Ibuprofen

Non-steroidal anti-inflammatory drugs (NSAIDs)

ATC code: M01AE01 (Ibuprofen)

Mechanism of action

Non-selectively inhibits cyclooxygenase COX-1 and COX-2, reducing prostaglandin synthesis responsible for pain, inflammation, and fever. Analgesic effect begins within 30–60 minutes. Anti-inflammatory effect builds over the first week of regular use.

Indications

Fever

First line

Ibuprofen is a first-line antipyretic alongside paracetamol. Adult single dose is 200–400 mg. In children the dose is 5–10 mg/kg. Antipyretic effect lasts 6–8 hours, longer than paracetamol.

Mild to moderate pain in adults

First line

Ibuprofen 200–400 mg every 6–8 hours is one of the most studied NSAIDs for mild to moderate pain. Maximum OTC daily dose is 1200 mg, up to 2400 mg under medical supervision. Superior to paracetamol for inflammatory pain. Taking with food reduces dyspepsia risk.

Osteoarthritis

First line

NSAIDs are first-line in osteoarthritis when paracetamol provides insufficient relief. Ibuprofen is prescribed at the lowest effective dose for the shortest duration. Patients with GI risk factors receive a concomitant PPI.

Migraine

Second line

Ibuprofen 400 mg is an option for mild to moderate migraine attacks. Take as early as possible after headache onset. Less effective than triptans in severe attacks.

Practical notes

Timing and administration

Take with or after food. Swallow with a full glass of water. Remain upright for 10–15 minutes after the dose to reduce esophageal irritation risk. Maintain at least 6-hour intervals between doses.

Special situations

Ibuprofen can attenuate the cardioprotective effect of low-dose aspirin. If the patient takes aspirin for CV prevention, ibuprofen should be taken at least 30 minutes after aspirin or 8 hours before it. Ibuprofen is contraindicated in patients with aspirin-exacerbated respiratory disease.

Safety

Contraindications

Active peptic ulcer disease or GI bleeding
Severe renal impairment (eGFR below 30)
Severe heart failure (NYHA III–IV)
Third trimester of pregnancy
Aspirin-exacerbated respiratory disease (aspirin triad)

Serious adverse effects

GI bleeding, ulcer perforation
Acute kidney injury
Cardiovascular thrombotic events with prolonged high-dose use
Severe cutaneous reactions – Stevens-Johnson syndrome (very rare)

Common adverse effects

Dyspepsia, nausea, epigastric pain
Headache, dizziness
Fluid retention, peripheral edema

PregnancyFDA C

FDA category C in the first and second trimesters. Contraindicated in the third trimester (category D) due to premature ductus arteriosus closure and oligohydramnios. Avoid after 20 weeks.

Breastfeeding

Excreted in breast milk in minimal amounts. Short-term use at standard doses is acceptable during breastfeeding.