Yes: Tablet

Nonsteroidal Anti-Inflammatory Agent (NSAID)

Dental: Management of pain and swelling

Medical: Inflammatory diseases and rheumatoid disorders including juvenile rheumatoid arthritis, mild to moderate pain, fever, dysmenorrhea, gout, ankylosing spondylitis, acute migraine headache

B (D in 3rd trimester)

Hypersensitivity to ibuprofen, any component, aspirin, or other nonsteroidal anti-inflammatory drugs (NSAIDs)

Do not exceed 3200 mg/day; use with caution in patients with congestive heart failure, dehydration, hypertension, decreased renal or hepatic function, history of GI disease (bleeding or ulcers), or those receiving anticoagulants; safety and efficacy in children <6 months of age have not yet been established; elderly are a high-risk population for adverse effects from nonsteroidal anti-inflammatory agents. As much as 60% of elderly can develop peptic ulceration and/or hemorrhage asymptomatically.

>10%:

Central nervous system: Dizziness, fatigue

Dermatologic: Rash, urticaria

Gastrointestinal: Abdominal cramps, heartburn, indigestion, nausea

1% to 10%:

Central nervous system: Headache, nervousness

Dermatologic: Itching

Endocrine & metabolic: Fluid retention

Gastrointestinal: Dyspepsia, vomiting, abdominal pain, peptic ulcer, GI bleed, GI perforation

Otic: Tinnitus

<1%: Edema, congestive heart failure, arrhythmias, tachycardia, hypertension, confusion, hallucinations, mental depression, drowsiness, insomnia, aseptic meningitis, erythema multiforme, toxic epidermal necrolysis, Stevens-Johnson syndrome, polydipsia, hot flashes, gastritis, GI ulceration, cystitis, polyuria, neutropenia, anemia, agranulocytosis, inhibition of platelet aggregation, hemolytic anemia, bone marrow suppression, leukopenia, thrombocytopenia, hepatitis, peripheral neuropathy, vision changes, blurred vision, conjunctivitis, dry eyes, toxic amblyopia, decreased hearing, acute renal failure, allergic rhinitis, shortness of breath, epistaxis

Symptoms include apnea, metabolic acidosis, coma, and nystagmus; leukocytosis, renal failure

Management of a nonsteroidal anti-inflammatory drug (NSAID) intoxication is primarily supportive and symptomatic. Fluid therapy is commonly effective in managing the hypotension that may occur following an acute NSAID overdose, except when this is due to an acute blood loss. Seizures tend to be very short-lived and often do not require drug treatment; although, recurrent seizures should be treated with I.V. diazepam. Since many of the NSAIDs undergo enterohepatic cycling, multiple doses of charcoal may be needed to reduce the potential for delayed toxicities.

CYP2C8 and 2C9 enzyme substrate

Increased toxicity: May increase digoxin, methotrexate, and lithium serum concentrations; other nonsteroidal anti-inflammatories may increase adverse gastrointestinal effects

Inhibits prostaglandin synthesis by decreasing the activity of the enzyme, cyclo-oxygenase, which results in decreased formation of prostaglandin precursors

Onset of analgesia: 30-60 minutes

Duration: 4-6 hours

Onset of anti-inflammatory effect: Up to 7 days

Peak action: 1-2 weeks

Absorption: Oral: Rapid (85%)

Time to peak serum concentration: Within 1-2 hours

Protein binding: 90% to 99%

Metabolism: In the liver by oxidation

Half-life: 2-4 hours

End-stage renal disease: Unchanged

Elimination: In urine (1% as free drug); some biliary excretion occurs

Oral:

Antipyretic: 6 months to 12 years: Temperature <102.5°F (39°C): 5 mg/kg/dose; temperature >102.5°F: 10 mg/kg/dose given every 6-8 hours; maximum daily dose: 40 mg/kg/day

Juvenile rheumatoid arthritis: 30-70 mg/kg/24 hours divided every 6-8 hours

<20 kg: Maximum: 400 mg/day

20-30 kg: Maximum: 600 mg/day

30-40 kg: Maximum: 800 mg/day

>40 kg: Adult dosage

Start at lower end of dosing range and titrate upward; maximum: 2.4 g/day

Analgesic: 4-10 mg/kg/dose every 6-8 hours

Adults:

Inflammatory disease: 400-800 mg/dose 3-4 times/day; maximum dose: 3.2 g/day

Analgesia/pain/fever/dysmenorrhea: 200-400 mg/dose every 4-6 hours; maximum daily dose: 1.2 g (unless directed by physician)

Dosing adjustment/comments in severe hepatic impairment: Avoid use

Food: May decrease the rate but not the extent of oral absorption; drug may cause GI upset, bleeding, ulceration, perforation; take with food or milk to minimize GI upset

CBC; occult blood loss and periodic liver function tests; monitor response (pain, range of motion, grip strength, mobility, ADL function), inflammation; observe for weight gain, edema; monitor renal function (urine output, serum BUN and creatinine); observe for bleeding, bruising; evaluate gastrointestinal effects (abdominal pain, bleeding, dyspepsia); mental confusion, disorientation; with long-term therapy, periodic ophthalmic exams

Plasma concentrations >200 mg/mL may be associated with severe toxicity

Drowsiness and dizziness are common; may cause nervousness; may rarely cause insomnia, confusion, hallucinations, or depression

May rarely cause agranulocytosis; use caution with clozapine and carbamazepine; may decrease lithium clearance resulting in an increase in serum lithium levels and potential lithium toxicity; monitor serum lithium levels

No information available to require special precautions

<1% of patients experience dry mouth; NSAID formulations are known to reversibly decrease platelet aggregation via mechanisms different than observed with aspirin. The dentist should be aware of the potential of abnormal coagulation. Caution should also be exercised in the use of NSAIDs in patients already on anticoagulant therapy with drugs such as warfarin (Coumadin®).

If self-administered, use exactly as directed (do not increase dose or frequency); adverse reactions can occur with overuse. Do not take longer than 3 days for fever, or 10 days for pain without consulting medical advisor. Take with food or milk. While using this medication, do not use alcohol, excessive amounts of vitamin C, or salicylate containing foods (curry powder, prunes, raisins, tea, or licorice), other prescription or OTC medications containing aspirin or salicylate, or other NSAIDs without consulting prescriber. Maintain adequate hydration (2-3 L/day of fluids unless instructed to restrict fluid intake). May discolor urine (red/pink). You may experience nausea, vomiting, gastric discomfort (frequent mouth care, small frequent meals, chewing gum, sucking lozenges may help). GI bleeding, ulceration, or perforation can occur with or without pain. Stop taking medication and report ringing in ears; persistent cramping or pain in stomach; unresolved nausea or vomiting; difficulty breathing or shortness of breath; unusual bruising or bleeding (mouth, urine, stool); skin rash; unusual swelling of extremities; chest pain; or palpitations. Pregnancy/breast-feeding precautions: Inform prescriber if you are or intend to be pregnant. Consult prescriber if breast-feeding.

Do not crush tablet

Caplet: 100 mg

Drops, oral (berry flavor): 40 mg/mL (15 mL)

Suspension, oral: 100 mg/5 mL [OTC] (60 mL, 120 mL, 480 mL)

Suspension, oral, drops: 40 mg/mL [OTC]; 50 mg/1.25 mL

Tablet: 100 mg [OTC], 200 mg [OTC], 300 mg, 400 mg, 600 mg, 800 mg

Tablet, chewable: 50 mg, 100 mg

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