Bedside Snapshot

Use It For: Mild to moderate pain and fever (oral or IV); moderate to severe acute pain as an adjunct to opioids and postoperative pain (IV); primary dysmenorrhea and arthritis (oral Rx)
Adult Dose: IV: 400–800 mg over 30 min every 6 hr as needed (max 3,200 mg/day)
Oral Rx: 400 mg every 4–6 hr as needed (max 3,200 mg/day)
OTC: 200–400 mg every 4–6 hr (max 1,200 mg/24 hr)
Pediatric Dose: IV, 6 mo to <12 yr: 10 mg/kg (max 400 mg) every 4–6 hr as needed; 12–17 yr: 400 mg. Max 40 mg/kg or 2,400 mg/day, whichever is less. 3 to <6 mo: single 10 mg/kg (max 100 mg). Oral: labeled 6 mo to <2 yr only
Onset / Duration: IV: 30-min infusion (no labeled onset time); oral: peak 1–2 hr; dosing interval 4–6 hr
Do Not Give / Hold If: Hypersensitivity; asthma, urticaria or allergy after aspirin or other NSAIDs; CABG surgery; active GI bleeding (clinical hold); advanced renal disease or volume depletion; about 30 weeks or later in pregnancy
Watch For: GI bleeding (melena, falling hemoglobin); acute kidney injury and hyperkalemia; new hypertension or heart failure; anaphylaxis or bronchospasm; serious skin reactions
Reversal / Rescue: No specific antidote: stop the drug and give supportive care. GI bleed: resuscitate per protocol. Anaphylaxis: IM epinephrine per protocol
Must Remember: Never stack NSAIDs: do not add IV ibuprofen to ketorolac, meloxicam or aspirin for analgesia; hydrate before IV dosing; ask about home ibuprofen

Indications

Emergency & Prehospital

Mild to moderate pain: oral and IV. The label covers adults, and children 3 months and older for IV.
Moderate to severe acute pain: IV, alongside an opioid analgesic (labeled for adults and children)
Fever reduction: oral and IV (labeled)
EMS: the 2023 prehospital pain guideline lists IV NSAIDs as one conditional option. Evidence specific to ibuprofen is thin (see Clinical Pearls). Oral NSAIDs are a conditional option when oral is the preferred route. Use them only where the protocol lists them

ED / ICU / Transport

Postoperative pain: IV, alone or paired with an opioid (labeled)
Primary dysmenorrhea: oral Rx, 400 mg every 4 hr as needed, starting with earliest pain (labeled)
Rheumatoid arthritis, osteoarthritis, juvenile arthritis: oral Rx for scheduled long-term therapy. This is not an acute ED use.

Other Uses

Over-the-counter self-care: pain and fever in adults and children 12 and older (OTC label). For children under 12, ask a doctor.
Patent ductus arteriosus (neonates): ibuprofen lysine (NeoProfen) is a different IV product, used in the NICU. This page does not cover it. Do not swap it in for adult or pediatric ibuprofen.

Dosing & Administration

Doses vary by protocol; follow local protocols and medical direction.

Available Forms

IV vial (Caldolor): 800 mg/8 mL (100 mg/mL). It must be diluted before use
IV ready-to-use bag (Caldolor): 800 mg/200 mL (4 mg/mL). Use it for 800 mg doses only. Weight-based pediatric doses need 4 mg/mL or less
Oral tablets, Rx: 400, 600 and 800 mg. The label dosing text names these three strengths
Oral tablets, OTC: 200 mg
Oral suspension (children): 100 mg/5 mL, berry flavored. Dose by weight with the supplied measuring device

