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NSAID — Non-selective COX Inhibitor Pregnancy: From the 20th week of pregnancy onward use may cause oligohydramnios resulting from foetal renal dysfunction, and ductus arteriosus constriction has been reported after treatment in the second trimester. During the first and second trimesters it should not be given unless clearly necessary, at the lowest dose and for the shortest duration; antenatal monitoring for oligohydramnios and ductus arteriosus constriction should be considered after several days of exposure from gestational week 20 onward, and treatment discontinued if either is found. Contraindicated during the third trimester of pregnancy. In limited studies ibuprofen appears in breast milk in very low concentrations and is unlikely to affect the breast fed infant adversely.

Ibuprofen (Orthopaedic Musculoskeletal Pain)

Brand names: Brufen, Nurofen, Calprofen (paediatric)

Ibuprofen is a propionic-acid NSAID used for mild-to-moderate orthopaedic musculoskeletal pain and inflammation such as sprains, strains, soft-tissue injury and osteoarthritic flares.

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: 1 or 2 tablets (the fetched product is Anadin Joint Pain 200 mg tablets, so 200 mg or 400 mg), taken with water
Route: Oral, short-term use only
Frequency: Up to 3 times a day as required; leave at least 4 hours between doses. When 2 tablets are taken, pain relief can last for up to 8 hours
Max: Do not take more than 6 tablets in any 24 hour period (the SPC states the limit in tablets; 6 x 200 mg = 1200 mg for this product)
SCOPE NOTE: the fetched UK SPC is an over-the-counter product ('Anadin Joint Pain 200mg Tablets', https://www.medicines.org.uk/emc/product/6174/smpc), so the ceiling above is the OTC maximum of 1200 mg a day. Prescription anti-inflammatory ibuprofen regimens (for example the higher daily doses used in inflammatory arthritis) are NOT covered by this source and must be sourced separately. §4.4 of the same SPC refers to doses of 2400 mg/day only in the context of cardiovascular risk (high doses, particularly 2400 mg/day, may be associated with a small increased risk of arterial thrombotic events, and should be avoided in patients with uncontrolled hypertension, congestive heart failure NYHA II-III, established ischaemic heart disease, peripheral arterial disease and/or cerebrovascular disease) — it is a warning, not a posology, and must not be read as a permitted dose from this label. Undesirable effects may be minimised by using the lowest effective dose for the shortest duration necessary. For adults aged 18 years or older, if the product is required for more than 10 days, or if symptoms worsen or persist, the patient should consult a pharmacist or doctor. PAEDIATRIC (no per-kg dose is stated in this SPC, so none is recorded as a structured paediatric dose): the same 1 to 2 tablet regimen covers children and adolescents over 12 years of age, and if it is required for more than 3 days in those aged 12 to 18, or if symptoms worsen, a doctor should be consulted; the product is NOT to be given to children under 12 years of age. Verify any under-18 use against a children's formulary. §4.4 also advises caution when initiating treatment in children with considerable dehydration because of the risk of renal impairment. The US OTC label in the same bundle (Ibuprofen Dye Free, CVS Pharmacy) states 1 tablet every 4 to 6 hours while symptoms persist, 2 tablets if 1 does not respond, not exceeding 6 tablets in 24 hours unless directed by a doctor.

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.

Contraindications

  • Hypersensitivity to ibuprofen or any of the constituents of the product
  • Previous hypersensitivity reactions (asthma, rhinitis, angioedema or urticaria) in response to aspirin or other NSAIDs
  • Active or previous peptic ulcer (two or more distinct episodes of proven ulceration or bleeding)
  • History of upper gastrointestinal bleeding or perforation related to previous NSAID therapy
  • Severe hepatic failure, renal failure or severe heart failure (NYHA Class IV)
  • Use in the last trimester of pregnancy

Side effects

  • Nausea, dyspepsia, diarrhoea, vomiting (common); abdominal pain, flatulence, constipation (uncommon); peptic ulcer, perforation or gastrointestinal haemorrhage, sometimes fatal, particularly in the elderly (very rare)
  • Headache, drowsiness, dizziness (common)
  • Skin rashes (uncommon); severe cutaneous adverse reactions including erythema multiforme, exfoliative dermatitis, Stevens-Johnson syndrome, toxic epidermal necrolysis and DRESS (very rare)
  • Cardiac failure, hypertension and oedema (rare); arterial thrombotic events such as myocardial infarction or stroke, and Kounis syndrome (frequency not known)
  • Tubulointerstitial nephritis, nephrotic syndrome, haematuria, proteinuria (rare); acute renal failure and papillary necrosis, especially in long-term use (very rare); hypokalaemia and renal tubular acidosis (frequency not known)

Clinical monograph

How it works

It 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 and consider gastroprotection in those at risk of gastrointestinal bleeding, the elderly or those on other NSAIDs.
  • Caution in cardiovascular disease, heart failure, renal impairment and asthma; avoid in active peptic ulceration and the third trimester of pregnancy.
  • Interactions with anticoagulants, antiplatelets, SSRIs, diuretics and ACE inhibitors increase bleeding and renal risk; concurrent low-dose aspirin may have its cardioprotection blunted.

Monitoring

Monitor blood pressure, renal function and for gastrointestinal symptoms in prolonged use or at-risk patients.

Counselling the patient

  • Take with food and use only as long as needed.
  • Report indigestion, black stools or vomiting blood.
  • Avoid taking other NSAIDs at the same time.

Evidence & guidelines

NICE and MHRA advise the lowest effective NSAID dose for the shortest duration because of dose-related gastrointestinal, renal and cardiovascular risks.

Reference: MHRA NSAID Cardiovascular Safety Update; NICE Musculoskeletal Pain Guidelines; SPC Brufen; 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).

Related

Curated clinical cross-links plus same-class fallbacks.

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