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# Ibuprofen (Nurofen, Advil, Motrin)
## Overview
Ibuprofen is a non-steroidal anti-inflammatory drug (NSAID) that acts by inhibiting cyclooxygenase-1 (COX-1) and COX-2 enzymes, reducing prostaglandin synthesis. It possesses analgesic, antipyretic, and anti-inflammatory properties.
## Primary Indications
* Mild to moderate pain.
* Fever reduction.
* Inflammatory conditions (e.g., rheumatoid arthritis, osteoarthritis).
* Dysmenorrhea.
## Adult Dosing
* **Analgesia/Antipyresis:** 200–400 mg every 4–6 hours as needed.
* **Inflammatory Conditions:** 400–800 mg 3–4 times daily.
* **Maximum daily dose:** 3200 mg per day under medical supervision; 1200 mg/day for self-care.
## Pediatric Dosing
* **Fever/Pain:** 5–10 mg/kg per dose orally every 6–8 hours.
* **Maximum:** 40 mg/kg/day or 400 mg per dose.
* **Age restriction:** Do not use in infants younger than 6 months without direct medical provider oversight.
## Dose Adjustments
* **Renal Impairment:** Avoid or exercise extreme caution in patients with CrCl <30 mL/min.
* **Hepatic Impairment:** Use with caution; monitor for fluid retention or worsening hepatic function.
* **Geriatric:** Use the lowest effective dose for the shortest duration to minimize gastrointestinal and renal risks.
## Contraindications
* History of asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs.
* Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery.
* Active gastrointestinal bleeding or peptic ulcer disease.
* Severe heart failure.
## Adverse Effects
* **Common:** Dyspepsia, abdominal pain, nausea, dizziness, fluid retention.
* **Serious:** Gastrointestinal ulceration/perforation, myocardial infarction, stroke, acute kidney injury, severe skin reactions (e.g., SJS/TEN).
## Key Drug Interactions
* **Antiplatelets/Anticoagulants (e.g., Warfarin, Clopidogrel, SSRIs):** Increased risk of major bleeding.
* **ACE Inhibitors/ARBs/Diuretics:** Increased risk of renal impairment ("triple whammy").
* **Lithium/Methotrexate:** NSAIDs can decrease renal clearance, leading to potential toxicity.
* **Aspirin:** May negate the cardioprotective antiplatelet effects of low-dose aspirin.
## Monitoring
* **Renal:** Serum creatinine, BUN, and urine output if at high risk or long-term use.
* **GI:** Monitor for signs of occult blood loss (e.g., melena, pallor).
* **Cardiovascular:** Blood pressure monitoring, particularly in hypertensive patients.
## Clinical Pearls
* **Administration:** Take with food or milk to decrease gastrointestinal irritation.
* **Duration:** Always use the lowest dose for the shortest period necessary to achieve therapeutic goals.
* **Hydration:** Ensure patients are adequately hydrated to reduce the risk of NSAID-induced nephrotoxicity.
* **Availability:** Pediatric dosing varies by product concentration (Infant drops vs. Children’s suspension); ensure caregivers use the provided measuring device.
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*Disclaimer: This information is for educational purposes only. Drug information, protocols, and regulatory guidelines change frequently. Always verify current prescribing information, institutional protocols, and patient-specific factors with a qualified healthcare professional before administration.*