Adult Dosing

Indication	Dose & Route	Repeat / Max	Notes
Mild to moderate pain (oral Rx)	400 mg PO	Every 4–6 hr as needed; max 3,200 mg/day	Doses above 400 mg per dose were no more effective in analgesic trials. Take with food or milk if GI upset occurs
Primary dysmenorrhea (oral Rx)	400 mg PO	Every 4 hr as needed; max 3,200 mg/day	Start at the earliest onset of pain
Pain or fever, OTC self-care (age 12 and older)	200–400 mg PO (1–2 tablets)	Every 4–6 hr as needed; max 1,200 mg in 24 hr (6 tablets) unless a doctor directs	Smallest effective dose. Children under 12: ask a doctor (OTC label)
Moderate to severe acute pain (IV)	400–800 mg IV over at least 30 min	Every 6 hr as needed; max 3,200 mg/day	Adjunct to opioids. Fixed adult dose, not weight-based. Hydrate first (Dosing & Administration). Use the lower dose when pain is milder
Fever (IV)	400 mg IV over at least 30 min, then 400 mg IV every 4–6 hr or 100–200 mg IV every 4 hr as needed	Max 3,200 mg/day	Label alternative: 100–200 mg every 4 hr as needed

Pediatric Dosing

Indication	Dose (per kg) & Route	Max Single / Max Total	Notes
Pain or fever, IV, 12–17 years	400 mg IV over at least 10 min, every 4–6 hr as needed	400 mg / 40 mg/kg or 2,400 mg per day, whichever is less	Label dosing for age 12 and older
Pain or fever, IV, 6 months to <12 years	10 mg/kg IV over at least 10 min, every 4–6 hr as needed	400 mg / 40 mg/kg or 2,400 mg per day, whichever is less	Actual body weight. Infusion at least 10 min per label. Do not exceed 40 mg/kg in 24 hr
Pain or fever, IV, 3 months to <6 months	10 mg/kg IV over at least 10 min, single dose	100 mg single dose / no daily total in label	Label gives a single dose at this age. Any repeat dose needs medical direction (specialist use)
Fever, oral suspension, 6 months to 2 years	5 mg/kg PO if temperature under 102.5 °F (39.2 °C); 10 mg/kg PO if 102.5 °F or higher	Max 40 mg/kg per day	Each dose reduces fever for about 6–8 hr. Dosing interval per label; do not exceed the daily maximum
Pain, oral suspension, 6 months to 2 years	10 mg/kg PO	Every 6–8 hr as needed; max 40 mg/kg per day	Schedule doses so they do not disturb sleep (label). Actual body weight
Juvenile arthritis, oral (chronic)	30–40 mg/kg/day in 3–4 divided doses; 20 mg/kg/day for milder disease	Max 40 mg/kg/day; above 50 mg/kg/day not recommended	Long-term pediatric rheumatology use, not acute ED dosing

Not established in young infants: young infants are the gap. Oral safety and effectiveness are not established below 6 months (label). IV labeling starts at 3 months. Under those ages, a specialist or medical direction has to guide the dose.

Oral scope: the oral doses above (fever and pain, 6 months to under 2 years) are taken from the suspension label. Children 2 years and older: follow the manufacturer's current weight-based chart or the pediatric protocol. Keep the IV ceiling, 40 mg/kg/day or 2,400 mg/day, as your reference maximum.

Preparation & Administration

IV dilution: the 800 mg/8 mL vial must be diluted to 4 mg/mL or less in 0.9% sodium chloride, D5W or lactated Ringer’s. Example: 800 mg is 8 mL in at least 200 mL. Diluted solution is stable 24 hr at room temperature and room light
Visual check: inspect for particles and discoloration before use; do not use a solution that is cloudy, discolored or has particles
Infusion time: at least 30 min for adults and at least 10 min for children (label). Use a pump so the infusion time is met
Hydration: the label requires well-hydrated patients before IV dosing; correct volume depletion first
Oral: take with food or milk for GI upset. Shake the suspension and use only the supplied measuring device
Line: confirm the IV access and pump requirements against institutional policy

Contraindications & Precautions

Contraindications

Known hypersensitivity to ibuprofen or any component (anaphylactic reactions and serious skin reactions in the label)
History of asthma, urticaria or allergic-type reactions after aspirin or other NSAIDs (severe, sometimes fatal anaphylaxis reported)
Setting of coronary artery bypass graft (CABG) surgery (boxed warning)

