Ibuprofen - 400mg, 600mg, or 800mg?

Written by Vivian Lei

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For short term relief of acute pain in the ED, 400 mg of oral ibuprofen offers a similar decrease in pain score compared to both 600 mg and 800 mg of ibuprofen.

Why does this matter?
Ibuprofen is one of the most frequently used oral analgesics in the ED and it is often given in higher doses than its analgesic ceiling with the assumption that it may have a greater effect on pain.

More ibuprofen may not be better
This was a randomized, double-blind study in which researchers enrolled 225 adult ED patients with acutely painful conditions and randomized them to receive 3 different doses of ibuprofen: 400, 600, and 800 mg. Pain scores were obtained at baseline and after 60 minutes following ibuprofen administration on a standard 0 to 10 pain scale. Reductions in pain score from baseline were similar in each group and there were no clinically meaningful differences in mean pain scores between the 3 groups at 60 minutes. Mean pain scores in the 400, 600, and 800 mg ibuprofen groups changed from 6.48 to 4.36, 6.35 to 4.5, and 6.46 to 4.5 after 60 minutes, respectively. No adverse effects were reported, although patients were only followed for 60 minutes. This a good reminder of ibuprofen’s analgesic ceiling for short term pain relief.

Source
Comparison of Oral Ibuprofen at Three Single-Dose Regimens for Treating Acute Pain in the Emergency Department: A Randomized Controlled Trial. Ann Emerg Med. 2019 Aug 2. pii: S0196-0644(19)30449-4. doi: 10.1016/j.annemergmed.2019.05.037. [Epub ahead of print]

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Reviewed by Clay Smith

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