NSAID Pregnancy: During the first and second trimester, avoid unless clearly necessary and keep dose as low and duration as short as possible; from gestational week 20 onward may cause oligohydramnios (foetal renal dysfunction) and ductus arteriosus constriction. Contraindicated during the third trimester (cardiopulmonary and renal toxicity, prolonged bleeding time, inhibition of uterine contractions). Breast-feeding: NSAIDs appear in breast milk in very low concentrations and should if possible be avoided.

Ibuprofen

Brand names: Nurofen, Brufen

Ibuprofen is a non-steroidal anti-inflammatory drug (NSAID) used for pain, inflammation and fever.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: 200-400 mg

Route: Oral

Frequency: Up to three times a day as required (leave at least 4 hours between doses)

Max: 1200 mg in any 24-hour period

SPC for Ibuprofen 100 mg/5 ml Oral Suspension. For oral administration and short-term use only; use the lowest effective dose for the shortest duration. Adults, the elderly and children over 12 years: 200-400 mg (10-20 ml) up to three times a day; at least 4 hours between doses; do not exceed 1200 mg (60 ml) in 24 hours. Consult a doctor if required for more than 10 days. Elderly: no special modification unless renal or hepatic function is impaired, when the dose should be assessed individually. Paediatric dosing is weight- and age-banded (see paedDose) and should be verified against a children's formulary.

Paediatric dose

Dose: 20 mg/kg

Route: Oral

Frequency: In divided doses (per day)

Max: For Juvenile Rheumatoid Arthritis (prescription only), up to 30-40 mg/kg/day in three or four divided doses

For pain and fever: 20 mg/kg/day in divided doses (including OTC use). Age-banded suspension doses per SPC: infants 3-6 months and >5 kg, 2.5 ml three times in 24 hours (max 24 hours' use); 6 months-1 year, 2.5 ml three to four times daily; 1-4 years, 5 ml three times daily; 4-7 years, 7.5 ml three times daily; 7-12 years, 10 ml three times daily (suspension is 100 mg/5 ml). Post-immunisation fever: 2.5 ml (50 mg), repeated once after 6 hours if needed (max 2 doses in 24 hours). Do not give under 3 months of age. Risk of renal impairment in dehydrated children. Verify against a children's formulary.

Dose adjustments

Renal

Contraindicated in renal failure. In the elderly, assess dose individually if renal function is impaired. Risk of renal impairment in dehydrated children and adolescents.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Paediatric weight-based calculator

Patient weight (kg)

Verify in a children's formulary

US labelling (FDA)

Reference — US labelling, may differ from UK

Directions do not take more than directed the smallest effective dose should be used adults and children 12 years and over: take 1 tablet every 4 to 6 hours while symptoms persist if pain or fever does not respond to 1 tablet, 2 tablets may be used do not exceed 6 tablets in 24 hours, unless directed by a doctor children under 12 years: ask a doctor

Source: US FDA prescribing information (openFDA / DailyMed), label dated 2026-04-29. Accessed 2026-06-12. US dosing and indications can differ from UK practice — use UK sources for prescribing decisions.

Contraindications

Hypersensitivity to ibuprofen or to any of the excipients
Previous hypersensitivity reactions (e.g. asthma, rhinitis, angioedema or urticaria) to ibuprofen, aspirin or other NSAIDs
History of gastrointestinal bleeding or perforation related to previous NSAID therapy; active or history of recurrent peptic ulcer/GI haemorrhage
Conditions with an increased tendency to bleeding
Severe hepatic failure, renal failure and heart failure (NYHA Class IV)
Last trimester of pregnancy

Side effects

Gastrointestinal: nausea, vomiting, diarrhoea, flatulence, constipation, dyspepsia, abdominal pain; peptic ulcer, perforation or GI bleeding (sometimes fatal, particularly in the elderly)
Hypersensitivity reactions: non-specific allergic reactions and anaphylaxis
Respiratory reactivity: asthma, aggravated asthma, bronchospasm, dyspnoea
Skin: rashes, pruritus, urticaria, angioedema; very rarely erythema multiforme, Stevens-Johnson syndrome and toxic epidermal necrolysis
Cardiac/vascular: oedema, hypertension, cardiac failure; high-dose use (2400 mg/day) may carry a small increased risk of arterial thrombotic events (e.g. myocardial infarction or stroke)

Interactions

Other NSAIDs, including COX-2 selective inhibitors: avoid concomitant use (increased risk of ulceration/bleeding)
Anticoagulants such as warfarin; anti-platelet agents such as aspirin; SSRIs; oral corticosteroids: increased risk of GI ulceration or bleeding
Low-dose aspirin: increased gastrointestinal risk (consider protective agents such as misoprostol or a proton pump inhibitor)
Excessive alcohol: may increase risk of GI or CNS adverse effects

Clinical monograph

How it works

Ibuprofen non-selectively inhibits cyclo-oxygenase (COX-1 and COX-2), reducing prostaglandin synthesis and thereby pain, inflammation and fever.

Prescribing in practice

Use the lowest effective dose for the shortest time; gastrointestinal, renal and cardiovascular risks rise with dose and duration.
Avoid or use caution in peptic ulcer disease, significant renal impairment, heart failure, and uncontrolled hypertension; consider gastroprotection in at-risk patients.
It reduces the renal clearance of several drugs and adds to bleeding risk with anticoagulants/antiplatelets; the combination with an ACE inhibitor or ARB plus a diuretic is a particular renal risk.

Monitoring

Short courses in healthy adults need no routine monitoring; with longer use or in at-risk patients monitor renal function and blood pressure and review GI symptoms.

Counselling the patient

Take it with or after food.
Report indigestion, black stools, or reduced urine output.
Avoid combining it with other NSAIDs.

Evidence & guidelines

NSAIDs are effective for inflammatory and musculoskeletal pain but are used at the lowest effective dose for the shortest duration because of GI, renal and cardiovascular risk.

Reference: NICE CKS Analgesia; MHRA NSAID safety advice; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

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