Precautions

Heart failure or edema: avoid in severe heart failure unless the benefit clearly outweighs the risk of making it worse
Kidney disease or volume depletion: avoid in advanced renal disease unless the benefit outweighs the risk. Correct volume first. Monitor renal function (label)
Liver disease: hepatotoxicity is labeled. ALT or AST at 3 times the upper limit of normal (ULN) showed up in about 1% of NSAID-treated patients in trials. Stop if it persists
Hypertension: it can raise blood pressure and also blunt the effect of ACE inhibitors, ARBs and diuretics
GI bleeding risk: older age, prior ulcer or GI bleeding, anticoagulant or antiplatelet therapy, and SSRI or SNRI use all raise the risk. Asthma without aspirin sensitivity needs monitoring
Anemia and hyperkalemia: check hemoglobin when anemia is suspected. Hyperkalemia is labeled, including in patients without renal impairment

Hold / Reassess If

SBP under 90 mmHg or signs of hypovolemia: correct volume before any dose (practice-based; the label requires hydration before IV use)
Melena, hematemesis, new bleeding or a falling hemoglobin: stop
Rash with blistering or mucosal lesions, fever with eosinophilia or organ involvement, or signs of anaphylaxis: stop and treat per protocol
Falling urine output or rising creatinine: stop and reassess renal function
Known bleeding disorder, thrombocytopenia, suspected intracranial hemorrhage, major trauma or perioperative bleeding: avoid or reassess with the prescriber (practice-based; these are not labeled contraindications)
New chest pain or focal neurologic deficit: stop and follow the ACS or stroke pathway
Worsening dyspnea, edema or weight gain in heart failure: stop and reassess

FDA Boxed Warning: NSAIDs can cause serious cardiovascular thrombotic events. Heart attack and stroke are on that list, and either can be fatal. It can appear early, and the risk climbs the longer the drug runs. Serious GI bleeding, ulceration and perforation are also possible. These can kill and can come with no warning. Older adults, and anyone with an old ulcer or bleed, face higher risk. Ibuprofen is contraindicated in the setting of CABG surgery.

Hidden NSAIDs: ask about home ibuprofen, naproxen and aspirin, and check combination products. Some IV combination products contain ibuprofen, such as acetaminophen plus ibuprofen (see the acetaminophen IV page). Count every NSAID before the first dose.

Adverse Effects & Toxicity

Common

The frequencies below come from the IV label, which covers adult and pediatric trials:

GI: nausea, vomiting, flatulence, dyspepsia, abdominal pain (adults, more than 5%)
CNS: headache and dizziness (adults, more than 5%)
Pediatric: infusion-site pain, vomiting, nausea, anemia and headache (2% or more)
Other: peripheral edema, urinary retention (less common)

Serious / Life-Threatening

Effect	Recognition	Management
GI bleeding, ulcer or perforation	Melena, hematemesis, abdominal pain or a falling hemoglobin; can be painless	Stop the drug; resuscitate; treat per protocol. IV proton-pump inhibitor per local protocol
Heart attack or stroke	Chest pain, dyspnea, focal weakness, speech or vision change	Stop; follow the ACS or stroke pathway
Acute kidney injury or hyperkalemia	Falling urine output, rising creatinine or potassium	Stop; restore volume; check creatinine and potassium
Anaphylaxis or bronchospasm	Urticaria, angioedema, wheeze or hypotension; may occur with the first dose	Stop; IM epinephrine and airway support per protocol
Serious skin reaction or DRESS	Blistering rash, mucosal lesions, fever, eosinophilia, organ involvement	Stop at the first sign; evaluate clinically
Hepatotoxicity	ALT or AST 3 times ULN or more; jaundice	Stop if it persists or worsens; evaluate liver disease
Hypertension or heart failure	New or worse blood pressure; edema, dyspnea, weight gain	Stop or reassess; treat per protocol

A 2025 meta-analysis of 25 studies compared the nonselective NSAIDs. Ibuprofen had the lowest significant GI bleeding risk (pooled OR 2.28, 95% CI 1.71–3.03). Ketorolac had the highest. The risk is still there with ibuprofen.

