Nuprin

Nu·prin (nprn)

A trademark for the drug ibuprofen.

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ibuprofen

Actiprofen Caplets (CA), Advil, Advil Migraine, Anadin Ibuprofen (UK), Anadin Ultra (UK), Apo-Ibuprofen (CA), Arthrofen (UK), Brufen (UK), Calprofen (UK), Children's Advil, Children's Motrin, Cuprofen (UK), Ebufac (UK), Excedrin IB, Fenbid (UK), Fenpaed (UK), Feverfen (UK), Galprofen (UK), Genpril, Hedex Ibuprofen (UK), Ibrufhalal (UK), Ibufem (UK), Ibugel (UK), Ibuleve (UK), Ibumousse (UK), Ibuspray (UK), Ibutop Cuprofen (UK), Ibutop Ralgex (UK), Junior Strength Advil, Junior Strength Motrin, Librofem (UK), Mandafem (UK), Manorfen (UK), Migrafen (UK), Motrin IB, Novo-Profen (CA), Nu-Ibuprofen (CA), NeoProfen, Novaprin (UK), Nuprin, Nurofen (UK), Obifen (UK), Orbifen (UK), Pacifene (UK), Phor Pain (UK), Proflex (UK), Radian-B Ibuprofen (UK), Relcofen (UK), Rimafen (UK)

Pharmacologic class: Nonsteroidal anti-inflammatory drug (NSAID)

Therapeutic class: Analgesic, antipyretic, anti-inflammatory

Pregnancy risk category B (third trimester: D )

FDA Boxed Warning

• Drug may increase risk of serious cardiovascular thrombotic events, myocardial infarction, and stroke. Risk may increase with duration of use, and may be greater in patients who have cardiovascular disease or risk factors for it.
• Drug is contraindicated for perioperative pain in setting of coronary artery bypass graft surgery.
• Drug increases risk of serious GI adverse events, including bleeding, ulcers, and stomach or intestinal perforation, which can be fatal. These events can occur at any time during therapy and without warning. Elderly patients are at greater risk.

Action

Unknown. Thought to inhibit cyclooxygenase, an enzyme needed for prostaglandin synthesis.

Availability

Capsules (liquigels): 200 mg

Oral suspension: 100 mg/2.5 ml, 100 mg/5 ml

Pediatric drops: 50 mg/1.25 ml

Tablets: 100 mg, 200 mg, 400 mg, 600 mg, 800 mg

Tablets (chewable): 50 mg, 100 mg

⊘Indications and dosages

➣ Rheumatoid arthritis; osteoarthritis

Adults: 1.2 to 3.2 g/day P.O. in three to four divided doses

➣ Mild to moderate pain

Adults: 400 mg P.O. q 4 to 6 hours p.r.n.

➣ Primary dysmenorrhea

Adults: 400 mg P.O. q 4 hours p.r.n.

➣ Juvenile arthritis

Children: 30 to 40 mg/kg/day P.O. in three or four divided doses. Daily dosages above 50 mg/kg aren't recommended.

➣ Fever reduction; pain relief

Children ages 6 to 12: 5 mg/kg P.O. if temperature is below 102.5º F (39.2º C) or 10 mg/kg if temperature is above 102.5º F. Maximum daily dosage is 40 mg/kg.

Off-label uses

• Migraine and tension headaches

Contraindications

• Hypersensitivity to drug or other NSAIDs
• Pregnancy

Precautions

Use cautiously in:
• severe cardiovascular, renal, or hepatic disease; GI disease; asthma; chronic alcohol use
• elderly patients
• breastfeeding patients.

Administration

• Ideally, give 1 hour before or 2 hours after meal. If GI upset occurs, give with meals.

Route	Onset	Peak	Duration
P.O. (analgesic)	30 min	1-2 hr	4-6 hr
P.O. (anti-inflam.)	7 days	1-2 wk	Unknown

Adverse reactions

CNS: headache, dizziness, drowsiness, nervousness, aseptic meningitis

CV: arrhythmias

EENT: amblyopia, blurred vision, tinnitus

GI: nausea, vomiting, constipation, dyspepsia, abdominal discomfort, GI bleeding

GU: cystitis, hematuria, azotemia, renal failure

Hematologic: anemia, prolonged bleeding time, aplastic anemia, neutropenia, pancytopenia, thrombocytopenia, leukopenia, agranulocytosis

Hepatic: hepatitis

Metabolic: hyperglycemia, hypoglycemia

Respiratory: bronchospasm

Skin: rash, pruritus, urticaria, Stevens-Johnson syndrome

Other: edema, allergic reactions including anaphylaxis

Interactions

Drug-drug. Acetaminophen: increased risk of adverse renal reactions

Antihypertensives, diuretics: decreased efficacy of these drugs

Antineoplastics: increased risk of adverse hematologic reactions

Aspirin and other NSAIDs, corticosteroids: additive adverse GI effects

Cefamandole, cefoperazone, cefotetan, drugs affecting platelet function (including abciximab, clopidogrel, eptifibatide, ticlopidine, tirofiban), plicamycin, thrombolytics, valproic acid, warfarin: increased risk of bleeding

Cyclosporine: increased risk of nephrotoxicity

Digoxin: slightly increased digoxin blood level

Lithium: increased lithium blood level, greater risk of lithium toxicity

Methotrexate: increased risk of methotrexate toxicity

Probenecid: increased risk of ibuprofen toxicity

Drug-diagnostic tests. Alanine aminotransferase, alkaline phosphatase, aspartate aminotransferase, blood urea nitrogen, creatinine, lactate dehydrogenase, potassium: increased values

Bleeding time: prolonged

Creatinine clearance, glucose, hematocrit, hemoglobin, platelets, white blood cells: decreased values

Drug-herbs. Anise, arnica, chamomile, clove, dong quai, fenugreek, feverfew, garlic, ginger, ginkgo, ginseng, licorice: increased risk of bleeding

White willow: additive adverse GI effects

Drug-behaviors. Alcohol use: additive adverse GI effects

Sun exposure: phototoxicity

Patient monitoring

• Monitor for desired effect.
• Watch for GI upset, adverse CNS effects (such as headache and drowsiness), and hypersensitivity reaction.
• Stay alert for GI bleeding and ulcers, especially in long-term therapy.
• In long-term therapy, assess renal and hepatic function regularly.

Patient teaching

• Tell patient to take with full glass of water, with food, or after meals to minimize GI upset.
• To help prevent esophageal irritation, instruct patient to avoid lying down for 30 to 60 minutes after taking dose.
☞ Instruct patient to immediately report irregular heartbeats, black tarry stools, vision changes, unusual tiredness, yellowing of skin or eyes, change in urination pattern, difficulty breathing, finger or ankle swelling, weight gain, itching, rash, fever, or sore throat.
• Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration, alertness, and balance.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, herbs, and behaviors mentioned above.