Non-selective COX inhibitor, propionic acid derivativeRENAL RISK IN HYPOVOLAEMIA

Ibuprofen

Ipren · Brufen · Ibumetin

The first-line NSAID in Sweden and the one with the least cardiovascular risk at a low dose. A short half-life of around 2 hours means the effect arrives and resolves quickly, which is an advantage: the drug suits as-needed use and can be discontinued with rapid recovery of renal function and platelet function. The short duration is also why three to four doses per day are required for continuous pain.

BOXED WARNING

Acute renal failure in the dehydrated or RAAS-treated patient. The combination of NSAID plus ACE inhibitor or ARB plus diuretics — the so-called triple whammy — is one of the most common drug-induced causes of acute kidney injury in outpatient care. Contraindicated from gestational week 20.

Dosing in adults

By indicationuppdaterad 2026-08-22

Indication	Regimen	Comment
Acute pain and fever, adult	400 mg every 6 to 8 hours, maximum 1 200 mg per day	doses above 400 mg per dose give no additional analgesia
Inflammatory rheumatic disease	400–800 mg × 3, maximum 2 400 mg per day	prescription-only dose level; for the shortest possible time
Dysmenorrhoea	400 mg at pain onset, then every 6 hours	started early in menstruation gives the best effect
Elderly or ulcer history	Lowest effective dose with a proton pump inhibitor	always weigh against paracetamol first
Children over 6 months	5–10 mg/kg every 6 to 8 hours, maximum 30 mg/kg per day	only in a well-hydrated child

Renal impairment

eGFR 30–60 ml/min: avoid if possible; otherwise lowest dose and creatinine monitoring. eGFR below 30 ml/min: contraindicated. Discontinue during acute illness with fluid loss.

Hepatic impairment

Reduce dose in hepatic impairment. Contraindicated in decompensated cirrhosis, where NSAIDs precipitate hepatorenal syndrome.

Children

5–10 mg/kg every 6 to 8 hours from 6 months of age, maximum 30 mg/kg per day. Avoid in gastroenteritis and other dehydrating conditions.

Pitfall

Avoid in patients with heart failure, renal failure, or ongoing RAAS blockade — and discontinue temporarily in gastroenteritis, fever with poor fluid intake, and before major surgery. The typical injury does not occur in a healthy person who takes one tablet, but in the multimorbid patient who continues taking their NSAID through a diarrhoeal illness.

Pharmacokinetics

BIOAVAIL.: > 80 % orally
Vd: 0,15 l/kg
t½: 2 h
PROTEIN BINDING: 99 %
METABOLISM: Hepatic, CYP2C9 and CYP2C8
EXCRETION: Renal as metabolites
ONSET: 30 min
DURATION: 4–8 h

Adverse effects by frequency

≥ 10 %

Dyspepsia, heartburn, abdominal pain, nausea

1–10 %

Headache, dizziness, oedema, blood pressure rise, creatinine rise, rash

< 1 %

Ulcer with bleeding or perforation, acute renal failure, worsening heart failure, bronchospasm in NSAID hypersensitivity, aseptic meningitis

Monitoring schedule

Creatinine and eGFR: before initiation and after 1–2 weeks in continuous treatment
Blood pressure: with treatment lasting more than a few weeks
Haemoglobin and gastrointestinal symptoms: with prolonged treatment and in the elderly
Treatment indication: at every renewal — NSAIDs should not become a standing prescription

Interaction burden

26clinically significant

2 contraindicated · 10 major · 14 moderate. The triple whammy — NSAID combined with an ACE inhibitor or ARB and a diuretic — is the most clinically important combination and causes acute kidney injury especially with concurrent fluid loss. Ibuprofen also competes with aspirin for COX-1 in platelets and can abolish the cardioprotective effect; take aspirin at least 2 hours before ibuprofen. Additive bleeding risk with warfarin, direct oral anticoagulants, and SSRIs.

Formulation & cost

Tablet and film-coated tablet: 200, 400 and 600 mg
Oral suspension: 20 mg/ml and 40 mg/ml
Restriction: over the counter up to 400 mg per dose; 600 mg and higher daily doses require a prescription