ibuprofen*

ibuprofen*

Indication

• A prostaglandin inhibitor to treat symptomatic patent ductus arteriosus (PDA)

Dosage Guidelines

• Post-menstrual age less than 28 weeks or Post-natal age less than 7 days: 10 mg/kg/dose oral/IV, followed by 5 mg/kg/dose oral/IV at 24 and 48 hours after the initial dose
• Post-menstrual age 28 weeks or greater and post-natal age 7 days or greater: 20 mg/kg/dose oral/IV, followed by 10 mg/kg/dose oral/IV at 24 and 48 hours after the initial dose 
• If anuria or marked oliguria (urine output less than 0.6 mL/kg/hour) is evident at the scheduled time of the second or third dose, hold dose until renal function returns to normal.

Administration

• Oral – preferred due to significantly lower cost than IV
• IV intermittent slow infusion over 15 minutes
• Add 2 mL of ibuprofen 10 mg/mL to 2 mL of sodium chloride 0.9% to produce a final concentration of 5 mg/mL
• PRIOR and SUBSEQUENT to IV administration:  the infusion line should be flushed over 15 minutes with 1.5 to 2 mL of sodium chloride 0.9%

Adverse Effects

• Reversable decrease in urine output, hyponatremia, hyperkalemia, increased serum creatinine and urea
• Platelet dysfunction and increased risk of bleeding, intestinal perforation, necrotizing enterocolitis (NEC)

Comments

• Before administration of the medication, the following studies should be considered: electrolytes, bilirubin, creatinine, CBC (hemoglobin, platelets)
• NOT compatible with TPN and SMOF
• Monitor accurate intake and output while on treatment
• If anuria or severe oliguria occurs, the next dose may be withheld or postponed, until renal function improves. 
• DO NOT give to infants on hydrocortisone or dexamethasone as there is a significant risk of GI bleeding and/or perforation.  Ensure there is a 48-72 hour period between finishing ibuprofen and starting steroids.
• Contraindicated in neonates with life-threatening infections, bleeding/coagulation defects, NEC, significant renal impairment, hepatic disease, thrombocytopenia, abdominal pathology, or “duct-dependent” congenital heart diseases in which patency of the ductus arteriosus is necessary for satisfactory pulmonary or systemic blood flow (e.g., pulmonary atresia, pulmonary stenosis, transposition of the great arteries, coarctation of the aorta, hypoplastic left heart)
• Caution if significant hyperbilirubinemia
• Concomitant administration with aminoglycosides, vancomycin or digoxin may increase the serum concentrations of these medication

Supplied As

• 20 mg/mL oral suspension
• 10 mg/mL (2 mL) vial * Special Access Medication - Pharmacy maintains a future use supply of IV ibuprofen -approval through the Special Access Program is not required prior to initiation