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

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.