Generic Name:

Ibuprofen Lysine

Trade Name:

NeoProfen

Action:

Prostaglandin synthesis inhibitor

Indications:

Treatment (i.e. closure) of a clinically significant patent ductus arteriosus (PDA) in premature infants 500-1500 grams and less than or equal to 32 weeks gestational age

Administration Guidelines:

Usual Dosage Range and Route:

** Orders require co-signature by the attending or in-house attending neonatologist or senior NNP before administration **

3 day course - each dose to be given 24 hours apart

Day 1: 10 mg/kg/dose IV x 1

Day 2: 5 mg/kg/dose IV x 1

Day 3: 5 mg/kg/dose IV x 1

Doses should be calculated using birth weight.

If anuria or marked oliguria (urinary output <0.6 mL/kg/hour) is evident at the scheduled time of the second or third dose, no additional doses should be given until renal function is evaluated.

A second course of treatment, alternative pharmacologic therapy, or surgery may be needed if the ductus arteriosus fails to close or reopens following the initial course of therapy.

Administration and Stability

Supplied as a 2 mL vial containing ibuprofen 10 mg/mL

Dilute to final concentration of 4 mg/mL with Normal Saline or D5W

Mixing Instructions:

4 mg/mL

•  Draw up 2 mL of ibuprofen 10 mg/mL = 20 mg

•  Mix with 3 mL of Normal Saline (or D5W)

•  Divide the dose required by 4 mg/mL to obtain the desired volume

•  E.g. 10 mg/kg/dose for 0.8 kg patient = 8 mg

•  Divide 8 mg by 4 mg/mL = 2 mL

Contact pharmacy if mixing assistance is required.

Administer within 30 minutes of preparation ; infuse via syringe pump over 15 minutes.

Central line administration may be preferred, but not required.

Vials should be protected from light until ready for use

Vials are SINGLE USE and must be discarded after use (does NOT contain preservative)

Incompatible with TPN and lipids

•  If necessary, TPN should be interrupted for a period 15 minutes before and after ibuprofen administration and line patency maintained with dextrose.

Contraindications:

Congenital heart disease where patency of the PDA is necessary for pulmonary or systemic blood flow

Active intracranial hemorrhage or gastrointestinal bleeding; thrombocytopenia; coagulation defects

Proven or suspected necrotizing enterocolitis (NEC)

Significant renal dysfunction

Precautions:

May alter signs of infection; use caution in the presence of infection or in infants at risk for infection.

May displace bilirubin from albumin binding sites; use caution when total bilirubin is elevated.

May inhibit platelet aggregation; monitor for signs of bleeding.

Administer carefully to avoid extravasation, as solution may be irritating to tissue.

Possible Side Effects:

Intraventricular hemorrhage

Edema, tachycardia, hypotension

Abdominal distension, gastritis, GI reflux, feeding intolerance

Cholestasis, jaundice

Adrenal insufficiency, hypernatremia, hypoglycemia, hypocalcemia

Renal impairment - decreased urine output, increased serum creatinine

Anemia, neutropenia, thrombocytopenia