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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), reducing prostaglandin synthesis.
## Primary Indications
* Mild to moderate pain.
* Fever reduction.
* Inflammatory conditions (e.g., rheumatoid arthritis, osteoarthritis).
* Dysmenorrhea.
## Adult Dosing
* **Analgesia/Fever:** 200–400 mg orally every 4–6 hours as needed.
* **Maximum Daily Dose:** 1200 mg (OTC); up to 3200 mg/day under medical supervision for inflammatory conditions.
## Pediatric Dosing
* **Fever/Pain:** 5–10 mg/kg/dose orally every 6–8 hours.
* **Maximum Daily Dose:** 40 mg/kg/day or 4 doses per 24 hours.
* **Age Restriction:** Do not use in infants younger than 6 months without physician consultation.
## Dose Adjustments
* **Renal Impairment:** Avoid or exercise extreme caution in severe renal impairment (CrCl < 30 mL/min). Dose reduction may be required for moderate impairment.
* **Hepatic Impairment:** Reduce dose in severe hepatic impairment; avoid if cirrhosis/severe disease is present.
## Contraindications
* History of asthma, urticaria, or allergic-type reactions triggered by aspirin or other NSAIDs.
* Coronary artery bypass graft (CABG) surgery (perioperative pain).
* Active peptic ulcer disease or GI bleeding.
* Third trimester of pregnancy.
## Adverse Effects
* **Gastrointestinal:** Dyspepsia, nausea, abdominal pain, ulceration, or hemorrhage.
* **Renal:** Acute kidney injury, fluid retention, or hyperkalemia.
* **Cardiovascular:** Hypertension; increased risk of serious thrombotic events (myocardial infarction, stroke).
## Key Drug Interactions
* **Anticoagulants/Antiplatelets (e.g., Warfarin, SSRIs):** Increased risk of bleeding.
* **ACE Inhibitors/ARBs/Diuretics:** Increased risk of renal impairment (the "triple whammy").
* **Methotrexate:** Reduced clearance of methotrexate, increasing risk of toxicity.
* **Lithium:** May increase serum lithium levels.
## Monitoring
* Baseline and periodic renal function (SCr, BUN) and electrolytes if used chronically.
* Monitor for signs of GI bleed (stools, hematemesis) or unexplained edema.
* Blood pressure monitoring, especially in hypertensive patients.
## Clinical Pearls
* **Administration:** Take with food or milk to minimize GI irritation.
* **CV Risk:** Use the lowest effective dose for the shortest duration necessary; carry a "black box" warning for cardiovascular thrombotic events.
* **Patient Education:** Avoid concomitant use with other NSAIDs (including aspirin) to minimize additive toxicity.
* **Local Protocols:** Institutional protocols may vary significantly regarding inpatient IV formulations (Caldolor); verify facility-specific guidelines.
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*Disclaimer: This information is for educational purposes only. Always verify dosing and contraindications against current clinical guidelines, manufacturer-specific prescribing information, and institutional protocols before administration.*
