Can ibuprofen (nonsteroidal anti-inflammatory drug) be used to manage symptoms of hand, foot, and mouth disease?

Ibuprofen for Hand, Foot, and Mouth Disease

Ibuprofen is safe and appropriate for managing pain and fever in children with hand, foot, and mouth disease, and should be dosed at 5-10 mg/kg every 6-8 hours (maximum 30-40 mg/kg/day) in children over 3 months of age weighing more than 5-6 kg. 1

Primary Treatment Approach

For symptom management in hand, foot, and mouth disease, treatment should focus on hydration and pain relief using either acetaminophen or ibuprofen. 1

Ibuprofen Dosing and Administration

• Administer ibuprofen at 5-10 mg/kg per dose, given 3-4 times daily, with a maximum total daily dose of 30-40 mg/kg. 2
• The dosing interval of every 6-8 hours provides longer duration of action compared to acetaminophen (which requires dosing every 4 hours). 3
• Ibuprofen is approved for use in children aged 3 months and older with body weight above 5-6 kg. 2
• Avoid rectal administration in young children due to erratic absorption. 2

Safety Considerations Specific to HFMD

Special attention must be given to hydration status before and during ibuprofen use. 2

• Do not administer ibuprofen to children with diarrhea and vomiting, as dehydration plays an important role in triggering renal damage. 4
• This is particularly relevant in hand, foot, and mouth disease where oral intake may be reduced due to painful oral ulcerations. 1
• Ensure adequate hydration before initiating ibuprofen therapy. 2

Contraindications

Ibuprofen should not be given to patients who:

• Are neonates (under 3 months of age). 4
• Have sensitivity to ibuprofen or other NSAIDs. 4
• Have wheezing, persistent asthma, or active varicella infection. 4
• Are dehydrated or have ongoing vomiting and diarrhea. 4

Comparative Efficacy

• Ibuprofen has been shown to be at least as effective as acetaminophen for analgesia and more effective as an antipyretic in pediatric populations. 3
• The longer duration of action (6-8 hours vs 4 hours) makes ibuprofen a suitable alternative to acetaminophen for managing the painful oral ulcerations characteristic of hand, foot, and mouth disease. 3

Safety Profile in Short-Term Use

• Short-term use of ibuprofen in children over 3 months is considered safe with a good safety profile comparable to acetaminophen. 2, 5
• Gastrointestinal events are rare in pediatric populations when ibuprofen is used appropriately with correct dosing. 4
• At over-the-counter doses (which are appropriate for HFMD management), ibuprofen has low risk of serious GI, renal, or cardiovascular events. 5

What NOT to Use

• Oral lidocaine is not recommended for managing oral pain in hand, foot, and mouth disease. 1
• Antiviral treatment is not available for hand, foot, and mouth disease. 1

Common Pitfalls to Avoid

• Do not use ibuprofen as a routine antipyretic for simple fever—reserve it for inflammatory pain or when fever causes significant distress. 4
• Never administer ibuprofen to children who are dehydrated or have reduced oral intake without first ensuring adequate hydration. 2, 4
• Do not exceed the maximum daily dose of 30-40 mg/kg, as toxicity risk is dose-dependent. 2
• Avoid using ibuprofen in neonates or infants under 3 months of age, as safety data are limited in this population. 2, 4