Ibuprofen Dosing in Pediatric Patients
For pediatric patients, ibuprofen should be dosed at 5-10 mg/kg per dose, administered every 6-8 hours, with a maximum of 3-4 doses per day (not exceeding 30-40 mg/kg/day total). 1
Age-Specific Dosing Guidelines
Infants 3-6 Months of Age
- Ibuprofen is safe for short-term use in infants older than 3 months with body weight above 5-6 kg, provided special attention is given to hydration status. 1
- Dose: 5-10 mg/kg per dose, administered every 6-8 hours 1
- Maximum daily dose: 30-40 mg/kg divided into 3-4 doses 1
- Avoid rectal administration in young infants due to erratic absorption. 1
Children 6 Months to 12 Years
- Dose: 5-10 mg/kg per dose 1, 2
- Optimal effective dose range: 7.5-10 mg/kg 2
- Dosing interval: Every 6-8 hours (maximum 3 doses per 24 hours) 3
- Maximum daily dose: 30-40 mg/kg 1
Children Over 40 kg
- Transition to adult dosing: 200-400 mg per dose 3
- Maximum daily dose: 1200 mg for over-the-counter use 2
Clinical Pharmacology Considerations
Onset and Duration of Action
- Maximum temperature reduction occurs 3-4 hours after administration. 2
- Peak plasma concentration (Cmax): 17-53 mcg/mL depending on dose 4
- Time to peak effect (Tmax): 1.1-1.2 hours 4
- Elimination half-life: 1.3-1.6 hours 5, 4
Pharmacokinetic Properties
- Ibuprofen pharmacokinetics in children are similar to adults, with linear dose-response relationship over the 5-10 mg/kg range. 2
- Clearance: 1.2-1.4 mL/min/kg 4
- Pharmacokinetics are not affected by age between 3 and 10 years 4
Comparative Efficacy
Versus Paracetamol (Acetaminophen)
- Ibuprofen provides longer duration of antipyretic action compared to paracetamol. 2
- Combined therapy (ibuprofen + paracetamol) provides 4.4 hours additional time without fever over 24 hours compared to paracetamol alone 3
- Combined therapy provides 2.5 hours additional time without fever compared to ibuprofen alone 3
- Ibuprofen monotherapy should be used first-line; consider adding paracetamol only if the benefit of 2.5 extra hours without fever outweighs the risk of inadvertently exceeding maximum recommended doses. 3
Safety Profile
General Safety
- Ibuprofen is better tolerated by children than adults and is safer in overdose than paracetamol or aspirin. 2
- No drug-related adverse events were reported in infants 1-6 months receiving IV ibuprofen 10 mg/kg every 6 hours 5
- Adverse effects are similar to other NSAIDs but occur less frequently in pediatric populations 2
Critical Safety Considerations
- Ensure adequate hydration before and during ibuprofen administration, especially in infants 3-6 months. 1
- Minimum body weight: 5-6 kg for safe use 1
- If using combination therapy with paracetamol, carefully record all dose times to avoid exceeding maximum recommended doses (8% exceeded paracetamol maximum, 11% exceeded ibuprofen maximum in one study). 3
Common Pitfalls to Avoid
- Do not use rectal ibuprofen in young infants due to unreliable absorption 1
- Do not dose based on age alone—always calculate dose based on body weight using mg/kg 1, 2
- When using combination therapy, parents must track dosing times meticulously to prevent overdosing either medication 3
- Most efficacy data derive from fever studies; evidence for pain management in young infants requires further investigation 1