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Version control and change history 
 
Version Date from Date to Amendment 
1.0 Nov 2012 March 2014 Original version 

2.0 March 2014 April 2017 Change in ibuprofen formulation  
Changes to dosing 

3.0 28 April 
2017 

Current Change to ibuprofen formulation, review of 
document 

    

  Department for Health and Ageing, Government of South Australia. All rights reserved. 

 

Clinical Guideline 
Ibuprofen 
 
 
Policy developed by: SA Maternal &amp; Neonatal Clinical Community of Practice       
Approved by 
Safety &amp; Quality Strategic Governance Committee on:  27 April 2017 
Next review due:        30 April 2020 
 
 

  
 
 

Summary The purpose of the Ibuprofen Neonatal Medication Guideline is to 
guide nursing, medical and pharmacy staff in the dosing and 
administration of ibuprofen.  
 
 

Keywords Ibuprofen, neonatal medication guideline, NSAID, PDA, patent 
ductus arteriosus, hypertension, aminoglycosides, gentamicin, 
bilirubin, clinical guideline,  Ibuprofen Neonatal Medication 
Guideline 
 

Policy history Is this a new policy?   N 
Does this policy amend or update an existing policy?  Y v2.0 
Does this policy replace an existing policy?  N 
If so, which policies?   
 

Applies to All Health Networks 
CALHN, SALHN, NALHN, CHSALHN, WCHN 
 

Staff impact All Clinical, Medical, Midwifery, Nursing,  Students, Allied Health, 
Emergency, Mental Health, Pathology, Pharmacy 
  

PDS reference CG034 
 

Neonatal Medication Guideline                                                             
 

 



South Australian Neonatal Medication Guidelines 

Ibuprofen 
 5mg/mL injection (as sodium salt) (SAS),  

20mg/mL oral mixture 
  Department of Health, Government of South Australia. All rights reserved 

 

ISBN number:  978-1-74243-404-9 
Endorsed by:                         South Australian Maternal, Neonatal &amp; Gynaecology Clinical Reference Group 
Last Revised: 27/04/2017 
Contact: South Australian Neonatal Medication Guidelines Workgroup at: 

 Health:NeoMed@sa.gov.au  Page 1 of 3 
 

Note 
 
This guideline provides advice of a general nature.  This statewide guideline has been prepared to promote and facilitate 
standardisation and consistency of practice, using a multidisciplinary approach.  The guideline is based on a review of 
published evidence and expert opinion.  

Information in this statewide guideline is current at the time of publication.  

SA Health does not accept responsibility for the quality or accuracy of material on websites linked from this site and does not 
sponsor, approve or endorse materials on such links. 

Health practitioners in the South Australian public health sector are expected to review specific details of each patient and 
professionally assess the applicability of the relevant guideline to that clinical situation. 

If for good clinical reasons, a decision is made to depart from the guideline, the responsible clinician must document in the 
patient s medical record, the decision made, by whom, and detailed reasons for the departure from the guideline. 

This statewide guideline does not address all the elements of clinical practice and assumes that the individual clinicians are 
responsible for discussing care with consumers in an environment that is culturally appropriate and which enables respectful 
confidential discussion. This includes: 

  The use of interpreter services where necessary, 
  Advising consumers of their choice and ensuring informed consent is obtained, 
  Providing care within scope of practice, meeting all legislative requirements and maintaining standards of 

professional conduct, and  
  Documenting all care in accordance with mandatory and local requirements 
 
 

Dose and Indications 

Treatment of significant patent ductus arteriosus (PDA) 

Intravenous, Oral 

Three day course of therapy, doses to be given 24 hours apart 

Day 1:  20 mg/kg  

Day 2 and 3:  10 mg/kg 

Oral mixture can be used if the neonate is tolerating enteral feeds  

If the ductus arteriosus does not close 24 hours after the third dose or if it re-opens, further 

doses may be given.  

 

 

 

 

 



South Australian Neonatal Medication Guidelines 

 Ibuprofen 
 5mg/mL injection (as sodium salt) (SAS),  

20mg/mL oral mixture  
 

ISBN number:  978-1-74243-404-9 
Endorsed by:                         South Australian Maternal, Neonatal &amp; Gynaecology Clinical Reference Group 
Last Revised: 27/04/2017 
Contact: South Australian Neonatal Medication Guidelines Workgroup at: 

 Health:NeoMed@sa.gov.au  Page 2 of 3 
 

Preparation and Administration 

Intravenous 

The intravenous injection contains 5mg/mL ibuprofen. 

