Ibuprofen Dosing in Pediatric Patients
The recommended dose of ibuprofen for pediatric patients is 10 mg/kg per dose every 6-8 hours (maximum 40 mg/kg/day), with dosing starting at 6 months of age for fever/pain management. 1, 2
Standard Dosing by Age and Weight
Infants and Young Children (≥6 months to <12 years)
- 10 mg/kg per dose orally every 6-8 hours 1, 2, 3
- Maximum daily dose: 40 mg/kg/day (not to exceed 3-4 doses per 24 hours) 2, 3
- For children weighing <15 kg: dose based on weight calculation 1
- For children weighing >40 kg: use adult dosing (see below) 2
Adolescents (≥12 years) and Children >40 kg
- 400-600 mg per dose every 6-8 hours 4
- Maximum single dose: 800 mg 4
- Maximum daily dose: 3200 mg (though 2400 mg is typically sufficient) 4
Age-Specific Considerations
Infants 3-6 Months
- Ibuprofen can be used in infants >3 months with body weight >5-6 kg when special attention is given to hydration 3
- Dose: 5-10 mg/kg every 6-8 hours (maximum 30-40 mg/kg/day) 3
- This represents off-label use below 6 months, as FDA approval begins at 6 months 4
Infants <3 Months
Clinical Efficacy Data
Fever Reduction
- Maximum temperature reduction occurs 3-4 hours after administration 5
- 10 mg/kg dose provides superior antipyresis compared to acetaminophen, especially with high fever (≥38.8°C) 5, 6
- Duration of action: 6-8 hours, longer than acetaminophen 5, 7
Comparative Effectiveness
- In head-to-head trials, ibuprofen 10 mg/kg provided 2.5 hours more time without fever over 24 hours compared to acetaminophen 15 mg/kg 7
- Combination therapy (ibuprofen + acetaminophen) provided 4.4 hours more fever-free time than acetaminophen alone and 2.5 hours more than ibuprofen alone 7
Pharmacokinetic Properties
- Time to peak concentration (Tmax): 1.1-1.2 hours 8
- Elimination half-life: 1.6 hours 8
- Oral clearance: 1.2-1.4 mL/min/kg 8
- Linear dose-response relationship exists between 5-10 mg/kg 5, 8
- Pharmacokinetics are not affected by age (3-10 years) or dose (5-10 mg/kg) 8
Route of Administration
- Oral route is preferred (liquid suspension, tablets, or capsules depending on age) 4, 3
- Rectal route is less reliable due to erratic absorption, especially in young infants 3
- May be administered with food or milk to reduce gastrointestinal complaints 4
Safety Profile
General Safety
- Better tolerated in children than adults 5
- Safer in overdose than acetaminophen or aspirin 5
- No difference in adverse effects between ibuprofen monotherapy and combination therapy with acetaminophen 7
Risk of Overdosing
- 8-11% of parents inadvertently exceed maximum recommended doses when using combination therapy 7
- Parents must be counseled to avoid other products containing ibuprofen and to carefully record all dose times 1, 7
Common Pitfalls to Avoid
- Do not use in infants <3 months or those weighing <5-6 kg 2, 3
- Ensure adequate hydration, particularly in young infants 3
- Do not exceed 40 mg/kg/day (approximately 3-4 doses per 24 hours) 2, 3
- Avoid rectal administration in young infants due to unreliable absorption 3
- When using combination therapy with acetaminophen, maintain careful dosing records to prevent exceeding maximum doses of either medication 7
- Do not use for >48-72 hours without medical evaluation if fever persists 7