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Advil
ibuprofen
Dosing .
12 yo and older
- [ oral tablet/capsule ]
- Dose: 1-2 tabs/caps PO q4-6h prn; Max: 6 tabs or caps/24h; Info: use lowest effective dose, shortest duration; give w/ food if GI upset occurs
renal dosing
- [ see below ]
- CrCl >60: no adjustment; CrCl 30-60: not defined, caution advised; CrCl <30: avoid use
- HD/PD: avoid use
hepatic dosing
- [ see below ]
- hepatic impairment: not defined, caution advised
Contraindications / Cautions .
- hypersensitivity to drug or ingredient
- hypersensitivity to ASA
- hypersensitivity to NSAIDs
- asthma, ASA-induced
- asthma, NSAID-induced
- urticaria, ASA-induced
- urticaria, NSAID-induced
- aspirin triad
- CrCl <30
- renal dz, advanced
- pregnancy starting at 30 wk gestation
- CABG surgery periop use
- MI, recent
- CHF, severe
- GI bleeding
- GI bleeding hx
- PUD hx
- caution: pregnancy at <30 wk gestation
- caution: elderly pts
- caution: debilitated pts
- caution: renal impairment
- caution: hepatic impairment
- caution: cardiovascular dz
- caution: cardiac dz risk
- caution: HTN
- caution: CHF
- caution: fluid retention
- caution: dehydration
- caution: hypovolemia
- caution: coagulation disorder
- caution: alcohol use, concurrent
- caution: smokers
- caution: asthma
- caution: prolonged use
- caution: pts of childbearing potential trying to conceive
Drug Interactions .
Overview
ibuprofen
NSAID
Interaction Characteristics:
- OAT1 inhibitor
- OAT3 inhibitor
- affects growth hormone diagnostic test results
- alters gallbladder contraction/motility
- antiplatelet effects
- bioavailability increased by hydroxypropyl betadex
- decreases renal perfusion/fxn
- GI mucosal injury/bleeding risk
- hyperkalemia
- hypertensive effects
- hyponatremia
- lowers seizure threshold
- thrombogenic effects
Contraindicated
- ketorolac
Avoid/Use Alternative
- amikacin
- aspirin
- bumetanide
- celecoxib
- clofarabine
- diclofenac
- diclofenac topical
- diflunisal
- enoxaparin
- epinephrine inhaled
- etodolac
- fenoprofen
- flurbiprofen
- fondaparinux
- ibuprofen
- ibuprofen lysine
- indomethacin
- ketoprofen
- lisinopril
- macimorelin
- magnesium salicylate
- meclofenamate
- mefenamic acid
- meloxicam
- methotrexate
- methyl salicylate topical
- midodrine
- nabumetone
- naproxen
- oxaprozin
- pemetrexed
- piroxicam
- potassium chloride
- pralatrexate
- salsalate
- sulindac
- tacrolimus
- tenofovir disoproxil
- tolmetin
- tranexamic acid
- vaccinia immune globulin
- valsartan
- willow bark
Monitor/Modify Tx
- abemaciclib
- abiraterone acetate
- abrocitinib
- acalabrutinib
- acebutolol
- acyclovir
- adefovir dipivoxil
- ado-trastuzumab emtansine
- afatinib
- aflibercept
- albuterol
- albuterol inhaled
- aldesleukin
- alendronate
- aliskiren
- almotriptan
- alteplase
- amikacin inhaled
- amiloride
- aminocaproic acid
- amlodipine
- amphetamine
- amphotericin
- anacaulase topical
- anagrelide
- angiotensin II
- anthrax immune globulin
- anti-inhibitor coagulant complex
- antihemophilic factor (factor VIII)/von Willebrand factor complex
- antithrombin
- apixaban
- aprocitentan
- arformoterol inhaled
- argatroban
- armodafinil
- asciminib
- asparaginase
- atenolol
- atidarsagene autotemcel
- atogepant
- atomoxetine
- atropine ophthalmic
- auranofin
- avapritinib
