Ibuprofen
Ibuprofen
Brand names:Motrin, Advil, Nuprin, Caldolor
A non-selective NSAID that reduces pain, inflammation, and fever through cyclooxygenase inhibition. Ibuprofen is the standard oral NSAID in PA civilian EMS protocols and the most commonly carried OTC anti-inflammatory in TCCC and TEMS aid bags.
Pharmacology and Actions
Ibuprofen reversibly inhibits both COX-1 and COX-2 cyclooxygenase enzymes, reducing prostaglandin synthesis. The result is decreased pain signaling, reduced inflammation, and antipyretic effect. Unlike aspirin, ibuprofen's antiplatelet effect is reversible and dose-dependent, returning to baseline within 24 to 48 hours of last dose. The drug is well-absorbed orally with bioavailability of approximately 80 percent.
Indications
- Mild to moderate pain (musculoskeletal, dental, headache, dysmenorrhea)
- Anti-inflammatory therapy for soft tissue injury
- Fever reduction in adults and pediatric patients (over 6 months)
- Adjunct to acetaminophen for pain not controlled by single-agent therapy
- Migraine headache pain in patients without contraindications
Absolute Contraindications
- Known ibuprofen or NSAID allergy
- Active gastrointestinal bleeding or peptic ulcer disease
- Known kidney disease, kidney failure, or kidney transplant
- Severe hepatic impairment
- Third-trimester pregnancy
- Aspirin-induced asthma or NSAID-sensitive bronchospasm
- Recent NSAID administration within the prior 6 hours
- Suspected or confirmed bleeding (external/internal trauma, GI, vascular)
Precautions and Side Effects
Gastrointestinal upset, dyspepsia, and GI bleeding are common with chronic use. Renal impairment can occur with dehydration, in elderly patients, or with prolonged use. Cardiovascular risk (MI, stroke) is increased with chronic high-dose use. Bronchospasm can occur in aspirin-sensitive asthmatics. NSAIDs impair platelet function for the duration of the drug, which is a concern in trauma. PA EMS protocols specifically prohibit NSAID use in suspected internal or external bleeding.
Adult Dosing
Pediatric Dosing
Pediatric dosing per PA Protocol 6003 Pediatric Oral Medication Dose Chart. Standard pediatric dosing: 10 mg/kg PO every 6 to 8 hours, maximum 600 mg per dose, in patients over 6 months of age. Do not administer if patient has had ibuprofen within the prior 6 hours.
Pharmacokinetics
Peak Effect: PO: 1 to 2 hours after administration
Duration: 4 to 6 hours per dose
Storage and Handling
Store at controlled room temperature (15 to 30 degrees Celsius). Protect from moisture. Liquid suspension and IV preparation require specific storage conditions per manufacturer. Tablets are stable in most field environments.
Reconstitution:
Tablet and liquid forms require no reconstitution. IV preparation (Caldolor) requires dilution per manufacturer instructions before infusion.
TCCC and TECC Role
Ibuprofen is not a primary CWMP component (meloxicam fills that role due to its 24-hour duration). Ibuprofen is widely carried as a backup NSAID and in TEMS aid bags because of its OTC availability, rapid onset, and well-established safety profile. The 6 to 8 hour dosing interval is operationally less convenient than meloxicam's once-daily schedule for prolonged casualty care, which is why meloxicam was selected for the CWMP. Ibuprofen remains the right choice for civilian EMS pain management protocols and short-duration pain control.
Ibuprofen is the NSAID providers reach for when pain is mild to moderate and bleeding is not a concern. In civilian EMS the bleeding contraindication eliminates ibuprofen from trauma pain management almost entirely. In TEMS settings, ibuprofen has a role for sport-injury type complaints, headaches, and musculoskeletal pain in personnel who do not have a wound that is actively bleeding or might bleed. Stack with acetaminophen for additive analgesia when neither is contraindicated.
Administering ibuprofen to a trauma patient with suspected internal bleeding because the external injury looks minor. NSAIDs impair platelet aggregation for the duration of the drug and can worsen occult hemorrhage. PA protocols specifically prohibit this. When in doubt with trauma, use acetaminophen instead.
This drug profile is provided as educational reference material for trained medical providers. It is not medical advice, not a substitute for formal training, and not a substitute for current published guidelines or medical direction.
Drug administration is governed by your scope of practice, agency standing orders, medical director protocols, and applicable state and federal regulations. Controlled substances are subject to additional handling, accountability, and documentation requirements per DEA and state law. Always verify dosing, indications, contraindications, and route of administration against current published guidelines and your local protocols before administration.
If this content is being viewed during a medical emergency, call 911 immediately and follow the direction of your local emergency dispatch and medical control. Do not use this reference as a substitute for emergency medical services.
Drug information evolves. Last reviewed dates and source citations are provided for each entry. Confirm currency against the cited source before clinical use.
Penn Tactical Solutions publishes this reference for educational purposes. PTS does not provide medical direction and does not assume responsibility for clinical decisions made in the field. Clinical responsibility rests with the administering provider, their medical director, and their agency.
Educational reference for trained medical providers. Not medical advice. Not a substitute for formal training, current published guidelines, or medical direction. Drug administration is governed by your scope of practice, agency standing orders, medical director protocols, and applicable state and federal regulations. Controlled substances require additional storage, accountability, and documentation per DEA and state law.
In a medical emergency, call 911. This reference is not a substitute for emergency medical services.
Verify dosing, indications, and contraindications against current published guidelines and your local protocols before administration. Confirm content currency against the source citation. Penn Tactical Solutions does not provide medical direction. Clinical responsibility rests with the administering provider, their medical director, and their agency.
Ibuprofen
| IV/IO | Hospital/specialty transport: 400 to 800 mg IV (Caldolor) over 30 minutes. Not commonly carried in prehospital EMS. (10 to 15 minutes) |
| PO | PA EMS (Musculoskeletal Trauma Protocol 6003): 10 mg/kg PO, maximum 600 mg single dose. Standard OTC dosing: 200 to 400 mg PO every 4 to 6 hours, maximum 1200 mg/day OTC or 3200 mg/day prescription. TCCC field use: 400 mg PO every 6 hours as needed. (20 to 30 minutes for analgesia; 60 minutes for full anti-inflammatory effect) |