Dexibuprofen

CLINICAL USE

NSAID and analgesic

DOSE IN NORMAL RENAL FUNCTION

Initially: 600–900 mg daily in divided doses, after food; Maximum 1.2 g daily (900 mg daily for dysmenorrhoea);Maximum single dose: 400 mg (300 mg for dysmenorrhoea)

PHARMACOKINETICS

Molecular weight :206.3

%Protein binding :>99

%Excreted unchanged in urine : 82 (mainly as inactive metabolites)

Volume of distribution (L/kg) :10–11 litres

half-life – normal/ESRD (hrs) :1.6–1.9/Unchanged

DOSE IN RENAL IMPAIRMENT

GFR (mL/MIN)

20 to 50 : Dose as in normal renal function, but avoid if possible

10 to 20 : Dose as in normal renal function, but avoid if possible

<10 : Dose as in normal renal function, but only use if on dialysis

DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

CAPD :Not dialysed. Dose as in GFR <10 mL/min

HD :Not dialysed. Dose as in GFR <10 mL/min

HDF/high flux :Unknown dialysability. Dose as in GFR <10 mL/min

CAV/VVHD :Not dialysed. Dose as in GFR=10–20 mL/min

IMPORTANT DRUG INTERACTIONS

Potentially hazardous interactions with other drugsACE inhibitors and angiotensin-II antagonists: antagonism of hypotensive effect, increased risk of nephrotoxicity and hyperkalaemiaAnalgesics: avoid concomitant use of 2 or more NSAIDs, including aspirin (increased side effects); avoid with ketorolac (increased risk of side effects and haemorrhage)Antibacterials: possibly increased risk of convulsions with quinolonesAnticoagulants: effects of coumarins enhanced; possibly increased risk of bleeding with heparins and coumarinsAntidepressants: increased risk of bleeding with SSRIs and venlafaxineAntidiabetic agents: effects of sulphonylureas enhancedAnti-epileptics: possibly increased phenytoin concentrationAntivirals: increased risk of haematological toxicity with zidovudine; concentration possibly increased by ritonavirCiclosporin: may potentiate nephrotoxicity Cytotoxic agents: reduced excretion of methotrexate; increased risk of bleeding with erlotinibDiuretics: increased risk of nephrotoxicity; antagonism of diuretic effect; hyperkalaemia with potassium-sparing diureticsLithium: excretion decreased Pentoxifylline: increased risk of bleeding Tacrolimus: increased risk of nephrotoxicity

ADMINISTRATION

Reconstition

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Route

Oral

Rate of Administration

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Comments

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OTHER INFORMATION

S (+)– enantiomer of racemic ibuprofen Inhibition of renal prostaglandin synthesis by NSAIDs may interfere with renal function, especially in the presence of existing renal disease – avoid if possible; if not, check serum creatinine 48–72 hours after starting NSAID – if raised, discontinue NSAID therapy. Use normal doses in patients with CKD 5 on dialysisUse with caution in renal transplant recipients – can reduce intrarenal autocoid synthesis.

See how to identify renal failure stages according to GFR calculation

See how to diagnose irreversible renal disease

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