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# Ibuprofen (Nurofen, Advil, Motrin)
## Overview
Ibuprofen is a non-steroidal anti-inflammatory drug (NSAID) that inhibits 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/Antipyretic:** 200–400 mg orally every 4–6 hours as needed.
* **Anti-inflammatory:** 400–800 mg orally 3–4 times daily.
* **Maximum daily dose:** 3,200 mg/day (prescription strength). OTC labeling usually limits self-administration to 1,200 mg/day unless directed by a physician.
## Pediatric Dosing
* **Age:** ≥ 6 months.
* **Fever/Pain:** 5–10 mg/kg/dose every 6–8 hours.
* **Maximum daily dose:** 40 mg/kg/day or 4 doses per 24-hour period.
* *Note: Use weight-based dosing; verify concentration (Infant Drops vs. Children’s Suspension) carefully to avoid dosing errors.*
## Dose Adjustments
* **Renal Impairment:** Avoid or use with extreme caution if CrCl < 30 mL/min. Decrease dose in mild-to-moderate impairment; close monitoring required.
* **Hepatic Impairment:** No specific adjustment defined, but use with caution in severe hepatic disease.
## Contraindications
* History of asthma, urticaria, or allergic-type reactions to aspirin or other NSAIDs.
* Coronary artery bypass graft (CABG) surgery (perioperative pain).
* Active gastrointestinal (GI) bleeding or peptic ulcer disease.
* Severe renal or heart failure.
* Third trimester of pregnancy (risk of premature closure of ductus arteriosus).
## Adverse Effects
* **GI:** Dyspepsia, nausea, abdominal pain, increased risk of GI ulceration and bleed.
* **Renal:** Fluid retention, edema, acute kidney injury (AKI), interstitial nephritis.
* **Cardiovascular:** Hypertension, increased risk of MI/stroke (class-wide NSAID warning).
## Key Drug Interactions
* **Anticoagulants/Antiplatelets (Warfarin, Clopidogrel):** Increased risk of major bleeding.
* **ACE Inhibitors/ARBs/Diuretics:** Increased risk of renal impairment (the "triple whammy").
* **Lithium:** May increase serum lithium levels, potentially causing toxicity.
* **Methotrexate:** May decrease renal clearance, increasing systemic toxicity.
## Monitoring
* **Renal function:** Serum creatinine/BUN, especially in elderly or patients on diuretics.
* **GI:** Monitor for signs of occult blood loss or epigastric pain.
* **Blood Pressure:** Regular monitoring in patients with hypertension.
## Clinical Pearls
* **Administration:** Take with food or milk to minimize GI irritation.
* **Hydration:** Advise patients to stay well-hydrated to reduce risk of renal toxicity.
* **Ductus Arteriosus:** Sometimes used intravenously in neonates to treat patent ductus arteriosus (PDAs) under specialized clinical protocols.
* **Ceiling Effect:** Anti-inflammatory effects may increase with dose up to 2400-3200 mg; however, analgesic effects plateau at lower doses (approx. 400 mg).
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**Disclaimer:** This information is for educational purposes only. Always consult current clinical guidelines, local institutional protocols, and the official product monograph before prescribing or administering medication. Confirm specific patient allergies and baseline organ function prior to initiation.
