MedBalans

Indications (Fever · mild–moderate pain · inflammatory conditions (otitis media adjunct, pharyngitis, musculoskeletal injury, post-immunization fever per local practice) — symptomatic NSAID relief, not disease-modifying (BNFC, AAP, NICE, WHO, CPS))
Minimum age and weight (≥3 months and **≥5 kg** per BNFC/NHS (AAP/CPS often cite **≥6 months** for OTC use) — **not for neonates** or infants <5 kg; 3–5 months: short course only, seek review if symptoms persist >24 h (BNFC, NHS, AAP, CPS))

First-line therapy

Ibuprofen • p.o. • 5–10 mg/kg/dose • 3×/day

Max 400 mg/dose · Max 1200 mg/day · Duration: PRN · 5–10 mg/kg/dose q8h (3×/day) — calculator default; use 10 mg/kg for moderate pain/fever, 5 mg/kg for younger infants or GI risk (BNFC, NHS, AAP)

• Standard dose: **5–10 mg/kg/dose** PO every **6–8 h** — younger infants, reduced oral intake, or GI sensitivity: prefer **5 mg/kg q6h** (4×/day); older children and moderate–severe pain: **10 mg/kg q8h** (3×/day) (BNFC, NHS, AAP, WHO, CPS).
• Maximum single dose: **400 mg/dose** for most children (weight-based 10 mg/kg capped at 400 mg); adolescents ≥12 years may receive **200–400 mg/dose** up to **600 mg/dose** in severe inflammatory pain per BNFC — calculator caps at **400 mg/dose** as safe pediatric default (BNFC, NHS, AAP).

• Maximum daily dose: **30 mg/kg/day** per BNFC standard limit; many pediatric references allow up to **40 mg/kg/day** with absolute cap **1200 mg/day** (WHO MSF, NHS OTC guidance); calculator uses **max 1200 mg/day** — do not exceed **30 mg/kg/day** in infants 3–11 months or dehydration without specialist advice (BNFC, WHO, CPS).
• Minimum age: **≥3 months and ≥5 kg** (BNFC/NHS); AAP/CPS OTC labeling often **≥6 months** — avoid in neonates; use paracetamol for younger infants when antipyretic needed (BNFC, AAP, CPS, NHS).
• Duration: OTC self-care typically **≤3 days** for fever, **≤5 days** for pain without medical review — discontinue and reassess if symptoms persist or worsen (NHS, BNFC, CPS).

Enter weight on Kids to calculate doses

Paracetamol (acetaminophen) • p.o.

Duration: PRN · 10–15 mg/kg/dose q4–6h — see **Paracetamol** card for full PO/IV/rectal calculators; preferred when NSAIDs contraindicated or in younger infants (AAP, NICE, CPS)

• **Younger infants** (<3–6 months) or weight <5 kg — paracetamol first-line antipyretic; ibuprofen not recommended (BNFC, AAP, CPS, NHS).
• **Dehydration** or significant **renal impairment** — avoid ibuprofen; paracetamol preferred if antipyretic/analgesic needed (BNFC, AAP, CPS).
• **Hepatic disease** or concern for hepatotoxicity — paracetamol usable with dose adjustment; ibuprofen does not replace hepatic caution but paracetamol may be preferred when GI bleeding risk is high (BNFC, CPS).
• **Active GI bleeding**, **peptic ulcer**, or **NSAID hypersensitivity** (including aspirin-exacerbated respiratory disease) — use paracetamol; do not give ibuprofen or other NSAIDs (BNFC, AAP, NICE).
• **Varicella** with systemic illness or concern for invasive infection — many clinicians prefer paracetamol for fever; if ibuprofen used, counsel caregivers and monitor closely — evidence on invasive GAS risk is inconclusive; AAP does not contraindicate routine short-course ibuprofen, NICE historically cautioned (AAP 2017 clarification, NICE, CPS).

Clinical notes

• Indications: symptomatic treatment of **fever**, **mild–moderate pain**, and **inflammation** — adjunct in otitis media, pharyngitis, musculoskeletal injury; not curative; use lowest effective dose for shortest time (BNFC, AAP, NICE, WHO, CPS).

• Contraindications: **dehydration** or hypovolemia · significant **renal impairment** · **active GI bleeding** or peptic ulcer disease · **NSAID/aspirin hypersensitivity** (urticaria, bronchospasm, anaphylaxis) · third-trimester pregnancy (adolescents) · caution in asthma with NSAID sensitivity (BNFC, AAP, NICE, CPS).
• Varicella: historical concern linking NSAIDs to invasive **group A streptococcal (GAS)** superinfection — **AAP 2017**: no convincing evidence to contraindicate short-course ibuprofen in uncomplicated varicella; **NICE** advises caution; prefer **paracetamol** when systemic illness or parental concern; monitor for secondary bacterial infection (AAP, NICE, CPS, BMJ review).
• Avoid **concomitant NSAIDs** (including ibuprofen + naproxen, ketorolac, aspirin) — increased GI and renal risk; do not combine with other ibuprofen-containing products; check combination cold/flu preparations (BNFC, AAP, CPS).
• When **paracetamol preferred**: infants <3–6 months · dehydration · renal/hepatic concerns · GI bleeding risk · NSAID allergy · varicella with caution — alternating paracetamol and ibuprofen is **not routinely recommended**; if used, document strict timing to avoid dosing errors (NICE NG143, AAP, CPS).

• BNFC — Ibuprofen (oral, pediatric dosing and age restrictions) (2024)
• AAP — Fever and antipyretic use in children (ibuprofen safety, varicella clarification) (2017)
• NICE NG143 — Fever in under 5s (antipyretic choice and NSAID caution) (2021)

+ 3 more

• WHO / MSF — Ibuprofen oral essential drug dosing (2024)
• CPS — Drug Therapy and Hazardous Substances Committee (ibuprofen in children) (2023)
• NHS — Ibuprofen for children (weight-based dosing and intervals) (2024)