What is the appropriate ibuprofen dosing regimen for adults and weight‑based dosing for children, including maximum daily limits and contraindications?

Ibuprofen Dosing

For adults, use 400 mg orally every 6 hours with a maximum daily dose of 1200 mg for mild-moderate pain or 2400 mg for anti-inflammatory effects; for children, use weight-based dosing of 5-10 mg/kg per dose every 6 hours, not exceeding 40 mg/kg/day. 1

Adult Dosing

• Standard dose: 400 mg orally every 6 hours 1
• Maximum daily limits:
  • 1200 mg/day for mild-moderate pain 1
  • 2400 mg/day for anti-inflammatory effects 1
• The 400 mg dose provides superior efficacy compared to 200 mg, with duration of action of at least 6 hours versus 4-6 hours for the lower dose 2
• Take with food to improve gastrointestinal tolerability 1

Pediatric Dosing (Weight-Based)

• Dose: 5-10 mg/kg per dose 1, 3
• Frequency: Every 6 hours as needed 1
• Maximum: 30-40 mg/kg/day (not exceeding 2400 mg/day) 3
• Round to nearest available formulation strength 1
• Minimum age: 3 months and body weight >5-6 kg 3
• Avoid rectal route due to erratic absorption in young infants 3

Practical Example

For a 39 kg child: 5-10 mg/kg = 195-390 mg per dose, rounded to 400 mg every 6 hours 1

Absolute Contraindications

• Active peptic ulcer disease or gastrointestinal bleeding 1
• Aspirin/NSAID-induced asthma 1
• Third trimester pregnancy 1

High-Risk Populations Requiring Caution

• Cardiovascular disease or hypertension 1
• Renal impairment or compromised fluid status 1
• Age ≥60 years 4
• History of peptic ulcer disease 4
• Concurrent anticoagulant use (warfarin, heparin) - significantly increases bleeding risk 4
• Concomitant nephrotoxic drugs (cyclosporin, cisplatin) 4
• Thrombocytopenia or bleeding disorders 4

Monitoring Requirements for Chronic Use (>10 days)

Monitor every 3 months: 1

• Blood pressure
• Renal function (BUN, creatinine)
• Liver function tests (alkaline phosphatase, LDH, SGOT, SGPT)
• Complete blood count
• Fecal occult blood

Discontinuation criteria: 1

• BUN or creatinine doubles 1
• Liver function tests increase to 3× upper limit of normal 1
• Development or worsening of hypertension 4
• Gastrointestinal hemorrhage 4

Critical Pitfalls to Avoid

• Do not trial more than 2 NSAIDs sequentially - if two NSAIDs fail, switch to opioid analgesics or non-pharmacologic interventions rather than trying additional NSAIDs 1
• Ensure adequate hydration, especially in infants and elderly 3
• Screen for over-the-counter NSAID use, as patients often take additional NSAIDs without disclosure 5
• Do not combine with other NSAIDs - provides no additional benefit but significantly increases adverse effects 5

Duration of Therapy

• Over-the-counter use: ≤10 days for pain 6
• Prescription doses (1800-2400 mg/day): For chronic inflammatory conditions under medical supervision 7
• Short-term use at OTC doses (600-1200 mg/day) has excellent safety profile comparable to paracetamol 7, 8