Brufen (Ibuprofen) Dosing in Pediatric Patients
The recommended dose of ibuprofen for pediatric patients is 10 mg/kg per dose, administered every 6-8 hours, with a maximum of 3-4 doses in 24 hours (maximum daily dose 30-40 mg/kg). 1, 2
Age-Specific Considerations
Infants Under 6 Months
- Ibuprofen is generally not recommended for infants under 6 months of age. 1
- For infants aged 3-6 months with body weight above 5-6 kg, short-term use may be considered safe when special attention is given to hydration, using 5-10 mg/kg per dose. 3
- Acetaminophen is the preferred analgesic for infants under 3 months. 1
Children 6 Months and Older
- Standard dosing is 10 mg/kg per dose, given every 6-8 hours. 1, 2
- Each dose must be separated by at least 6 hours, though 8-hour intervals are acceptable. 2
- Maximum frequency is 3-4 doses per 24 hours. 2, 4
Children Over 40 kg
- These children should receive adult dosing regimens. 1
Route of Administration
- Oral administration is strongly preferred as it provides more reliable and consistent absorption. 1
- Rectal administration has erratic absorption and should be avoided, particularly in young infants. 3
- Intravenous ibuprofen exists but is not commonly used for routine pain management in children. 4
Dosing Intervals and Maximum Doses
- The dosing interval is every 6-8 hours, which is longer than acetaminophen's 4-6 hour interval. 1
- Maximum total daily dose is 30-40 mg/kg when using 5-10 mg/kg per dose administered 3-4 times daily. 3
- The maximum reduction in temperature occurs 3-4 hours after administration. 5
Clinical Efficacy
- The effective dose range is 7.5-10 mg/kg based on clinical trials. 5
- A linear dose-response relationship exists, with 10 mg/kg doses producing maximum serum concentrations of 25-53 micrograms/mL. 6
- Ibuprofen has been shown to be equally or more effective than acetaminophen with a longer duration of action. 5
Safety Considerations
Hydration Status
- Special attention must be given to the child's hydration status, particularly in infants 3-6 months old. 3
- If the child shows decreased feeding, activity, or signs of dehydration, immediate medical assessment is required. 2
Dosing Errors
- Parents frequently misdose antipyretics, with 51% giving inaccurate doses in one study (26% for ibuprofen specifically). 7
- Infants under 1 year are at higher risk for receiving inaccurate doses. 7
- Caregivers should be explicitly instructed to base dosing on weight, not age, as weight-based dosing reduces misdosing errors. 7
- All dose times should be carefully recorded to avoid exceeding the maximum recommended dose. 8
Duration of Use
- If fever or symptoms persist beyond 48-72 hours without improvement, medical evaluation is necessary. 2
- Ibuprofen is better tolerated by children than adults and is safer in overdose than acetaminophen or aspirin. 5
Combination Therapy
- When alternating with acetaminophen, give acetaminophen every 4-6 hours and ibuprofen every 6-8 hours, staggering timing so medications are given every 3-4 hours if both are needed. 1
- Combined therapy provides an additional 2.5 hours without fever over 24 hours compared to ibuprofen alone, and 4.4 hours compared to acetaminophen alone. 8
- However, the risk of inadvertently exceeding maximum recommended doses increases with combination therapy. 8