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Ibuprofen efficacy, tolerability and safety in obese children: a systematic review
  1. Eman Shamsaee1,
  2. Alaw Huws2,
  3. Andrea Gill3,
  4. Stephen J McWilliam4,
  5. Daniel B Hawcutt3,4,5
  1. 1 Hull University Teaching Hospitals NHS Trust, Hull, UK
  2. 2 School of Medicine, University of Liverpool, Liverpool, UK
  3. 3 Paediatric Medicines Research Unit and Pharmacy Department, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
  4. 4 Department of Women’s and Children’s Health, University of Liverpool, Liverpool, UK
  5. 5 NIHR Alder Hey Clinical Research Facility, Aldey Hey Children's Hospital, Liverpool, UK
  1. Correspondence to Dr Daniel B Hawcutt, Paediatric Medicines Research Unit and Pharmacy Department, Alder Hey Children's NHS Foundation Trust, Liverpool L12 2AP, UK; dhawcutt{at}


Objective Childhood obesity can affect drug disposition and efficacy of ibuprofen. The primary objective was to assess efficacy of ibuprofen in obese children.

Design A 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.

Setting Any clinical setting.

Patients Patients under 18 years who were overweight/obese.

Interventions Patients taking ibuprofen for any indication, dose or regimen.

Main outcome measures The efficacy and tolerability of ibuprofen treatment in obese children and presence of any adverse drug reactions.

Results Searches 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.

Conclusion There are little published data to guide clinicians prescribing ibuprofen in obese children.

PROSPERO registration number CRD42021213500.

  • obesity
  • analgesia
  • child health
  • paediatrics
  • pain

Data availability statement

Data are available on request from the authors.

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Data availability statement

Data are available on request from the authors.

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  • Contributors ES, AH and DH were involved in the conception and design of the study. Data acquisition and drafting the manuscript were done by ES and AH. Data analysis and interpretation were done by ES, AH, AG and SJM. Revising the manuscript critically for important intellectual content was done by ES, DH, AG and SJM. Approval of the version of the manuscript to be published was made by ES, AH, AG, SJM and DH. Daniel B Hawcutt is guarantor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.