Ibuprofen efficacy, tolerability and safety in obese children: a systematic review

Abstract

ObjectiveChildhood obesity can affect drug disposition and efficacy of ibuprofen. The primary objective was to assess efficacy of ibuprofen in obese children.DesignA systematic review was undertaken following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses methodology. Studies were identified from 12 databases. Two independent reviewers evaluated studies against the inclusion criteria and assessed for methodological quality.SettingAny clinical setting.PatientsPatients under 18 years who were overweight/obese.InterventionsPatients taking ibuprofen for any indication, dose or regimen.Main outcome measuresThe efficacy and tolerability of ibuprofen treatment in obese children and presence of any adverse drug reactions.ResultsSearches identified 1305 studies. Four studies met inclusion criteria: three retrospective cohort studies (n=583, median age: 6 years, range: 1–18 years; n=200, median age: 11 years, range: 3–18 years; n=358 median age: 3.1 years, range: 1.2–8.5 years, respectively) and one case study. Each study differed in their method of dosing ibuprofen (weight-based, age-based and adjusted body weight dosing). Various doses were used: 5 mg/kg every 6 hours, 400 mg three times a day, 120 mg/dose and a dose calculated using adjusted body weight. One study reported efficacy (obese n=189, non-obese, n=394), where adequate pain control was achieved using 5 mg/kg. The other three studies did not determine if efficacy differed between obese and non-obese children.One study described adverse effects. An increased risk of bleeding with ibuprofen was noted but did not differentiate between obese and non-obese children.ConclusionThere are little published data to guide clinicians prescribing ibuprofen in obese children.PROSPERO registration numberCRD42021213500.

Perioperative Acetaminophen Dosing in Obese Children

“…There are few data concerning ibuprofen pharmacokinetics or dosing in obese children [ 97 ]. Ibuprofen dose could be based on normal fat mass with allometry.…”