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Introduction
  • Ibuprofen possesses analgesic, antipyretic and anti-inflammatory properties. Its mechanism of action is unknown, but is thought to be through peripheral inhibition of cyclo-oxygenases and subsequent prostaglandin synthetase inhibition.
Indications

Primary care guidelines only:

  • Fever (pyrexia), inflammation (anti- inflammatory), and mild to moderate pain (especially where inflammation is present).

Special operations activities only:

  • Fever (pyrexia)
  • Inflammation due to musculoskeletal and soft tissue injury
  • Mild to moderate pain where inflammation is present
Contraindications
  • Known hypersensitivity or idiosyncratic reaction to Ibuprofen or aspirin (or any of the other ingredients in the products) and other NSAIDs 
  • Asthmatic that is aspirin or NSAID sensitive
  • Active gastrointestinal bleeding or peptic ulceration
  • Pregnant patients
  • Medications containing codeine
Precautions / Notes
  • Previous history of GI haemorrhage or ulcers
  • Asthmatics who have not previously taken an NSAID
  • Hepatic, renal or cardiac impairment
  • Age over 65 years due to increased risk of side effects
  • Should not operate heavy machinery or drive if taking codeine.

Drug Interactions:

  • Anticoagulants, including Warfarin (ibuprofen interferes with the stability of INR and may increase risk of severe bleeding and sometimes fatal haemorrhage, especially from the gastrointestinal tract. Ibuprofen should only be used in patients taking Warfarin if absolutely necessary and they must be closely monitored)
  • Ibuprofen may decrease renal clearance and increase plasma concentration of lithium
  • Ibuprofen may reduce the anti-hypertensive effect of ACE inhibitors, beta-blockers and diuretics and may cause natriuresis and hyperkalemia in patients under these treatments
  • Ibuprofen reduces methotrexate clearance
  • Ibuprofen may increase plasma levels of cardiac glycoside
Management

Give tablets orally, with water to swallow

Ibuprofen 200mg (Nurofen)

Adults and children over 12 years of age:

  • Initial dose: 2 tablets, then 1-2 tablets every 4-6 hours (maximum 6 per 24 hours).
  • Children (7 - 12 years of age): 1 tablet every 4-6 hours if necessary (maximum 4 per 24 hours).

Ibuprofen 200mg + Codeine 12.8mg (Nurofen Plus)

Adults and children from 12 years:

  • 2 tablets, then 1 or 2 tablets every 4 hours as necessary (maximum 6 tablets in 24 hours).
  • Not for children under 12 years.

Mefenamic Acid 250mg (Ponstan)

Adults:

  • 2x tablets, 3 times a day with meals.
  • Not for children under 12 years.
    Special Considerations
    • Nausea
    • Heartburn
    • Stomach ulcers
    • Diarrhoea
    • Stomach cramps.


    References
    References
    Presentation
    • Ibuprofen 200mg
    • Ibuprofen 200mg + Codeine 12,8mg (See Codeine Containing Drugs CPG)
    • Mefenamic Acid 250mg
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