What is the recommended dosage of ibuprofen (Nonsteroidal Anti-Inflammatory Drug)?

Ibuprofen Dosage Recommendations

For acute pain, use 400 mg orally every 4-6 hours, with a maximum daily dose of 3200 mg, though most patients achieve adequate relief without exceeding 2400 mg/day. 1

Standard Dosing by Indication

Acute Pain (Mild to Moderate)

• 400 mg every 4-6 hours is the recommended dose for acute pain relief 1
• Doses greater than 400 mg in controlled trials showed no additional benefit over the 400 mg dose 1
• The 400 mg dose provides approximately 6 hours of pain relief, compared to 4-6 hours with 200 mg 2
• Maximum daily dose: 3200 mg, though use the lowest effective dose for the shortest duration 1

Chronic Inflammatory Conditions (Rheumatoid Arthritis, Osteoarthritis)

• 1200-3200 mg daily divided into 3-4 doses (400 mg, 600 mg, or 800 mg tid or qid) 1
• Rheumatoid arthritis patients typically require higher doses than osteoarthritis patients 1
• While 3200 mg/day is approved, patients on this dose did not show significantly better mean response compared to 2400 mg/day in controlled trials 1
• Therapeutic response may be seen within days to a week, but most often by two weeks 1

Dysmenorrhea

• 400 mg every 4 hours starting at the earliest onset of pain 1

ICU/Critical Care Settings

• 400-800 mg IV every 6 hours (infused over >30 minutes), maximum 3.2 g/day 3
• 400 mg PO every 4 hours, maximum 2.4 g/day 3

Pediatric Dosing

• 10 mg/kg every 8 hours in children 4

Critical Safety Considerations and Contraindications

Absolute Contraindications

• Active peptic ulcer disease 5
• Perioperative pain in coronary artery bypass graft surgery 3
• Severe renal impairment (creatinine clearance <10 mL/min) 5

High-Risk Populations Requiring Caution

Gastrointestinal Risk:

• Patients over 60 years, history of peptic ulcer, or significant alcohol consumption require monitoring 4
• The one-year risk of serious GI bleeding ranges from 1 in 2,100 in adults <45 years to 1 in 110 in adults >75 years 3
• Stop ibuprofen immediately if GI bleeding or peptic ulcer develops 4
• Consider combining with a proton pump inhibitor in high-risk patients 3

Cardiovascular Risk:

• Use extreme caution in patients with pre-existing cardiovascular disease, congestive heart failure, or hypertension 5
• Use the lowest effective dose for the shortest duration to minimize cardiovascular risk 5
• Critical timing issue: For patients taking low-dose aspirin for cardioprotection, take ibuprofen at least 30 minutes after immediate-release aspirin or at least 8 hours before aspirin to avoid interference with aspirin's antiplatelet effects 5

Renal Risk:

• Patients over 60 years, compromised hydration status, or interstitial nephritis are at high risk 4
• Stop ibuprofen if urea or creatinine doubles or if hypertension develops or worsens 4
• Avoid in patients with severe renal impairment without close monitoring 5

Geriatric Patients:

• Start with lower doses in adults >60 years due to increased risk of adverse effects 5
• Acetaminophen may be preferred as first-line therapy in this population 5

Hepatic Impairment:

• Use lower doses in patients with liver disease 5

Common Pitfalls to Avoid

• Never combine ibuprofen with other NSAIDs - this increases risk without providing additional benefit 5
• Avoid prolonged use without reassessing benefits and risks 5
• Do not use in patients with severe renal impairment or heart failure without close monitoring 5
• Never ignore the aspirin interaction in patients taking aspirin for cardioprotection 5
• Avoid NSAIDs in patients with renal dysfunction, active GI bleeding, platelet abnormalities, concomitant ACE inhibitor therapy, cirrhosis, or asthma 3

Administration Considerations

• If gastrointestinal complaints occur, administer with meals or milk 1
• Solubilized formulations and certain salts (lysine, arginine, potassium) have enhanced onset of activity 2
• The 200 mg dose is the smallest clinically useful dose, with 46% of patients achieving at least 50% pain relief 6
• The 400 mg dose provides 54% of patients with at least 50% pain relief 6