What is the recommended dosing for Motrin (ibuprofen)?

Motrin (Ibuprofen) Dosing

For adults, the FDA-approved maximum daily dose is 3200 mg, divided into doses of 400-800 mg every 4-6 hours, though most clinical guidelines recommend not exceeding 2400 mg daily for routine use to minimize cardiovascular, gastrointestinal, and renal risks. 1

Standard Adult Dosing by Indication

Acute Pain (Mild to Moderate)

• 400 mg every 4-6 hours as needed 1
• Maximum single dose: 800 mg 2
• Daily maximum: 2400 mg for routine use 2, 1
• Doses above 400 mg provide no additional analgesic benefit in controlled trials 1, 3

Inflammatory Conditions (Rheumatoid Arthritis, Osteoarthritis)

• 1200-3200 mg daily, divided into 3-4 doses (tid or qid) 1
• Start at 1200 mg daily and titrate upward based on response 1
• The 3200 mg dose should only be used when demonstrable clinical benefit outweighs increased risk 1
• Rheumatoid arthritis typically requires higher doses than osteoarthritis 1

Dysmenorrhea

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

Migraine Headache

• 400-800 mg every 6 hours 2
• Maximum: 2400 mg per day 2

Critical Safety Thresholds

Always use the lowest effective dose for the shortest duration to minimize dose-dependent toxicity risks. 2, 1

Maximum Dosing Limits

• FDA absolute maximum: 3200 mg/day (prescription strength only) 1
• Recommended maximum for most conditions: 2400 mg/day 2, 1
• Over-the-counter maximum: 1200 mg/day 4

Duration Limits

• Acute pain: 5-10 days maximum 2
• Chronic use beyond 2 weeks requires mandatory monitoring every 3 months 2

High-Risk Populations Requiring Dose Reduction or Avoidance

Elderly Patients (>60 years)

• Increased risk of all NSAID-related adverse effects 2
• One-year GI bleeding risk increases from 1 in 2,100 (<45 years) to 1 in 110 (>75 years) 2
• No pharmacokinetic adjustment needed based on age alone 5

Absolute Contraindications

• Perioperative CABG surgery 2
• Aspirin/NSAID-induced asthma 2
• Active gastrointestinal bleeding 2

Use With Extreme Caution

• Renal dysfunction, heart failure, or cirrhosis 2
• History of peptic ulcer disease (5% recurrent bleeding risk within 6 months) 2
• Concurrent anticoagulation (5-6 times increased GI bleeding risk) 2

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

Monitor every 3 months for patients requiring chronic therapy: 2

• Blood pressure 2
• BUN and creatinine 2
• Liver function tests 2
• Complete blood count 2
• Fecal occult blood 2

Discontinuation Criteria

Stop ibuprofen immediately if: 2

• BUN or creatinine doubles
• Hypertension develops or worsens
• Liver function tests exceed normal limits
• Gastrointestinal bleeding occurs

Pediatric Dosing

Weight-Based Dosing

• 10 mg/kg per dose (maximum single dose 400 mg for <40 kg, 800 mg for ≥40 kg) 2
• Children >40 kg: use adult dosing 2
• Liquid formulations preferred for children <40 kg to ensure accurate weight-based dosing 2

Special Pediatric Considerations

• Avoid in Kawasaki disease patients on aspirin (antagonizes antiplatelet effects) 2
• Cystic fibrosis patients (6-17 years, FEV1 >60%): high-dose ibuprofen with mandatory pharmacokinetic monitoring to maintain serum levels 50-100 mg/mL 2

Administration Recommendations

• Take with food or milk if GI complaints occur 1
• Onset of action: 1-3 hours for peak effect 3
• Duration: 6 hours for 400 mg dose, 4-6 hours for 200 mg dose 3
• Therapeutic response in chronic conditions typically seen within 2 weeks 1

Key Clinical Pearls

• Ibuprofen 400 mg is as effective as aspirin 600-900 mg for moderate pain 3
• Superior to acetaminophen for inflammatory conditions (standardized mean difference ~0.3) 2
• Comparable safety to opioids but superior safety profile for back pain 2
• At OTC doses (≤1200 mg/day), ibuprofen has excellent safety profile comparable to acetaminophen 4
• Short plasma half-life and lack of toxic metabolites contribute to favorable safety profile 4