Advil

Common Side Effects of Ibuprofen

• Stomachache
• Heartburn
• Dizziness
• Rash
• Drowsiness
• Nausea
• Vomiting
• Constipation
• Ringing in the ears

Serious Side Effects of Ibuprofen

• Liver failure or inflammation of the liver
• Low platelet count
• Blood in the urine
• Urinary tract infection
• A condition in which the bone marrow is unable to make enough white blood cells, known as agranulocytosis
• Low red blood cell count, or anemia
• Severe and potentially life-threatening skin reactions such as Stevens-Johnson Syndrome or toxic epidermal necrolysis (TEN)
• Stroke
• Heart attack
• High blood pressure (normally a greater risk with long-term use and while taking certain other medications)
• Kidney damage

Yes for 400 to 800 mg strengths and injection. It also is availableOTC (over-the-counter) without a prescription.

Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Some products that may interact with this drug include: aliskiren, ACE inhibitors (such as captopril, lisinopril), angiotensin II receptor blockers (such as losartan, valsartan), cidofovir, corticosteroids (such as prednisone), lithium.This medication may increase the risk of bleeding when taken with other drugs that also may cause bleeding. Examples include anti-platelet drugs such as clopidogrel, "blood thinners" such as dabigatran/enoxaparin/warfarin, among others.Check all prescription and nonprescription medicine labels carefully since many medications contain pain relievers/fever reducers (including aspirin, NSAIDs such as celecoxib, ketorolac, or naproxen). These drugs are similar to ibuprofen and may increase your risk of side effects if taken together. However, if your doctor has directed you to take low-dose aspirin for heart attack or stroke prevention (usually at dosages of 81-325 milligrams a day), you should continue taking the aspirin unless your doctor instructs you otherwise. Daily use of ibuprofen may decrease aspirin's ability to prevent heart attack/stroke. Talk to your doctor about using a different medication (such as acetaminophen) to treat pain/fever. If you must take ibuprofen, talk to your doctor about possibly taking immediate-release aspirin (not enteric-coated/EC) while taking ibuprofen. Take ibuprofen at least 8 hours before or at least 30 minutes after your aspirin dose. Do not increase your daily dose of aspirin or change the way you take aspirin/other medications without your doctor's approval.

Laboratory and/or medical tests (including kidney function tests) may be performed periodically to monitor your progress or check for side effects. Consult your doctor for more details.Keep all regular medical and laboratory appointments.

Take ibuprofen exactly as prescribed. Ibuprofen may be taken several times per day, depending on reason for use.

Shake oral suspension ibuprofen before use. May take ibuprofen with food or milk to prevent stomach irritation.

This medication is available in an injectable form to be given directly into a vein (IV) by a healthcare professional.

If you miss a dose, take the missed dose as soon as you remember. If it is almost time for the next dose, skip the missed dose and take your next dose at the regular time. Do not take two doses of ibuprofen at the same time unless instructed by your doctor.

Store ibuprofen at room temperature.

Keep this and all medicines out of the reach of children.

Pain reliever/Fever reducer

Advil can increase your risk of fatal heart attack or stroke, especially if you use it long term or take high doses, or if you have heart disease. Do not use this medicine just before or after heart bypass surgery (coronary artery bypass graft, or CABG).

Advil may also cause stomach or intestinal bleeding, which can be fatal. These conditions can occur without warning while you are using ibuprofen, especially in older adults.

Do not take more than your recommended dose. An Advil overdose can damage your stomach or intestines. Use only the smallest amount of medication needed to get relief from your pain, swelling, or fever.

Since Advil is used when needed, you may not be on a dosing schedule. If you are on a schedule, use the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not use extra medicine to make up the missed dose.

Avoid drinking alcohol. It may increase your risk of stomach bleeding.

Avoid taking aspirin while you are taking Advil.

Avoid taking Advil if you are taking aspirin to prevent stroke or heart attack. Ibuprofen can make aspirin less effective in protecting your heart and blood vessels. If you must use both medications, take the Advil at least 8 hours before or 30 minutes after you take the aspirin (non-enteric coated form).

