Ibuprofen Dosing Reference — Paediatric & Adult India
| Patient | Dose | Frequency | Max/day | Duration |
|---|---|---|---|---|
| Child ≥ 3 months, ≥ 5 kg | 5–10 mg/kg/dose | Every 6–8 hours | 40 mg/kg/day or 2.4g | 3–5 days fever; 7–10 days pain |
| Child — JIA | 30–40 mg/kg/day in 3–4 doses | Every 6–8 hours | 40 mg/kg/day | Specialist directed |
| Adult — mild pain/fever | 200–400 mg | Every 6–8 hours | 1.2 g/day (OTC) | 3–5 days |
| Adult — moderate pain/inflammation | 400–600 mg | Every 6–8 hours | 2.4 g/day | As directed |
| Adult — RA/OA | 400–800 mg | Three times daily | 2.4 g/day | Specialist directed |
| Adult — dysmenorrhoea | 400 mg | Every 4–6 hours | 1.2 g/day | Duration of symptoms |
Ibuprofen — Clinical Guide for Indian Doctors
Ibuprofen is a propionic acid NSAID and one of the most widely used antipyretic-analgesic drugs in India for both children and adults. It works by inhibiting cyclo-oxygenase (COX-1 and COX-2), reducing prostaglandin synthesis, which is responsible for its anti-inflammatory, analgesic, and antipyretic effects. It is available as Brufen, Ibugesic, and Combiflam across India in syrup, tablet, and combination forms. While effective and generally safe at recommended doses, ibuprofen carries important contraindications that are frequently missed in busy Indian OPD settings — particularly in dengue season, dehydrated children, and patients with renal impairment.
Paediatric ibuprofen — important India-specific cautions
Ibuprofen should not be used during dengue fever — prostaglandin inhibition reduces platelet aggregation and increases the risk of haemorrhage in dengue thrombocytopenia. Paracetamol is the only recommended antipyretic in suspected dengue. Ibuprofen should also be avoided in children with chickenpox (varicella) — a well-documented association with invasive Group A streptococcal necrotising fasciitis exists when NSAIDs are used during varicella. Additionally, avoid ibuprofen in any dehydrated child — renal prostaglandins are critical for maintaining GFR during dehydration and NSAID use can precipitate acute kidney injury.
Ibuprofen and paracetamol — alternating for high fever
When single-agent therapy is insufficient for high fever control, alternating paracetamol and ibuprofen every 3–4 hours (total interval between each drug ~6 hours) is an effective and safe strategy supported by evidence. Combiflam (ibuprofen 400mg + paracetamol 325mg) provides a fixed-dose combination but does not allow dose titration — weight-based dosing with separate agents is preferred for children. Always counsel parents that alternating should be based on time since the last dose, not solely on whether fever has returned.
NSAIDs and renal safety — triple whammy warning
The "triple whammy" combination of an ACE inhibitor (enalapril, ramipril), an ARB (losartan, telmisartan), and an NSAID causes a 31-fold increased risk of acute kidney injury compared to baseline. This combination should always be avoided. When prescribing ibuprofen, check the patient's current medication list — many Indian patients are on antihypertensives without being aware of the risk. Use paracetamol as the analgesic of choice in any patient on RAS-blocking antihypertensives.