- avatrombopag
- axitinib
- azilsartan medoxomil
- balsalazide
- baricitinib
- bazedoxifene
- benazepril
- benzphetamine
- betamethasone
- betaxolol
- bevacizumab
- binimetinib
- bismuth subsalicylate
- bisoprolol
- bivalirudin
- botulism immune globulin
- brentuximab vedotin
- brigatinib
- brolucizumab
- bromelain
- bromfenac ophthalmic
- budesonide
- bupropion
- C1 esterase inhibitor
- cabazitaxel
- cabozantinib
- caffeine
- caffeine citrate
- calaspargase
- candesartan cilexetil
- cangrelor
- cannabis
- capecitabine
- caplacizumab
- captopril
- carboplatin
- carfilzomib
- carvedilol
- chlorothiazide
- chlorthalidone
- chorionic gonadotropin
- cidofovir
- cilostazol
- cinacalcet
- cisplatin
- citalopram
- cladribine oral
- clevidipine
- clindamycin
- clonidine
- clopidogrel
- clozapine
- coagulation factor IX
- coagulation factor VIIa
- coagulation factor XIII A-subunit
- cocaine
- colistimethate
- collagenase clostridium histolyticum
- concizumab
- copanlisib
- corticotropin
- cortisone
- creatine
- cyclophosphamide
- cyclosporine
- cysteamine
- cytomegalovirus immune globulin
- dabigatran
- dalteparin
- danazol
- danshen
- darbepoetin alfa
- dasatinib
- decitabine
- deferasirox
- deferoxamine
- defibrotide
- deflazacort
- desmopressin
- desogestrel (contraceptive)
- desvenlafaxine
- deuruxolitinib
- dexamethasone
- dexmethylphenidate
- dextroamphetamine
- diclofenac ophthalmic
- dienogest (contraceptive)
- diethylpropion
- digoxin
- dihydroergotamine
- diltiazem
- dimethyl fumarate
- diosmin
- dipyridamole
- diroximel fumarate
- dobutamine
- donepezil
- dopamine
- doxapram
- doxazosin
- dronabinol
- drospirenone (contraceptive)
- drospirenone (hormone replacement)
- droxidopa
- duloxetine
- edoxaban
- eletriptan
- eltrombopag
- enalapril
- enalaprilat
- encorafenib
- enzalutamide
- ephedra
- ephedrine injection
- ephedrine oral
- epinephrine
- epirubicin
- eplerenone
- epoetin alfa
- epoprostenol
- eptifibatide
- eptinezumab
- erenumab
- ergotamine
- erlotinib
- escitalopram
- esketamine
- esmolol
- estetrol (contraceptive)
- estradiol (contraceptive)
- estradiol (hormone replacement)
- estrogens, conjugated (hormone replacement)
- estrogens, esterified (hormone replacement)
- etelcalcetide
- ethacrynic acid
- ethanol
- ethinyl estradiol (contraceptive)
- ethinyl estradiol (hormone replacement)
- ethynodiol (contraceptive)
- etonogestrel (contraceptive)
- etrasimod
- evening primrose oil
- everolimus
- factor XIII concentrate
- faricimab
- fedratinib
- felodipine
- fenfluramine
- fenofibrate
- fenofibric acid
- fenoldopam
- fenugreek
- finerenone
- fingolimod
- fitusiran
- flucytosine
- fludrocortisone
- fluoxetine
- flurbiprofen ophthalmic
- fluvoxamine
- follitropin
- formoterol inhaled
- foscarnet
- fosinopril
- fostamatinib
- fremanezumab
- frovatriptan
- fruquintinib
- furosemide
- galantamine
- galcanezumab
- ganciclovir
- garlic
- gefitinib
- gemtuzumab ozogamicin
- gentamicin
- ginkgo
- guanfacine
- heparin
- hepatitis B immune globulin
- hoodia
- hydralazine
- hydrochlorothiazide
- hydrocortisone
- ibandronate
- ibrutinib
- icosapent ethyl
- ifosfamide
- iloprost inhaled
- imatinib
- immune globulin
- indapamide
- iohexol
- iomeprol
- iopamidol
- irbesartan
- isradipine
- ketamine
- ketorolac ophthalmic
- labetalol
- landiolol
- lanreotide