Overdose & Toxicity Management

Signs: lethargy, drowsiness, nausea, vomiting and epigastric pain are typical. With larger ingestions, seizures, metabolic acidosis and, rarely, apnea (mainly in very young children) are reported. Rarely: hypertension, acute renal failure, respiratory depression and coma (label)
Immediate care: give supportive care and airway support. Check for GI bleeding, renal injury and acidosis. Manage hypotension and seizures per protocol
Antidote: none. Dialysis, hemoperfusion and forced diuresis may not help. The reason is that ibuprofen is highly protein bound (label)
Poison center: 1-800-222-1222 (US, from the label). Consult before decontamination. Activated charcoal may reduce absorption if given soon after a large ingestion. The poison center directs its use
Pediatric ingestion: any child who ingests more than 400 mg/kg needs immediate medical referral and observation

Monitoring

Parameter	When / How Often	Target / Act If
Clinical: pain score and sedation	Before the dose and at the protocol reassessment interval	Inadequate relief: add a different analgesic per protocol; do not add a second NSAID
Bleeding	Ongoing while the drug is used	Melena, hematemesis or new wound bleeding: stop and resuscitate
Blood pressure	Before the dose; repeat in patients on antihypertensives	New or worse hypertension, or SBP under 90 mmHg: stop and reassess
Urine output and creatinine	Baseline in renal risk; repeat per protocol or hospital course	Falling urine output or creatinine rise: stop. See Creatinine
Potassium	With renal risk or prolonged use	Rising K⁺: evaluate hyperkalemia. See Potassium
Hemoglobin or hematocrit	When anemia or bleeding is suspected (label)	Falling value: stop and evaluate the source
Liver tests (ALT, AST)	Prolonged therapy or known liver disease	ALT or AST 3 times ULN or more: stop if it persists
Heart failure signs	Ongoing; weight and edema when present	Worsening edema, dyspnea or weight gain: stop and reassess

Interactions & Compatibility

Clinically Significant Interactions

Drug / Class	Effect	What To Do
Low-dose aspirin	Ibuprofen blunts aspirin’s antiplatelet effect when given regularly, especially when ibuprofen is dosed before aspirin (label). Raises cardiovascular and GI event risk in patients on aspirin for cardiac prophylaxis	Discuss timing with the prescriber. Per label, immediate-release aspirin given at least 2 hr before ibuprofen reduces the effect; this spacing is not established for enteric-coated aspirin
Other NSAIDs and salicylates (ketorolac, meloxicam, naproxen, diflunisal)	Additive GI and renal toxicity with little or no added analgesia	Do not combine. Check the MAR and home medicines. See Ketorolac and Meloxicam
Anticoagulants (for example warfarin), antiplatelets, SSRIs, SNRIs	Synergistic bleeding risk	Avoid routine co-use where possible; monitor for bleeding
ACE inhibitors, ARBs, beta-blockers, diuretics	Blunted antihypertensive effect (label names beta-blockers, including propranolol); higher risk of renal decompensation, especially with volume depletion or heart failure	Hydrate; monitor blood pressure and creatinine
Lithium, digoxin, methotrexate, cyclosporine, pemetrexed	NSAIDs can raise lithium and digoxin levels and increase methotrexate, cyclosporine and pemetrexed toxicity (label: lithium, methotrexate, cyclosporine, pemetrexed myelosuppression, renal and GI toxicity)	Ask about these before dosing. Monitor lithium and digoxin levels, methotrexate toxicity, and renal function per prescriber or pharmacy. Pemetrexed: check the pemetrexed label for NSAID timing

IV Compatibility

Preferred diluents: 0.9% sodium chloride, D5W or lactated Ringer’s (label); keep the final concentration at 4 mg/mL or less
The label reviewed here does not state dedicated-line or Y-site compatibility. Verify it with an institutional compatibility resource

