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# Ibuprofen (Nurofen, Advil, Motrin)
## Overview
Ibuprofen is a non-steroidal anti-inflammatory drug (NSAID) that acts as a non-selective inhibitor of cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2) enzymes, reducing prostaglandin synthesis. It exhibits 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/Antipyretic:** 200–400 mg orally every 4–6 hours as needed.
* **Anti-inflammatory:** 400–800 mg orally every 6–8 hours.
* **Maximum Daily Dose:** OTC labeling generally limits users to 1,200 mg/day unless directed by a physician, who may increase this to a maximum of 3,200 mg/day under clinical supervision.
## Pediatric Dosing
* **Dose:** 5–10 mg/kg/dose orally every 6–8 hours.
* **Maximum Single Dose:** 400 mg.
* **Maximum Daily Dose:** 40 mg/kg/day or 1,200 mg/day (whichever is less), unless specified otherwise by a provider.
* **Age Restriction:** Generally not recommended for infants under 6 months of age without physician consultation.
## Dose Adjustments
* **Renal Impairment:** Avoid if CrCl < 30 mL/min. Use with caution and consider dose reduction for mild-to-moderate impairment.
* **Hepatic Impairment:** Use with caution; monitor for fluid retention and hepatotoxicity.
## Contraindications
* Hypersensitivity to ibuprofen, aspirin, or other NSAIDs.
* History of asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs.
* Perioperative setting for Coronary Artery Bypass Graft (CABG) surgery.
* Active GI bleeding or history of recurrent peptic ulcers.
## Adverse Effects
* **Gastrointestinal:** Dyspepsia, nausea, gastropathy, increased risk of GI bleeding/ulceration.
* **Renal:** Fluid retention, edema, acute kidney injury, hyperkalemia.
* **Cardiovascular:** Hypertension; increased risk of serious thrombotic events (myocardial infarction, stroke).
* **Other:** Tinnitus, dizziness, rash.
## Key Drug Interactions
* **Anticoagulants/Antiplatelets:** Increased risk of bleeding.
* **ACE Inhibitors/ARBs/Diuretics:** Increased risk of renal impairment (the "triple whammy").
* **Lithium/Methotrexate:** NSAIDs can decrease renal clearance of these drugs, increasing toxicity.
* **Aspirin:** May interfere with the cardioprotective antiplatelet effects of low-dose aspirin; take ibuprofen at least 30 minutes after or 8 hours before aspirin.
## Monitoring
* **Renal Function:** Serum creatinine and electrolytes (especially if on long-term therapy or higher doses).
* **GI:** Observe for signs of occult bleeding (melena, hematemesis).
* **Blood Pressure:** Monitor frequency in hypertensive patients.
## Clinical Pearls
* Administer with food or milk to minimize GI irritation.
* Maintain adequate hydration to reduce the risk of NSAID-associated nephrotoxicity.
* Ibuprofen is not indicated for the treatment of pain before or after heart surgery.
* Dosing for pediatric liquid formulations varies by concentration (e.g., 50 mg/1.25 mL vs. 100 mg/5 mL); always verify the product concentration before calculating the dose.
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*Disclaimer: This information is for educational purposes. Dosing should be verified against current institutional protocols, local guidelines, and official product labeling prior to administration.*
