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# Ibuprofen (Nurofen, Advil, Motrin)
## Overview
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that acts by inhibiting cyclooxygenase (COX-1 and COX-2) enzymes, leading to decreased prostaglandin synthesis. It possesses analgesic, antipyretic, and anti-inflammatory properties.
## Primary Indications
* Mild to moderate pain
* Fever reduction
* Osteoarthritis and rheumatoid arthritis
* Primary dysmenorrhea
## Adult Dosing
* **Analgesia:** 200–400 mg orally every 4–6 hours as needed. Maximum 1200 mg/day (OTC) or 3200 mg/day (prescription under medical supervision).
* **Inflammatory Conditions:** 400–800 mg orally 3–4 times daily. Maximum 3200 mg/day.
## Pediatric Dosing
* **Fever/Pain:** 5–10 mg/kg/dose orally every 6–8 hours.
* **Maximum:** 40 mg/kg/day or 400 mg/single dose.
* **Minimum Age:** Not recommended for infants <6 months unless directed by a physician.
## Dose Adjustments
* **Renal Impairment:** Avoid or exercise extreme caution in patients with CrCl <30 mL/min.
* **Hepatic Impairment:** Use lowest effective dose; monitor for signs of liver dysfunction.
* **Elderly:** Use lowest effective dose for the shortest duration to minimize gastrointestinal and cardiovascular risk.
## Contraindications
* History of asthma, urticaria, or allergic-type reactions after aspirin or other NSAID use.
* Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery.
* Active gastrointestinal (GI) bleeding or peptic ulcer disease.
* Advanced renal failure.
## Adverse Effects
* **Common:** Dyspepsia, nausea, abdominal pain, dizziness.
* **Serious:** Gastrointestinal ulceration/bleed, myocardial infarction, stroke, acute kidney injury, congestive heart failure exacerbation, hypertension.
## Key Drug Interactions
* **Anticoagulants/Antiplatelets (e.g., Warfarin, Clopidogrel):** Increased risk of bleeding.
* **ACE Inhibitors/ARBs/Diuretics:** Increased risk of acute kidney injury and reduced antihypertensive efficacy.
* **Lithium/Methotrexate:** Increased risk of toxicity due to decreased renal clearance.
* **SSRI/SNRIs:** Increased risk of GI bleeding.
## Monitoring
* **Renal Function:** Monitor serum creatinine in high-risk patients.
* **GI:** Monitor for signs of occult blood loss or dyspepsia.
* **Cardiovascular:** Monitor blood pressure; observe for edema.
* **Efficacy:** Duration of pain relief and fever reduction.
## Clinical Pearls
* Take with food or milk to minimize gastric irritation.
* NSAIDs should not be used in the third trimester of pregnancy due to risk of premature closure of the ductus arteriosus.
* In patients requiring low-dose aspirin for cardiovascular protection, ibuprofen may interfere with the antiplatelet effect; take aspirin at least 30 minutes after or 8 hours before ibuprofen.
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**Educational Disclaimer:** This information is for educational purposes only. Drug dosing, contraindications, and interactions may vary by jurisdiction or specific clinical guidelines. Always verify current prescribing information, local protocols, and patient-specific factors via a reliable clinical database (e.g., Lexicomp, UpToDate) before administering or prescribing.