Special Populations

Pediatrics: IV labeling starts at 3 months. Oral labeling is weight-based from 6 months. Use the Pediatric Dosing table. Do not repeat doses here
Neonates: IV ibuprofen lysine for patent ductus arteriosus is a separate NICU product. It is not covered here
Pregnancy: from about 20 weeks, NSAIDs can cause fetal kidney dysfunction and oligohydramnios. Avoid them from about 30 weeks, because they can close the fetal ductus arteriosus prematurely. The label says to limit dose and duration between about 20 and 30 weeks. Before about 20 weeks, the label’s restriction does not apply. Use the lowest effective dose for the shortest time
Lactation: the oral label says it is not known whether ibuprofen passes into human milk. The decision to continue nursing or the drug should weigh the mother’s need for the drug. Some EMS protocols give other analgesics first. Follow local protocol
Older Adults: higher GI bleeding risk (label). AGS Beers 2023 lists oral non-COX-2-selective NSAIDs, ibuprofen included, as potentially inappropriate. Avoid chronic use unless other alternatives are not effective and the patient can take a gastroprotective agent (proton-pump inhibitor or misoprostol). Avoid short-term scheduled use with corticosteroids, anticoagulants or antiplatelet agents under the same condition. Beers also says to avoid NSAIDs at creatinine clearance under 30 mL/min
Renal Impairment: avoid in advanced renal disease unless the benefit outweighs the risk. Correct volume depletion first. Monitor renal function. The IV label gives no numeric cutoff. Beers avoids NSAIDs at creatinine clearance under 30 mL/min. Dialysis may not remove ibuprofen, because it is highly protein bound
Hepatic Impairment: monitor liver tests. Stop if ALT or AST stay at 3 times ULN or more. In cirrhosis with ascites, NSAIDs add a high risk of kidney injury and bleeding. Prefer a non-NSAID analgesic when one can be used
Obesity / Dosing Weight: adult doses are fixed. Pediatric mg/kg doses are written per kg. This page uses actual body weight, with the stated caps
Cardiovascular Disease: avoid after a recent heart attack or in severe heart failure unless the benefit clearly outweighs the risk. The boxed warning applies

Field & Transport Considerations

Scope: whether EMT, AEMT and paramedic crews can use it depends on state and agency protocol. In the sources reviewed, IV ibuprofen is not a standard prehospital drug. Every medication history should ask about home OTC ibuprofen
Storage & Stability: store at 20–25 °C (68–77 °F). Excursions to 15–30 °C (59–86 °F) are permitted (label). Discard the unused portion of a vial
Carried Concentration: in a busy transport, the 100 mg/mL vial and the 4 mg/mL bag look alike. Confirm the concentration and the dose in mg before hanging
Infusions in Transport: adults get a 30-minute infusion and children get 10 minutes. Use a pump. Keep the patient hydrated. Document the infusion start and finish
Handoff Essentials: dose in mg and mg/kg, time of the last dose, total dose in the previous 24 hr, pain score before and after, any bleeding or vomiting

Clinical Pearls

Stacked NSAIDs: IV ibuprofen and IV ketorolac both carry the NSAID boxed warning. Stack them and you add GI and kidney toxicity with no extra pain relief. Ask about OTC ibuprofen or naproxen before any NSAID.

Hydrate first: the label requires a well-hydrated patient before IV dosing. Vomiting or hypotensive? Volume comes before the analgesic.

Per kg, then the cap: pediatric doses run per kg, with a cap on each dose and a cap on the 24-hour total. Calculate from a measured weight. Check the daily total as well as each dose.

Exam discriminator (NREMT, CCRN, CFRN, FP-C, CCP-C): ketorolac's boxed warning sets a 5-day total limit. The IV ibuprofen label has a daily maximum but no 5-day limit. Its boxed warning covers cardiovascular and GI risk only.

Prehospital evidence: the 2023 evidence-based prehospital pain guideline makes conditional recommendations. It favors IV NSAIDs over IV acetaminophen, IV NSAIDs or IV opioids as alternatives. When oral is preferred, it accepts either oral acetaminophen or oral NSAIDs (conditional). Those recommendations are written for IV NSAIDs as a class. Follow the local protocol that names the product.

