration schedule for ibuprofen (Non-Steroidal Anti-Inflammatory Drug) when used in conjunction with paracetamol (acetaminophen) for fever management?

Administering Ibuprofen and Paracetamol Together for Fever Management

When managing fever, paracetamol and ibuprofen can be given together, with ibuprofen administered first followed by paracetamol, ensuring proper dosing intervals and careful recording of administration times to avoid exceeding maximum recommended doses. 1, 2

Dosing Schedule and Administration

• Ibuprofen should be given first at a dose of 10 mg/kg every 6-8 hours (maximum of three doses in 24 hours) 2, 3
• Paracetamol can be administered at a dose of 15 mg/kg every 4-6 hours (maximum of four doses in 24 hours) 2
• For adults, ibuprofen can be given at 400 mg every 4-6 hours as needed for pain or fever relief (not exceeding 3200 mg total daily dose) 4
• When using both medications together, carefully record all dose times to avoid accidentally exceeding the maximum recommended dose 2

Evidence for Combined Use

• The combination of paracetamol and ibuprofen provides more time without fever in the first 24 hours compared to either medication alone (additional 4.4 hours versus paracetamol alone and 2.5 hours versus ibuprofen alone) 2
• For the first 4 hours of treatment, using both medicines together is superior to paracetamol alone (providing an additional 55 minutes without fever) 2
• The combination of paracetamol and ibuprofen has been shown to be particularly effective in patients with bacterial fever, showing greater efficacy one hour after administration compared to paracetamol alone 5

Safety Considerations

• Always use the lowest effective dose for the shortest duration consistent with treatment goals 4
• The risk of accidentally exceeding the maximum recommended dose is higher when using two medications, so careful timing and recording of doses is essential 2
• There is no evidence of increased adverse effects when both medications are used together compared to either medication alone 2, 6
• Ibuprofen should be used with caution in patients with:
  • History of gastrointestinal issues 1
  • Renal impairment 1
  • Cardiovascular disease 1

Practical Administration Tips

• For optimal fever management, start with ibuprofen first as it has been found to be marginally more effective in reducing fever 7
• Wait 2-3 hours after giving ibuprofen before administering paracetamol 2
• Both medications can be given together at the same time if fever is particularly high or the patient is experiencing significant discomfort 5, 6
• Keep a written record of when each medication was given to prevent accidental overdosing 2
• Continue this alternating schedule as needed, always ensuring you don't exceed the maximum daily dose for either medication 4, 2

Common Pitfalls to Avoid

• Do not exceed the maximum recommended daily dose of either medication (paracetamol: 4 doses in 24 hours; ibuprofen: 3 doses in 24 hours) 2
• Avoid giving ibuprofen to children with chicken pox or influenza due to the risk of Reye syndrome 1
• Do not use antipyretics with the sole aim of reducing body temperature if the patient is comfortable; treat the symptoms rather than the number on the thermometer 1
• If using flexible dosing for adults with influenza-like symptoms, ensure the total daily dose of ibuprofen doesn't exceed the recommended maximum (3200 mg/day) 4, 8

Remember that fever is typically a short-lived symptom, and both medications should be used judiciously based on the patient's comfort level rather than temperature alone 2, 1.