What is the recommended dose of ibuprofen (Nonsteroidal Anti-Inflammatory Drug - NSAID) for adults and children?

Ibuprofen Dosing Recommendations

For adults, ibuprofen should be dosed at 400 mg every 4-6 hours as needed for pain relief, not exceeding 2400 mg per day, while children require weight-based dosing of 10 mg/kg per dose every 6-8 hours. 1

Adult Dosing

Standard Acute Pain Management

• 400 mg every 4-6 hours is the optimal dose for acute pain, as controlled trials demonstrate that doses greater than 400 mg provide no additional analgesic benefit 1
• The maximum daily dose is 2400 mg for over-the-counter use and up to 3200 mg for prescription use in chronic inflammatory conditions, though the 3200 mg dose should only be used when demonstrable clinical benefits offset the increased risk 1, 2
• Use the lowest effective dose for the shortest duration necessary to minimize gastrointestinal, cardiovascular, and renal toxicity 1, 2

Condition-Specific Dosing

• For migraine headaches: 400-800 mg every 6 hours, with a maximum of 2400 mg daily 2, 3
• For dysmenorrhea: 400 mg every 4 hours beginning at the earliest onset of pain 1
• For rheumatoid arthritis and osteoarthritis: 1200-3200 mg daily divided into 3-4 doses (400 mg, 600 mg, or 800 mg three or four times daily) 1

Formulation Considerations

• Soluble formulations (lysine, arginine, or potassium salts) provide more rapid onset of relief, particularly beneficial for headache within the first hour 4, 3
• Standard tablets are equally effective by 2 hours 3

Pediatric Dosing

Weight-Based Calculation

• 10 mg/kg per dose is the standard pediatric dosing 5
• Administer every 6-8 hours (maximum 3 doses per 24 hours) 5
• Children weighing more than 40 kg should receive adult dosing 6, 5
• Maximum daily dose: 40 mg/kg/day for children under 40 kg 5

Special Pediatric Population: Cystic Fibrosis

• For children 6-17 years with cystic fibrosis and FEV1 >60% predicted: High-dose ibuprofen to slow lung function decline 6
• Critical requirement: Pharmacokinetic monitoring to maintain serum concentration of 50-100 mg/mL, as subtherapeutic doses may paradoxically worsen inflammation 6
• This indication requires specialized monitoring and should not be attempted without appropriate serum level testing 6

Critical Safety Considerations

High-Risk Populations Requiring Caution or Avoidance

• Patients over 60 years: Increased risk of all NSAID-related adverse effects, particularly GI bleeding (1 in 110 annual risk in those >75 years versus 1 in 2,100 in those <45 years) 2
• History of peptic ulcer disease: 5% risk of recurrent bleeding within 6 months even with protective measures 2
• Concurrent anticoagulant use: 5-6 fold increased GI bleeding risk 2, 7
• Renal impairment, heart failure, or cirrhosis: Use extreme caution or avoid entirely 2

Absolute Contraindications

• Aspirin/NSAID-induced asthma 2
• Perioperative pain in coronary artery bypass graft surgery 2
• Pregnancy after 28 weeks gestation (risk of premature ductus arteriosus closure) 7

Mandatory Monitoring for Long-Term Use (>3 months)

• Blood pressure 2
• BUN and creatinine 2
• Liver function tests 2
• Complete blood count 2
• Fecal occult blood testing 2
• Discontinue immediately if: BUN/creatinine doubles, hypertension develops or worsens, liver function tests exceed normal limits, or GI bleeding occurs 2

Common Pitfalls to Avoid

Drug Interactions

• Do not combine with other NSAIDs (including over-the-counter products like naproxen or aspirin at analgesic doses), as this increases adverse effects without additional benefit 7, 2
• Timing with aspirin for cardioprotection: Take ibuprofen at least 30 minutes after aspirin or at least 8 hours before aspirin to avoid interference with aspirin's antiplatelet effects 7
• Wait at least 4-6 hours after ketorolac before administering ibuprofen 7

Hidden Sources

• Many patients take over-the-counter ibuprofen without informing physicians while on prescription NSAIDs—specifically ask about all OTC medications 7
• Combination products may contain hidden NSAIDs 5

Gastroprotection Strategy

• Co-prescribe a proton pump inhibitor in high-risk patients (age >60, history of ulcer, concurrent anticoagulants) 7, 2
• Buffered or coated formulations do not significantly reduce GI risk 7

Duration of Therapy

• For acute pain: Limit to 5-10 days maximum 2
• If pain persists beyond 2 weeks: Investigate for underlying treatable cause or transition to multimodal approach 2
• For chronic conditions requiring ongoing therapy: Institute mandatory 3-month monitoring protocol 2