- lanthanum
- lazertinib
- leflunomide
- lenalidomide
- lenvatinib
- levalbuterol inhaled
- levomilnacipran
- levonorgestrel (contraceptive)
- levonorgestrel (hormone replacement)
- licorice
- lifileucel
- lisdexamfetamine
- lithium
- lorlatinib
- losartan
- lumacaftor/ivacaftor
- luspatercept
- lusutrombopag
- lutetium Lu 177 vipivotide tetraxetan
- magnesium citrate
- mannitol
- medroxyprogesterone (contraceptive)
- medroxyprogesterone (hormone replacement)
- megestrol
- menotropins
- mesalamine
- mesalamine rectal
- methamphetamine
- methoxy polyethylene glycol-epoetin beta
- methyldopa
- methylergonovine
- methylphenidate
- methylprednisolone
- methyltestosterone
- metoclopramide
- metolazone
- metoprolol
- milnacipran
- minoxidil
- mirabegron
- mitomycin
- mitotane
- modafinil
- moexipril
- momelotinib
- monomethyl fumarate
- mycophenolate mofetil
- mycophenolic acid
- nadolol
- naratriptan
- nattokinase
- naxitamab
- nebivolol
- necitumumab
- neomycin
- nepafenac ophthalmic
- niacin (vitamin B3)
- nicardipine
- nifedipine
- nilotinib
- nimodipine
- nintedanib
- niraparib
- nisoldipine
- norelgestromin (contraceptive)
- norepinephrine
- norethindrone (contraceptive)
- norethindrone (hormone replacement)
- norgestimate (contraceptive)
- norgestrel (contraceptive)
- nusinersen
- olaparib
- olmesartan medoxomil
- olodaterol inhaled
- olsalazine
- omega-3-acid
- osilodrostat
- ospemifene
- oxaliplatin
- oxymetazoline nasal
- oxytocin
- ozanimod
- pacritinib
- pamidronate
- paromomycin
- paroxetine
- pazopanib
- pegaspargase
- penicillamine
- penicillin G
- pentamidine
- pentosan polysulfate sodium
- pentostatin
- pentoxifylline
- perindopril
- pexidartinib
- phendimetrazine
- phenoxybenzamine
- phentermine
- phentolamine
- phenylephrine
- phenylephrine injection
- phenylephrine nasal
- phenylephrine ophthalmic
- phenylephrine rectal
- pindolol
- piperacillin
- pirtobrutinib
- plasminogen, human
- plazomicin
- polyethylene glycol
- polyethylene glycol/electrolytes
- polymyxin B
- pomalidomide
- ponatinib
- ponesimod
- porfimer
- potassium acid phosphate
- potassium bicarbonate
- potassium citrate
- potassium iodide
- potassium phosphate
- pralsetinib
- prasugrel
- prazosin
- prednisolone
- prednisone
- progesterone (hormone replacement)
- progesterone vaginal (hormone replacement)
- propranolol
- prothrombin complex concentrate (human)
- pseudoephedrine
- pyridostigmine
- quetiapine
- quinapril
- raloxifene
- ramipril
- ramucirumab
- ranibizumab
- regorafenib
- resveratrol
- reteplase
- revakinagene taroretcel
- Rho(D) immune globulin
- rimegepant
- ripretinib
- risedronate
- ritlecitinib
- rituximab
- rivaroxaban
- rivastigmine
- rizatriptan
- romiplostim
- ropeginterferon alfa-2b
- ropinirole
- rotigotine transdermal
- ruxolitinib
- ruxolitinib topical
- salmeterol inhaled
- saw palmetto
- segesterone (contraceptive)
- selpercatinib
- selumetinib
- sepiapterin
- sertraline
- sincalide
- siponimod
- sipuleucel-T
- sirolimus
- sirolimus albumin-bound
- sitagliptin
- sodium tetradecyl sulfate
- solriamfetol
- sorafenib
- sotatercept
- sparsentan
- spironolactone
- streptomycin
- streptozocin
- sulfate bowel prep
- sumatriptan
- sunitinib
- tagraxofusp
- tamoxifen
- telavancin
- telmisartan
- temsirolimus
- tenecteplase
- tenofovir alafenamide
- terazosin
