Drug reference

Ibuprofen

NSAID · Analgesic

Also known as Ibuprofen lysine, Ibuprofen sodium, Nurofen, Advil, Motrin

START

400 mg PO q6h PRN with food

TYPICAL MAX

2,400 mg/day OTC · 3,200 mg/day prescribed

STOP IF

Active GI bleed · severe CKD · 3rd-trimester pregnancy

WATCH

GI symptoms · creatinine · BP

CDSCO approvedJan AushadhiNPPA price-controlledATC M01AE01

Dose laddermg/d

Renal dose adjustmenteGFR mL/min/1.73m²

KDIGO 2024 + manufacturer label

Pharmacokineticsplasma · t hours

ONSET: 30min · analgesic effect
PEAK: 1.5h · Cmax
t½: 2h · plasma t½
DURATION: 6h · single-dose effect

EXCRETION

Hepatic CYP2C9 · <1% renal unchanged

route + CYP

INTERACTIONS

12 major

incl. contraindicated

PREGNANCY

Category C (1st/2nd) → D (3rd: ductal closure, oligohydramnios)

FDA category + note

Top interactionssee all 12 →

AlcoholContraindicatedTextbook-citedKDT 7e · p950
MethotrexateContraindicatedTextbook-citedKDT 7e · p949
CiprofloxacinSevereTextbook-citedKDT 7e · p949
DexamethasoneSevereTextbook-citedKDT 7e · p950

Available in India

66 branded formulations and 420 fixed-dose combinations. Look up specific brands in the Drugs workspace.

Jan Aushadhi — generic available at GoI pharmacies

Mechanism

Ibuprofen exerts its therapeutic effects by reversibly inhibiting cyclooxygenase (COX-1 and COX-2) enzymes. This inhibition prevents the synthesis of prostaglandins, which are key mediators of pain, inflammation, and fever, thereby reducing these symptoms.

Indications

Mild to moderate pain (e.g., headache, dental pain, muscular pain, back pain)FeverInflammation (e.g., osteoarthritis, rheumatoid arthritis)Primary dysmenorrheaMigraine (off-label)Pericarditis (off-label)Symptomatic treatment of rheumatoid arthritisJuvenile arthritisOsteoarthritisPainAnkylosing spondylitisAcute gouty arthritisTendinitisBursitisHeadachePostoperative dental pain and swellingClosure of patent ductus arteriosus in premature infants (injectable formulation)Inflammatory diseasessimple analgesicantipyreticdysmenorrhoearheumatoid arthritismusculoskeletal disorders (especially where pain is prominent)soft tissue injuriesfracturesvasectomytooth extractionpostpartumpostoperatively (to suppress swelling and inflammation)

Dosing

Adult: Oral: For pain/fever, 200-400 mg every 4-6 hours as needed. For inflammatory conditions, 400-800 mg 3-4 times daily. Maximum 3200 mg/day for prescription use, typically 1200 mg/day for OTC use.
Pediatric: Oral: For fever/pain, 5-10 mg/kg/dose every 6-8 hours. Not recommended for infants less than 6 months of age. Maximum 40 mg/kg/day.
Renal adjustment: CrCl 30-60 mL/min: Use with caution, consider dose reduction and close monitoring. CrCl <30 mL/min: Avoid use due to increased risk of renal toxicity.
Hepatic adjustment: Use with caution in mild to moderate hepatic impairment. Consider dose reduction. Avoid in severe hepatic failure.
Geriatric: Start with lower doses (e.g., 200 mg) and titrate cautiously due to increased risk of GI, renal, and cardiovascular adverse effects. Monitor renal function and fluid status closely.
Max dose: Adults: 3200 mg/day (prescription); 1200 mg/day (OTC). Pediatric: 40 mg/kg/day.

Pharmacokinetics

Onset

30-60 minutes

Peak effect

1-2 hours (oral)

Duration

4-6 hours

Half-life

1.8-2.5 hours

Bioavailability

80-100% (oral)

Protein binding

>90% (primarily to albumin)

Metabolism

Extensive hepatic metabolism via oxidation (primarily CYP2C9 and CYP2C8) and conjugation to inactive metabolites.

Excretion

Primarily renal excretion as inactive metabolites

Contraindications

Hypersensitivity to ibuprofen, aspirin, or other NSAIDs
Active gastrointestinal bleeding or peptic ulcer disease
Severe renal impairment (CrCl <30 mL/min)
Severe hepatic impairment
Severe uncontrolled heart failure
Third trimester of pregnancy
Coronary artery bypass graft (CABG) surgery (peri-operative pain)
Patients who develop ocular disturbances should discontinue the use of ibuprofen and have an ophthalmic evaluation.
pregnant women
peptic ulcer patients

Side effects

Common

NauseaDyspepsiaHeartburnAbdominal painDiarrheaConstipationHeadacheDizzinessRashFluid retentionGI side effects (5% to 15% of patients)Rashes (3%–9%)Headache (1%–3%)Dizziness (3%–9%)Fluid retention (1%–3%)Edema (1%–3%)gastric discomfortvomitingblurring of visiontinnitusdepressionrashesitching

Serious

Gastrointestinal bleeding or perforation
Renal impairment or acute kidney injury
Cardiovascular thrombotic events (e.g., MI, stroke)
Severe cutaneous adverse reactions (e.g., SJS, TEN)
Anaphylactic reactions
Exacerbation of asthma
Hepatotoxicity
Hypertension
Thrombocytopenia (<1%)
Blurred vision (<1%)
Toxic amblyopia (<1%)
gastric erosion (rare)
occult blood loss (rare)
precipitation of aspirin-induced asthma

Pregnancy & lactation

Pregnancy

Category C (1st/2nd) → D (3rd: ductal closure, oligohydramnios)

Lactation

Excreted in breast milk in very small amounts. Generally considered compatible with breastfeeding at usual doses. Monitor infant for any adverse effects.