No, Motrin (ibuprofen) should NOT be given for subdural hematoma
Subdural hematoma is an absolute contraindication to NSAIDs like Motrin (ibuprofen) due to the risk of hematoma expansion and worsening bleeding. 1
Why NSAIDs Are Contraindicated
All antiplatelet agents, including NSAIDs, must be discontinued immediately when subdural hematoma is present or suspected, as they impair platelet function and increase bleeding risk 1
NSAIDs like ibuprofen inhibit platelet aggregation through COX-1 inhibition, which can promote hematoma expansion during the critical first 12-36 hours when 30-40% of intracranial hemorrhages naturally expand 1
Recent central nervous system bleeding is classified as an absolute contraindication to medications that affect hemostasis, and this prohibition applies to all clinical situations 1
Acute Management Priorities for SDH
Discontinue all antiplatelet and anticoagulant medications for at least 1-2 weeks during the acute period after subdural hematoma diagnosis 1, 2
Immediate Actions:
- Stop all antiplatelet agents (aspirin, NSAIDs, clopidogrel) and anticoagulants immediately 1, 2
- Reverse any existing coagulopathy with appropriate agents (vitamin K, prothrombin complex concentrate, fresh frozen plasma) 1, 2
- Monitor for hematoma expansion with serial imaging, as elevated coagulation parameters are associated with larger hematoma volumes and worse outcomes 1, 2
Alternative Pain Management
For pain control in patients with subdural hematoma:
- Acetaminophen (Tylenol) is the preferred analgesic as it does not affect platelet function 3
- Opioid analgesics may be used if acetaminophen is insufficient, though they require careful monitoring for sedation and respiratory depression 3
- Avoid all NSAIDs (ibuprofen, naproxen, ketorolac) and aspirin-containing products 1, 3
Critical Pitfalls to Avoid
- Do not assume "just one dose" of ibuprofen is safe - even single doses can impair platelet function for 24-48 hours and increase bleeding risk during the vulnerable expansion period 1
- Patients may not realize over-the-counter combination products contain NSAIDs or aspirin - specifically counsel them to check all medication labels 3
- The antiplatelet effect of NSAIDs persists beyond the analgesic effect, so timing of last dose matters when assessing bleeding risk 1