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NSAID / Analgesic / Antipyretic Pregnancy: Avoid, especially 3rd trimester — premature closure of ductus arteriosus

Ibuprofen (Paediatric)

Brand names: Nurofen for Children, Calprofen

Adult dose

Dose: 300–600 mg TDS–QDS
Route: Oral
Frequency: TDS–QDS
Max: 2400 mg/day
Full adult dosing in general medicine section

Paediatric dose

Dose: 7.5 mg/kg
Route: Oral
Frequency: Every 6–8 hours PRN
Max: 400 mg per dose; 30 mg/kg/day (max 2.4 g/day)
Concentration: 100 mg/5 mL suspension mg/ml
BNF for Children: 5–10 mg/kg every 6–8h (≥3 months, ≥5 kg). Calculator uses 7.5 mg/kg (mid-range). JIA: 30–40 mg/kg/day in 3–4 divided doses. Do NOT use <3 months or if dehydrated. Source: BNF for Children 2024; NICE NG143

Dose adjustments

Renal

Avoid in renal impairment — nephrotoxicity risk

Hepatic

Caution in hepatic impairment

Paediatric weight-based calculator

BNF for Children: 5–10 mg/kg every 6–8h (≥3 months, ≥5 kg). Calculator uses 7.5 mg/kg (mid-range). JIA: 30–40 mg/kg/day in 3–4 divided doses. Do NOT use <3 months or if dehydrated. Source: BNF for Children 2024; NICE NG143

Clinical pearls

  • Do not give to dehydrated child — significant AKI risk (NHS sick day guidance: hold ibuprofen if reduced oral intake/dehydration)
  • Alternating paracetamol and ibuprofen every 3–4 hours: PITCH trial showed no clinical benefit over single agent for fever — NICE recommends single agent
  • For juvenile idiopathic arthritis: ibuprofen first-line NSAID (30–40 mg/kg/day)
  • Febrile illness with rash/vesicles: avoid ibuprofen (theoretical invasive GAS risk if chickenpox, though evidence disputed)

Contraindications

  • Age <3 months
  • Weight <5 kg
  • Varicella or current viral infection (Reye's syndrome — though mainly aspirin risk, ibuprofen avoided by convention)
  • Active GI ulcer/bleed
  • Dehydrated child (AKI risk)
  • Renal/hepatic failure

Side effects

  • GI upset
  • Nausea
  • Bronchospasm (aspirin-sensitive asthma)
  • Renal impairment (especially if dehydrated)
  • Rash

Interactions

  • Aspirin — reduced antiplatelet effect
  • Anticoagulants — increased bleeding risk
  • ACEi — AKI risk

Monitoring

  • Pain/temperature response
  • Renal function if prolonged use
  • GI symptoms

Reference: BNF for Children; NICE NG143; PITCH Trial (Hay et al, Lancet 2008). Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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