Can I give Motrin (ibuprofen) to a patient with fever?

Can You Give Motrin (Ibuprofen) for Fever?

Yes, ibuprofen (Motrin) is safe and effective for treating fever in children aged ≥3 months and adults, and should be considered as a first-line antipyretic agent. 1, 2

Age-Specific Recommendations

Infants and Children

• Ibuprofen is approved for use in children ≥3 months of age with body weight above 5-6 kg 3
• Dose: 5-10 mg/kg per dose, administered every 4-6 hours (maximum 3-4 times daily, not exceeding 30-40 mg/kg total daily dose) 1, 3
• The American College of Physicians recommends ibuprofen as first-line treatment when temperature exceeds 38.5°C 1
• Ibuprofen should be used first in young febrile children who can be managed at home 4

Adults

• Standard dosing: 200 mg (0.2g) per dose, every 4-6 hours, maximum 4 times in 24 hours 1

Critical Safety Considerations and Contraindications

Absolute Contraindications

• Never use in neonates (age <3 months) 3, 5
• Contraindicated in children with dehydration, diarrhea, or vomiting - dehydration plays an important role in triggering renal damage 5
• Do not use in children with wheezing, persistent asthma, or during varicella (chickenpox) infection 5
• Avoid in patients with known hypersensitivity to ibuprofen or other NSAIDs 5

Special Populations Requiring Caution

• Children with Kawasaki disease on aspirin therapy: Repeated doses of ibuprofen should be avoided as ibuprofen antagonizes aspirin-induced platelet inhibition in patients taking aspirin for coronary artery thrombosis prophylaxis 6
• Influenza or varicella infections: If a child on long-term aspirin therapy (e.g., for Kawasaki disease) develops influenza or chickenpox, aspirin should be discontinued and ibuprofen can be used as an alternative antipyretic 6

Clinical Effectiveness

Comparative Efficacy

• No substantial difference in safety and effectiveness between acetaminophen and ibuprofen for generally healthy febrile children 2
• Ibuprofen may provide longer duration of fever control: In the first 4 hours, ibuprofen alone was as effective as combined therapy and superior to acetaminophen alone 4
• Combined paracetamol plus ibuprofen provides an additional 2.5 hours without fever over 24 hours compared to ibuprofen alone, but this must be weighed against the risk of inadvertently exceeding maximum recommended doses 4

Important Clinical Principles

Primary Goal of Treatment

• The primary goal should be improving the child's overall comfort rather than normalizing body temperature 2
• Fever itself is a physiologic mechanism with beneficial effects in fighting infection and does not worsen illness course or cause long-term neurologic complications 2
• Maintaining temperature below 38°C is acceptable; much lower body temperature is not conducive to antiviral treatment 1

Hydration and Supportive Care

• Adequate oral hydration should be encouraged (up to 2 liters per day in adults) to prevent dehydration 1
• Special attention must be given to hydration status when prescribing ibuprofen 3
• For persistent fever despite initial antipyretic therapy, consider IV fluids and IV antipyretics in patients unable to tolerate oral intake or showing signs of dehydration 1

Common Pitfalls to Avoid

Dosing Errors

• 8% of children exceeded the recommended maximum number of paracetamol doses and 11% exceeded ibuprofen doses in 24 hours when using combination therapy 4
• If using two antipyretics, all dose times must be carefully recorded to avoid accidentally exceeding maximum recommended doses 4
• Prescribe based on body weight, not age 3

Inappropriate Use

• Ibuprofen should not be used as a routine antipyretic except in rare cases - it remains the drug of first choice for inflammatory pain in children 5
• Most adverse events reported in studies occurred when ibuprofen was used for fever symptoms or flu-like syndrome 5
• The rectal route is less reliable due to erratic absorption, especially in young infants 3

Reye Syndrome Risk

• Never use aspirin in children aged ≤18 years with fever due to risk of Reye syndrome 6
• This is particularly important during influenza or varicella infections 6

When to Reassess

• Patients should begin to improve within 24-48 hours of appropriate treatment 7
• If symptoms worsen or fail to improve within 48-72 hours, reassessment is necessary 7
• Monitor for signs of serious illness and encourage appropriate fluid intake 2
• Over a 5-day period, approximately one-quarter of children are "back to normal" by 48 hours and one-third by day 5 4