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NSAID Pregnancy: C (first/second trimester) — D (third trimester, contraindicated)

Ibuprofen

Brand names: Nurofen, Brufen

Adult dose

Dose: 200–400mg three times daily
Route: Oral
Frequency: Three times daily with food
Max 2.4g/day (standard); 3.2g/day (supervised). Always use lowest effective dose for shortest duration.

Paediatric dose

Dose: 5 mg/kg
Route: Oral
Frequency: Every 6–8 hours
Max: 400mg per dose
Children >3 months. Not recommended <3 months. Max 30mg/kg/day.
Paediatric weight-based calculator

Children >3 months. Not recommended <3 months. Max 30mg/kg/day.

Clinical pearls

  • PPI gastroprotection (e.g., omeprazole 20mg OD) recommended if age >65, history of PUD, or concurrent corticosteroids/antiplatelets
  • Avoid in AKI risk: elderly, dehydrated, CKD, heart failure, hypovolaemia
  • AVOID in third trimester — premature closure of ductus arteriosus
  • Lower CV risk than diclofenac — but all NSAIDs increase CV events with long-term use

Contraindications

  • Active peptic ulcer disease
  • Severe renal or hepatic impairment
  • NSAID hypersensitivity / aspirin-sensitive asthma
  • Third trimester of pregnancy
  • Concurrent anticoagulant use (relative)

Side effects

  • GI bleeding/ulceration
  • AKI
  • Hypertension
  • Fluid retention
  • Bronchospasm
  • Rash

Interactions

  • Aspirin — increased GI risk (avoid combination)
  • SSRIs — increased GI bleed risk
  • ACE inhibitors — reduced antihypertensive effect and AKI risk
  • Lithium — increased levels

Monitoring

  • Renal function (if prolonged use)
  • Blood pressure
  • Stool for occult blood

Reference: BNFc; NICE CKS Analgesia; MHRA NSAID safety advice. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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