From the 20th week of pregnancy onward, Ibuprofen use may cause oligohydramnios resulting from foetal renal dysfunction. This may occur shortly after treatment initiation and is usually reversible upon discontinuation. In addition, there have been reports of ductus arteriosus constriction following treatment in the second trimester, most of which resolved after treatment cessation. Therefore, during the first and second trimester of pregnancy, Ibuprofen should not be given unless clearly necessary. If Ibuprofen is used by a woman attempting to conceive, or during the first and second trimester of pregnancy, the dose should be kept as low and duration of treatment as short as possible. Antenatal monitoring for oligohydramnios and ductus arteriosus constriction should be considered after exposure to Ibuprofen for several days from gestational week 20 onward. Ibuprofen should be discontinued if oligohydramnios or ductus arteriosus constriction are found. Doses should be taken every 6 – 8 hours when required, and at least 4 hours should be left between doses. Patients should be well hydrated prior to IV infusion to reduce the risk of renal adverse events; doses should be infused over at least 30 minutes. Ibuprofen lysine injection (NeoProfen): Preterm infants with significant impairment of renal function: Contraindicated Liver Dose Adjustments

Ibuprofen is a propionic acid derivative NSAID that has demonstrated its efficacy by inhibition of prostaglandin synthesis. In humans ibuprofen reduces inflammatory pain, swellings and fever. Furthermore, ibuprofen reversibly inhibits platelet aggregation. Patients should be well hydrated prior to infusion to reduce the risk of renal adverse events; doses should be infused over at least 10 minutes. Renal tubular acidosis and hypokalaemia have been reported in the post- marketing setting typically following prolonged use of the ibuprofen component at higher than recommended doses. Sodium – this medicine contains less than 1 mmol sodium (23 mg) per dose, that is to say essentially 'sodium-free'. If during continued medical management the ductus arteriosus fails to close or reopens, then a second course, alternative pharmacological therapy, or surgery may be needed.

Initial dose: 10 mg/kg IV once, then 5 mg/kg IV at 24 and 48 hours after first dose for a total of 3 doses Severe forms of skin reactions such as bullous reactions, including Stevens- Johnson Syndrome, Erythema multiforme and Toxic Epidermal Necrolysis can occur This medicine can mask symptoms of infection, which may lead to delayed initiation of appropriate treatment and thereby worsening the outcome of the infection. This has been observed in bacterial community acquired pneumonia and bacterial complications to varicella. When this medicine is administered for fever or pain relief in relation to infection, monitoring of infection is advised. In nonhospital settings, the patient should consult a doctor if symptoms persist or worsen. Use: For the relief of signs and symptoms of rheumatoid arthritis and osteoarthritis Usual Adult Dose for Pain

Caution should be advised in patients receiving concomitant medications which could increase the risk of ulceration or bleeding, such as oral corticosteroids, anticoagulants such as warfarin, selective serotonin-reuptake inhibitors or antiplatelet agents such as aspirin (see section 4.5). If anuria or marked oliguria (urinary output less than 0.6 mL/kg/hr) is evident at time of the second or third dose, hold drug until laboratory studies indicate renal function has returned to normal The risk of GI bleeding, ulceration or perforation is higher with increasing NSAID doses, in patients with a history of ulcer, particularly if complicated with haemorrhage or perforation (see section 4.3) and in the elderly. These patients should commence treatment on the lowest dose available.IV Ibuprofen (Caldolor): For IV use only; must be diluted prior to use to a concentration of 4 mg/mL or less