lRENAL IMPAIRMENTAvoid if possible or use with caution.
Avoid in severe impairment.
Dose adjustmentsThe lowest effective dose should be used
for the shortest possible duration.
MonitoringIn renal impairment monitor renal function;
sodium and water retention may occur and renal function
may deteriorate, possibly leading to renal failure.
lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Tablet
CAUTIONARY AND ADVISORY LABELS 21
▶Flurbiprofen (Non-proprietary)
Flurbiprofen 50 mgFlurbiprofen 50 mg tablets| 100 tabletP
£ 21. 30 – £ 35. 97 DT = £ 35. 97
Flurbiprofen 100 mgFlurbiprofen 100 mg tablets| 100 tabletP
£ 64. 34 DT = £ 64. 34
Ibuprofen
lINDICATIONS AND DOSE
Closure of ductus arteriosus
▶BY SLOW INTRAVENOUS INJECTION
▶Neonate:Initially 10 mg/kg for 1 dose, followed by
5 mg/kg every 24 hours for 2 doses, the course may be
repeated after 48 hours if necessary.Mild to moderate pain|Pain and inflammation of soft-
tissue injuries|Pyrexia with discomfort
▶BY MOUTH USING IMMEDIATE-RELEASE MEDICINES
▶Child 1–2 months: 5 mg/kg 3 – 4 times a day
▶Child 3–5 months: 50 mg 3 times a day, maximum daily
dose to be given in 3 – 4 divided doses; maximum
30 mg/kg per day
▶Child 6–11 months: 50 mg 3 – 4 times a day, maximum
daily dose to be given in 3 – 4 divided doses; maximum
30 mg/kg per day
▶Child 1–3 years: 100 mg 3 times a day, maximum daily
dose to be given in 3 – 4 divided doses; maximum
30 mg/kg per day
▶Child 4–6 years: 150 mg 3 times a day, maximum daily
dose to be given in 3 – 4 divided doses; maximum
30 mg/kg per day
▶Child 7–9 years: 200 mg 3 times a day, maximum daily
dose to be given in 3 – 4 divided doses; maximum
30 mg/kg per day; maximum 2. 4 g per day
▶Child 10–11 years: 300 mg 3 times a day, maximum daily
dose to be given in 3 – 4 divided doses; maximum
30 mg/kg per day; maximum 2. 4 g per day
▶Child 12–17 years:Initially 300 – 400 mg 3 – 4 times a day;
increased if necessary up to 600 mg 4 times a day;
maintenance 200 – 400 mg 3 times a day, may be
adequate
Pain and inflammation
▶BY MOUTH USING MODIFIED-RELEASE MEDICINES
▶Child 12–17 years: 1. 6 g once daily, dose preferably taken
in the early evening, increased to 2. 4 g daily in
2 divided doses, dose to be increased only in severe
cases
Pain and inflammation in rheumatic disease including
juvenile idiopathic arthritis
▶BY MOUTH USING IMMEDIATE-RELEASE MEDICINES
▶Child 3 months–17 years: 30 – 40 mg/kg daily in
3 – 4 divided doses; maximum 2. 4 g per day
Pain and inflammation in systemic juvenile idiopathic
arthritis
▶BY MOUTH USING IMMEDIATE-RELEASE MEDICINES
▶Child 3 months–17 years:Up to 60 mg/kg daily in
4 – 6 divided doses; maximum 2. 4 g per dayPost-immunisation pyrexia in infants (on doctor’s advice
only)
▶BY MOUTH USING IMMEDIATE-RELEASE MEDICINES
▶Child 2–3 months: 50 mg for 1 dose, followed by 50 mg
after 6 hours if requiredlUNLICENSED USE
▶With intravenous useOrphan licence for the injection for
closure of ductus arteriosus in premature neonates less
than 34 weeks corrected gestational age.
▶With oral useNot licensed for use in children under
3 months or body-weight under 5 kg. Maximum dose for
systemic juvenile idiopathic arthritis is unlicensed.
lCONTRA-INDICATIONSActive gastro-intestinal bleeding.
active gastro-intestinal ulceration.history of gastro-
intestinal bleeding related to previous NSAID therapy.
history of gastro-intestinal perforation related to previous
NSAID therapy.history of recurrent gastro-intestinal
haemorrhage (two or more distinct episodes).history of
recurrent gastro-intestinal ulceration (two or more
distinct episodes).severe heart failure
▶With intravenous useActive bleeding (especially intracranial
or gastro-intestinal).coagulation defects.known or
suspected necrotising enterocolitis.life-threatening
infection.marked unconjugated hyperbilirubinaemia.
pulmonary hypertension.thrombocytopenia
lCAUTIONSCardiac impairment (NSAIDs may impair renal
function).cerebrovascular disease.coagulation defects.
connective-tissue disorders.Crohn’s disease (may be
exacerbated).heart failure.ischaemic heart disease.
peripheral arterial disease.risk factors for cardiovascular
events.risk factors for cardiovascular events.ulcerative
colitis (may be exacerbated).uncontrolled hypertension
▶With intravenous useMay mask symptoms of infection
CAUTIONS, FURTHER INFORMATION
▶High-dose ibuprofenA small increase in cardiovascular risk,
similar to the risk associated with cyclo-oxygenase- 2
inhibitors and diclofenac, has been reported with high-
dose ibuprofen ( 2. 4 g daily); use should be avoided in
patients with established ischaemic heart disease,
peripheral arterial disease, cerebrovascular disease,
congestive heart failure (New York Heart Association
classification II-III), and uncontrolled hypertension.
lINTERACTIONS→Appendix 1 : NSAIDs
lSIDE-EFFECTS
▶Common or very common
▶With intravenous useFluid retention.gastrointestinal
disorders.haemorrhage.intraventricular haemorrhage.
neutropenia.periventricular leukomalacia.renal
impairment.thrombocytopenia
▶Uncommon
▶With oral useGastrointestinal discomfort.headache.
hypersensitivity.nausea.rash (discontinue).skin
reactions
▶Rare or very rare
▶With oral useAcute kidney injury.agranulocytosis.
anaemia.angioedema.constipation.diarrhoea.dyspnoea
.fatigue.fever.gastrointestinal disorders.haemorrhage.
hypotension.influenza like illness.leucopenia.liver
disorder.meningitis aseptic (patients with connective-
tissue disorders such as systemic lupus erythematosus may
be especially susceptible).oedema.oral disorders.
pancytopenia.renal papillary necrosis.respiratory
disorders.severe cutaneous adverse reactions (SCARs).
shock.tachycardia.throat pain.thrombocytopenia.
vomiting
▶Frequency not known
▶With oral useAsthma.Crohn’s disease.fertility decreased
female.fluid retention.heart failure.hypertension.
increased risk of arterial thromboembolism.renal failureBNFC 2018 – 2019 Pain and inflammation in musculoskeletal disorders 655
Musculoskeletal system10