Does Nurofen Lower Fever?
Yes, Nurofen (ibuprofen) effectively lowers fever in both children and adults, and is actually more effective than acetaminophen (paracetamol) at reducing temperature at 2,4, and 6 hours after administration. 1, 2
Evidence for Antipyretic Efficacy
Comparative Effectiveness
Ibuprofen demonstrates superior fever reduction compared to acetaminophen across multiple timepoints, with effect sizes of 0.19 at 2 hours, 0.31 at 4 hours, and 0.33 at 6 hours post-treatment when comparing ibuprofen 5-10 mg/kg to acetaminophen 10-15 mg/kg. 2
Multiple randomized controlled trials and systematic reviews confirm that NSAIDs such as ibuprofen are more effective than placebo for reducing fever in both children and adults with various febrile illnesses. 1
A recent clinical trial in Nigerian children aged 6-59 months found that ibuprofen had a better fever-reducing effect compared to paracetamol, with statistically significant differences in the proportion of afebrile children at 1.5-2.5 hours after administration (p = 0.04). 3
Dosing and Timing
Standard dosing is 10 mg/kg per dose for children, given every 6-8 hours with a maximum of three doses in 24 hours. 4
The antipyretic effect begins within hours of administration, with peak effectiveness typically occurring between 2-6 hours post-dose. 5, 2
Safety Profile
Ibuprofen and acetaminophen have comparable safety profiles when used appropriately for short-term fever management in children and adults. 6, 2, 7
Meta-analysis of 1,820 children found no evidence that ibuprofen differed from acetaminophen or placebo in incidence of minor or major harm. 2
The FDA label notes that ibuprofen's pharmacological activity in reducing fever and inflammation may diminish the utility of diagnostic signs in detecting complications of underlying conditions. 8
Critical Clinical Considerations
Important Caveats
Antipyretics do NOT prevent febrile seizures in children, though they may improve comfort—this is a common misconception among parents. 1, 9
The primary goal should be improving overall comfort rather than normalizing temperature, as fever itself is a physiologic mechanism with beneficial effects in fighting infection. 6
Avoid ibuprofen in patients with aspirin-sensitive asthma, as cross-reactivity including bronchospasm has been reported and can be fatal. 8
When to Avoid Ibuprofen
Do not use in heatstroke, as it may aggravate coagulopathy; physical cooling becomes the primary treatment modality in this setting. 9
Use with caution in patients with coagulation disorders or those receiving anticoagulants, as ibuprofen inhibits platelet aggregation and prolongs bleeding time. 8
Combination Therapy
Evidence suggests that combining ibuprofen and acetaminophen provides an additional 2.5 hours without fever over 24 hours compared to ibuprofen alone, and 4.4 hours compared to acetaminophen alone. 4
However, 8-11% of children exceeded the recommended maximum doses when using combination therapy, raising safety concerns about inadvertent overdosing. 4
If using both medicines, all dose times should be carefully recorded to avoid exceeding maximum recommended doses. 4
Practical Recommendations
For fever management in children who can be managed at home, ibuprofen should be the first-line antipyretic given its superior temperature-reducing efficacy. 1, 2
Monitor the child's overall well-being, activity level, and signs of serious illness rather than focusing solely on temperature normalization. 6
Encourage appropriate fluid intake and emphasize safe storage of antipyretics to parents. 6
Temperature should be monitored after administration to assess response, particularly in patients with temperatures >38°C who may be relatively unresponsive to treatment. 5