• Useful analgesia but also antipyretic
• Particularly useful in musculoskeletal pain, joint inflammation & bone metastasis
• Can be used in combination with paracetamol and opioids. May lower the dose of opioid required for effective analgesia
• Risk of gastric bleed should not be forgotten, particularly for children using these medications for longer periods. Ibuprofen is the safest from this point of view. Always consider the need for gastro-protectants particularly in prolonged use.
• There is considerable variation in individual response and tolerance to these drugs. A large proportion of children will respond to any NSAID; those who do not respond to one may well respond to another

Ibuprofen

Form

Tablets: (immediate release) 200mg, 400mg, 600mg
Capsule (modified release) 300mg
Liquid: 100mg/5ml. Granules: 600mg/sachet
Sprays, creams and gel 5%

Dose (oral): preferably after food

1 month -12yr: 5mg/kg t.d.s.-q.d.s. (max. 2.4g/24h)
>12yr: 200-600mg t.d.s.-q.d.s. (max. 2.4g/24h)
1–3 months: 5mg/kg t.d.s.-q.d.s.
3–6 months: 50mg t.d.s.; in severe conditions up to 30mg/kg daily in 3–4 divided doses
6 months–1 year: 50 mg t.d.s.-q.d.s.; in severe conditions up to 30 mg/kg daily in 3–4 divided doses
1-4 years: 100 mg t.d.s.; in severe conditions up to 30 mg/kg daily in 3–4 divided doses
4–7 years: 150 mg t.d.s. In severe conditions up to 30mg/kg daily in 3–4 divided doses. Maximum daily dose 2.4g
7–10 years: 200mg t.d.s. In severe conditions up to 30mg/kg daily in 3–4 divided doses. Max. daily dose 2.4g
10–12 years: 300mg t.d.s. In severe conditions, up to 30mg/kg daily in 3–4 divided doses. Maximum daily dose 2.4g
> 12 years: 300–400mg t.d.s-q.d.s; increased in severe conditions to 2.4g/day

Cautions: Preferably give after food. Contraindicated in duct dependent congenital heart disease. avoid if risk of gastrointestinal bleeding if coagulation defects (ibuprofen considered safer than other NSAIDS) or thrombocytopaenia; avoid if hypersensitivity to other NSAIDS or aspirin. Caution in renal, cardiac or hepatic impairment and asthma.

Licence: licensed for use in children

Diclofenac

Form

Tablets (enteric coated): 25mg Tablets (dispersible): 10mg, 50mg
Tablets (modified release): 75mg, 100mg
Capsule (modified release): 75 mg, 100mg. Suppositories: 12.5mg, 25mg, 50mg, 100mg
Injection (IM or IV): 25mg in 1mL

Dose (oral/rectal)

6 months–18yr: 0.3–1 mg/kg (max. 50 mg) t.d.s.

Dose (IV infusion)

2-18yr: 0.3mg/kg od-bd (max: 150mg/day for 2 days)

Cautions: as for Ibuprofen

Licence: solid forms licensed for use in children over the age of 1 up to 25mg dose. Injection forms not licensed.