ibuprofen

CLINICAL USE

NSAID and analgesic

DOSE IN NORMAL RENAL FUNCTION

Initially: 1.2–1.8 g daily in 3–4 divided doses, after food. Maximum 2.4 g daily

PHARMACOKINETICS

Molecular weight :206.3

%Protein binding :90–99

%Excreted unchanged in urine : 1

Volume of distribution (L/kg) :0.14

half-life – normal/ESRD (hrs) :2/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 normal renal function.

HD :Not dialysed. Dose as in normal renal function.

HDF/high flux :Not dialysed. Dose as in normal renal function.

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 hyperkalaemia

Analgesics: avoid concomitant use of 2 or more NSAIDs, including aspirin (increased side effects); avoid with ketorolac (increased risk of side effects and haemorrhage); possibly reduced antiplatelet effect with aspirin

Antibacterials: possibly increased risk of convulsions with quinolones

Anticoagulants: effects of coumarins enhanced; possibly increased risk of bleeding with heparins and coumarins

Antidepressants: increased risk of bleeding with SSRIs and venlafaxineAntidiabetic agents: effects of sulphonylureas enhanced

Anti-epileptics: possibly increased phenytoin concentration

Antivirals: increased risk of haematological toxicity with zidovudine; concentration possibly increased by ritonavir

Ciclosporin: may potentiate nephrotoxicity Cytotoxic agents: reduced excretion of methotrexate; increased risk of bleeding with erlotinib

Diuretics: increased risk of nephrotoxicity; antagonism of diuretic effect; hyperkalaemia with potassium-sparing diuretics

Lithium: 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

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 therapyUse normal doses in patients with ERF on dialysis if they do not pass any urineUse 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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