Ask a doctor or pharmacist before using any cold, allergy, or pain medicine. Many medicines available over the counter contain aspirin or other medicines similar to ibuprofen. Taking certain products together can cause you to get too much of this type of medication. Check the label to see if a medicine contains aspirin, ibuprofen, ketoprofen, or naproxen.

Dosage Forms & Strengths

tablet

• 100mg
• 200mg
• 400mg (Rx)
• 600mg (Rx)
• 800mg (Rx)

capsule

• 200mg

tablet, chewable

• 50mg
• 100mg

oral suspension

• 100mg/5mL
• 40mg/mL

Pain/Fever/Dysmenorrhea

OTC: 200-400 mg PO q4-6hr; not to exceed 1200 mg unless directed by physician

Prescription: 400-800 mg PO q6hr; not to exceed 3200 mg/day

Inflammatory Disease

400-800 mg PO q6-8hr; not to exceed 3200 mg/day

Osteoarthritis

300 mg, 400 mg, 600 mg, or 800 mg PO q6-8hr; not to exceed 3200 mg/day

Monitor for gastrointestinal (GI) risks

Rheumatoid Arthritis

300 mg, 400 mg, 600 mg, or 800 mg PO q6-8hr; not to exceed 3200 mg/day

Monitor for GI risks

Dosage Modifications

Significantly impaired renal function: Monitor closely; consider reduced dosage if warranted

Severe hepatic impairment: Avoid use

Dosage Forms & Strengths

tablet

• 100mg
• 200mg
• 400mg (Rx)
• 600mg (Rx)
• 800mg (Rx)

capsule

• 200mg

tablet, chewable

• 50mg
• 100mg

oral suspension

• 100mg/5mL
• 40mg/mL

Fever

Pregnancy

≥30 weeks' gestation: May cause premature closure of ductus arteriosus; avoid during 1st and 3rd trimesters

Quebec Pregnancy Registry identified 4705 women who had spontaneous abortions by 20 weeks' gestation; each case was matched to 10 control subjects (n=47,050) who had not had spontaneous abortions; exposure to nonaspirin NSAIDs during pregnancy was documented in approximately 7.5% of cases of spontaneous abortions and in approximately 2.6% of controls

Lactation

Drug excreted into human breast milk in extremely low levels

Ibuprofen has a short half-life and is considered safe in infants in doses much higher than those excreted in breast milk

Considered the preferred choice for analgesia or inflammation in breastfeeding women (LactMed from NIH)

Pregnancy Categories

A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

NA: Information not available.

Mechanism of Action

Inhibits synthesis of prostaglandins in body tissues by inhibiting at least 2 cyclo-oxygenase (COX) isoenzymes, COX-1 and COX-2

May inhibit chemotaxis, alter lymphocyte activity, decrease proinflammatory cytokine activity, and inhibit neutrophil aggregation; these effects may contribute to anti-inflammatory activity

Absorption

Rapidly absorbed (85%)

Bioavailability: 80-100%

Onset: 30-60 min

Duration: 4-6 hr

Peak plasma time (adults)

• Conventional tablet: 120 min
• Chewable tablet: 62 min
• Oral suspension: 47 min

Peak plasma time (febrile children)

• Chewable tablet: 86 min
• Oral suspension: 58 min

Peak plasma concentration

• Conventional tablet: 20 mcg/mL
• Chewable tablet: 15 mcg/mL
• Oral suspension: 19 mcg/mL

Distribution

Protein bound: 90-99%; concentrations >20 mcg/mL

Vd: 0.12 L/kg (adults); 0.164 L/kg (children)

Metabolism

Rapidly metabolized in liver (primarily by CYP2C9; CYP2C19 substrate) via oxidation to inactive metabolites

Metabolites

• Metabolite A: (+)-2-[4'-(2-hydroxy-2-methylpropyl) phenyl] propionic acid
• Metabolite B: (+)-2-[4'-(2-carboxypropyl) phenyl] propionic acid

Elimination

Half-life: 2-4 hr (adults); 1.6 hr (children 3 mon to 1 year; 35-51 hr (day 3), 20-33 hr (day 5)

Excretion: Urine (50-60%;

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