- terbutaline
- teriflunomide
- testosterone
- thalidomide
- ticagrelor
- timolol
- tiopronin
- tipranavir
- tirofiban
- tisotumab vedotin
- tivozanib
- tobramycin
- tobramycin inhaled
- tocilizumab
- tofacitinib
- tolvaptan
- toremifene
- torsemide
- tovorafenib
- trametinib
- trandolapril
- trazodone
- treprostinil
- tretinoin
- triamcinolone
- triamterene
- trimethoprim
- ubrogepant
- upadacitinib
- vadadustat
- valacyclovir
- valganciclovir
- valoctocogene roxaparvovec
- valproic acid
- vamorolone
- vancomycin
- vandetanib
- varicella zoster immune globulin
- vasopressin
- venlafaxine
- verapamil
- vilanterol inhaled
- vilazodone
- viloxazine
- vinpocetine
- voclosporin
- von Willebrand factor
- vorapaxar
- voriconazole
- vorinostat
- vortioxetine
- warfarin
- yohimbe
- zanubrutinib
- zavegepant
- ziv-aflibercept
- zoledronic acid
- zolmitriptan
- zonisamide
Caution Advised
- carbamazepine
- ciprofloxacin
- delafloxacin
- emtricitabine
- levofloxacin
- moxifloxacin
- ofloxacin
Adverse Reactions .
Serious Reactions
- GI bleeding
- GI perforation
- GI ulcer
- MI
- stroke
- thromboembolism
- HTN
- CHF
- CHF exacerbation
- renal papillary necrosis
- nephrotoxicity
- hepatotoxicity
- hypersensitivity rxn
- anaphylaxis
- exfoliative dermatitis
- Stevens-Johnson syndrome
- toxic epidermal necrolysis
- drug rxn w/ eosinophilia and systemic sx
- generalized bullous fixed drug eruption
- aseptic meningitis
- prolonged bleeding time
- thrombocytopenia
- blood dyscrasia
- medication overuse headache (acute migraine or headache use >10 days/mo)
- hyperkalemia
Common Reactions
- dyspepsia
- nausea
- abdominal pain
- constipation
- vomiting
- diarrhea
- flatulence
- appetite decr.
- headache
- dizziness
- drowsiness
- rash
- pruritus
- nervousness
- renal impairment
- ALT or AST elevated
- fluid retention
- tinnitus
- ecchymosis
- Hgb decr.
- visual disturbance
- photosensitivity
- delayed ovulation
Pregnancy/Lactation .
Pregnancy
Clinical Summary
weigh risk/benefit if <30 wk gestation, esp. at 20-29 wk gestation, avoid use starting at 30 wk gestation; if must use at 20-29 wk gestation, limit dose and duration, and consider monitoring amniotic fluid if use >48h; risk of embryo-fetal toxicity and death low in 1st trimester based on conflicting human data; risk of fetal harm, incl. renal dysfxn and oligohydramnios, starting at 20 wk gestation and premature ductus arteriosus closure, starting at 30 wk gestation, based on human data w/ NSAID class and drug's mechanism of action
Individuals of Reproductive Potential
weigh risk/benefit in pts of childbearing potential trying to conceive, esp. if long-term use; NSAIDs may reversibly delay ovulation during tx based on limited human or animal data and drug's mechanism of action
Lactation
Clinical Summary
may use while breastfeeding; NSAID of choice for analgesic use while breastfeeding; no known risk of infant harm or adverse effects on milk production based on human data
Pharmacology .
Metabolism: liver; CYP450: 2C9 substrate
Excretion: urine 45-79% (1% unchanged); Half-life: 1.8-2h
Subclass: Nonsteroidal Anti-inflammatory Drugs (NSAIDs)
Mechanism of Action: exact mechanism of action unknown; inhibits cyclooxygenase, reducing prostaglandin and thromboxane synthesis
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