Dose 2.5mg 5mg 7.5mg 10mg 12.5mg 15mg 20mg 

Volume 0.5mL 1mL 1.5mL 2ml 2.5mL 3mL 4mL 

Administer as an intravenous infusion over at least 15 minutes.  

Oral 

The oral mixture contains 20mg/mL ibuprofen. 

Dose 3mg 6mg 9mg 12mg 15mg 

Volume 0.15mL 0.3mL 0.45mL 0.6mL 0.75mL 

Give with feeds to minimise gastrointestinal irritation.  

Compatible Fluids 

Sodium chloride 0.9%, glucose 5% 

Adverse Effects 

Common 

Bleeding, salt and fluid retention, hypertension, bronchopulmonary dysplasia 

Infrequent 

Gastrointestinal perforation (particularly if used concurrently or in close proximity to 

corticosteroids), hyperkalaemia, renal impairment, rash 

Rare 

Blood dyscrasias, interstitial nephritis, acute renal failure, hepatitis  

Monitoring  

? Assess for ductal closure 

? Renal function and urine output 

? Assess for signs of bleeding 

 

 

 



South Australian Neonatal Medication Guidelines 

 Ibuprofen 
 5mg/mL injection (as sodium salt) (SAS),  

20mg/mL oral mixture  
 

ISBN number:  978-1-74243-404-9 
Endorsed by:                         South Australian Maternal, Neonatal &amp; Gynaecology Clinical Reference Group 
Last Revised: 27/04/2017 
Contact: South Australian Neonatal Medication Guidelines Workgroup at: 

 Health:NeoMed@sa.gov.au  Page 3 of 3 
 

Version control and change history 

PDS reference: OCE use only 

 
Version Date from Date to Amendment 

1.0 November 2012 March 2014 Original version 

2.0 March 2014 April 2017 Change in ibuprofen formulation 

Changes to dosing 

3.0 April 2017 Current Change to ibuprofen formulation, 

review of document 

    

 
 

Practice Points 

? If anuria or oliguria occurs after any dose, further dosing should be reviewed. 

? Congenital heart disease with a duct-dependent pulmonary or systemic circulation and 

pulmonary hypertension are absolute contraindications to Ibuprofen. 

? Ibuprofen should be used with a high level of caution in babies with active bleeding, 

severe thrombocytopenia and bleeding disorders, known or suspected necrotising 

enterocolitis, or renal failure.  

? Use with caution in known infection. 

? Ibuprofen has been shown to displace bilirubin from its binding site to albumin; hence it 

may cause a significant increase in unbound bilirubin in those infants with a high 

unconjugated bilirubin.  

? Ibuprofen may decrease clearance of aminoglycosides. Hence strict surveillance of 

aminoglycoside serum levels is recommended in those babies who have both ibuprofen 

and aminoglycosides prescribed.  

? Ibuprofen is a better tolerated medication than indomethacin. There is less effect on renal 

and gastrointestinal function. 

? Before administration of ibuprofen an echocardiographic examination should generally be 

performed in order to detect a haemodynamically significant patent ductus arteriosus and 

to exclude pulmonary hypertension and duct-dependent congenital heart disease. 

References  

1. Dani C, Vangi V, Bertini G, Pratesi S, Lori I, Favelli F et al. High-Dose Ibuprofen for Patent 

Ductus Arteriosus in Extremely Preterm Infants: A Randomized Controlled Study. Clinical 

Pharmacology &amp; Therapeutics 2012; 91(4) 590-596 

2. Erdeve O, Yurttutan S, Altug N, Uras N et al. Oral versus intravenous ibuprofen for patent 

ductus arteriosus closure: a randomised controlled trial in extremely low birth weight 

infants:.Arch Dis Child Fetal Neonatal Ed 2012;97; F279 F283  

 


	Ibuprofen_Neo_Cover_v3
	Clinical Guideline
	Ibuprofen
	Policy developed by: SA Maternal &amp; Neonatal Clinical Community of Practice
	Approved by
	Safety &amp; Quality Strategic Governance Committee on:  27 April 2017
	Next review due:        30 April 2020

	Ibuprofen_Neo_v3

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