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The usual dose by mouth for painful conditions in adults is 1.2 to 1.8 g daily in divided doses although maintenance doses of 600 mg to 1.2 g daily may be effective in some patients. If necessary the dose may be increased; in the UK the maximum recommended dose is 2.4 g daily whereas in the USA it is 3.2 g daily. Modified-release preparations of ibuprofen are available for once- or twice daily dosing, although actual dosages vary with different preparations. Patients with rheumatoid arthritis generally require higher doses of ibuprofen than those with osteoarthritis. The recommended dose for fever reduction in adults is 200 to 400 mg every 4 to 6 hours to a maximum of 1.2 g daily.
In the UK, the following oral doses, according to age, are recommended by the BNFC for the treatment of pain or fever in children:
1 to 6 months, 5 mg/kg 3 or 4 times daily
6 to 12 months, 50 mg 3 times daily
1 to 2 years, 50 mg 3 to 4 times daily
2 to 7 years, 100 mg 3 to 4 times daily
7 years and over, 200 mg 3 to 4 times daily
in severe conditions, a dose of 30 mg/kg daily in 3 or 4 divided doses may be given, provided the child weighs over 7 kg. The usual adult maximum dose (see above) would apply for heavier children.
In the treatment of rheumatic disease including juvenile idiopathic arthritis, the BNFC recommends a dose of 10 mg/kg 3 or 4 times daily in children aged 6 months and over, and weighing more than 7 kg; if necessary up to 60 mg/kg daily in 4 to 6 divided doses may be given in systemic juvenile idiopathic arthritis. Similar dosage regimens are also suggested by licensed drug information; however, ibuprofen use is not generally recommended in children weighing less than 7 kg and some suggest a maximum daily dose of 500 mg in those weighing less than 30 kg. For postimmunisation pyrexia, a dose of 50 mg has been recommended; a second dose may be given after six hours. If the pyrexia persists after the second dose, use medical advice should be sought. Infants aged 2 to 3 months may also be given a 50-mg dose of ibuprofen for post-immunisation pyrexia on the advice of a doctor.
In the USA, suggested doses for children are: for fever, 5 to 10 mg/kg (depending on the severity of the fever) and for pain, 10 mg/kg; doses may be given every 6 to 8 hours up to a maximum daily dose of 40 mg/kg. A usual daily dose in the USA for juvenile idiopathic arthritis is 30 to 40 mg/kg in divided doses. Ibuprofen may be given parenterally for the treatment of patent ductus arteriosus in preterm infants of less than 34 weeks' gestation. It is given as three intravenous doses (infused over 15 minutes) at 24-hour intervals; the initial dose is 10 mg/kg followed by two further doses of 5 mg/kg. If, 48 hours after this course of therapy, the ductus remains open, a second course may be given, but if this produces no response surgery may be necessary. Ibuprofen injection should be given undiluted, but if necessary it may be reconstituted with sodium chloride 0.9% or glucose 5% for injection. Ibuprofen is also applied topically as a 5% cream, foam, gel, or spray solution; a 10% gel is also available. Ibuprofen is usually given as the base but derivatives, including various salts, esters, and other complexes, are also used. These include lysine and sodium salts, guaiacol and pyridoxine esters, and mabuprofen (ibuprofen aminoethanol), isobutanolammonium, and meglumine derivatives.