Pharmacology

Mechanism of Action

Inhibits cyclooxygenase COX-1 and COX-2 (label). Less prostaglandin synthesis means less sensitization of pain nerves and less fever, which gives analgesia and antipyresis
Platelet COX-1 inhibition is reversible. The antiplatelet effect wears off as the drug clears, unlike aspirin’s irreversible effect. That is why regular ibuprofen can interfere with aspirin
The S-enantiomer is the active form. The R-enantiomer converts to S (about 60% in adults) and acts as a circulating reservoir (label)

Pharmacokinetics

Route	Onset	Peak	Duration
IV (adults)	Not labeled	Not labeled; 30-min infusion (label)	Dosing interval 4–6 hr
Oral (Rx)	Not labeled; well absorbed	1–2 hr	Dosing interval 4–6 hr

Half-life: adults, IV about 2.2–2.4 hr; children, IV about 1.3–1.8 hr (shorter than adults); oral about 2 hr
Metabolism: hepatic, to hydroxylated and carboxylated metabolites; the majority of an oral dose is recovered in urine within 24 hr; less than 1% is excreted unchanged
Protein binding: more than 99%, saturable above about 20 mcg/mL; volume of distribution changes with age and fever (label)

Names & Classification

Generic Name: Ibuprofen (racemic; the S-enantiomer is active)
Brand Names: Motrin (oral Rx and OTC); Advil (OTC); Caldolor (IV, adults and children 3 months and older); NeoProfen (ibuprofen lysine IV, neonatal PDA, separate product); Combogesic IV (acetaminophen with ibuprofen; see acetaminophen IV)
Pharmacologic Class: Nonsteroidal anti-inflammatory drug (nonselective COX-1 and COX-2 inhibitor)
Therapeutic Class: Analgesic, antipyretic and anti-inflammatory
Controlled Substance: Not controlled
ISMP High-Alert: No (as used here; see Dosing & Administration for error traps)
Look-Alike / Sound-Alike: Ibuprofen IV (Caldolor, adults) and ibuprofen lysine (NeoProfen, neonatal PDA) are different products and doses. None commonly reported for the oral forms
Error-Prone Abbreviations to Avoid: None specific; write “ibuprofen” and the dose in mg

References

Cumberland Pharmaceuticals Inc. (2026). CALDOLOR (ibuprofen) injection, for intravenous use [prescribing information] (label version 17, effective January 29, 2026). DailyMed, National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=1eaa7790-f1a1-4f51-b10a-cbbaf033f684
Aurobindo Pharma Limited. (2025). Ibuprofen tablets, USP, for oral use [prescribing information] (effective February 14, 2025). DailyMed, National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=00872852-680a-41b3-901b-b991b12a176d
NuCare Pharmaceuticals, Inc. (2024). Ibuprofen oral suspension USP, 100 mg/5 mL [prescribing information; repackager label] (effective March 20, 2024). DailyMed, National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=141b7964-cce6-74e4-e063-6294a90af746
Lindbeck, G., Shah, M. I., Braithwaite, S., Powell, J. R., Panchal, A. R., Browne, L. R., et al. (2023). Evidence-based guidelines for prehospital pain management: Recommendations. Prehospital Emergency Care, 27(2), 144–153. https://doi.org/10.1080/10903127.2021.2018073
Tawfik, A. G., Gomez-Lumbreras, A., Del Fiol, G., et al. (2026). Nonsteroidal anti-inflammatory drugs and risk of gastrointestinal bleeding: A systematic review and meta-analysis. Clinical Pharmacology & Therapeutics, 119(1), 46–62 (online 2025). https://doi.org/10.1002/cpt.70054
2023 American Geriatrics Society Beers Criteria Update Expert Panel. (2023). American Geriatrics Society 2023 updated AGS Beers Criteria for potentially inappropriate medication use in older adults. Journal of the American Geriatrics Society, 71(7), 2052–2081. https://doi.org/10.1111/jgs.18372

Last updated October 2026 Spotted something wrong? Report an error and include the page URL.

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