What is the recommended dose of Motrin (ibuprofen) for a patient with mild arthritis in the wrist?

Recommended Ibuprofen Dosing for Mild Wrist Arthritis

For mild arthritis in the wrist, start with ibuprofen 400 mg every 4-6 hours as needed, which can be increased to a range of 1200-2400 mg daily in divided doses (400-800 mg three to four times daily) if needed for adequate symptom control. 1

Initial Dosing Strategy

• Begin with 400 mg every 4-6 hours for mild pain, as this is the FDA-approved dose for mild to moderate pain and controlled trials show doses above 400 mg are no more effective for acute pain relief 1
• If symptoms persist or worsen after several days, escalate to 1200-2400 mg daily divided into 3-4 doses (e.g., 400-800 mg three to four times daily), which is the recommended range for osteoarthritis 1
• The maximum daily dose should not exceed 3200 mg, though doses above 2400 mg rarely provide additional benefit and increase risk 1

Duration and Monitoring Considerations

• Use the lowest effective dose for the shortest duration to minimize gastrointestinal, cardiovascular, and renal toxicity 1
• For patients requiring chronic NSAID therapy, limit initial courses to 5-7 days and reassess rather than continuing long-term without evaluation 2
• Take with meals or milk if gastrointestinal complaints occur 1

Risk Assessment and Gastroprotection

If you are over 60 years old, have a history of peptic ulcer disease, consume ≥2 alcoholic beverages daily, or require high-dose/long-term NSAIDs, you need gastroprotection with a proton pump inhibitor (PPI). 3, 2

• Baseline monitoring should include blood pressure, kidney function (BUN/creatinine), liver function tests, CBC, and fecal occult blood 3
• Repeat monitoring every 3 months during chronic use 3
• Discontinue if kidney function doubles, hypertension develops/worsens, or liver enzymes exceed 3 times upper limit of normal 3

Important Caveats

• Avoid combining with other NSAIDs (including aspirin for cardioprotection at anti-inflammatory doses), as this increases risk without additional benefit 2
• For elderly patients ≥75 years, topical NSAIDs are strongly preferred over oral formulations when applicable 4
• If pain persists beyond 2 weeks despite adequate dosing, reassess the diagnosis and consider alternative treatments rather than indefinitely continuing NSAID monotherapy 5
• Assess cardiovascular risk factors, particularly uncontrolled hypertension, before prescribing 4

Dose Titration Approach

• Start at 400 mg every 4-6 hours for the first few days 1
• If inadequate relief, increase to 600-800 mg three times daily (1800-2400 mg/day total) 1
• A therapeutic response is sometimes seen within days but most often by two weeks 1
• Once satisfactory response is achieved, review and adjust to the smallest dose that maintains acceptable control 1