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# Ibuprofen (Nurofen, Advil, Motrin)
## Overview
Ibuprofen is a non-steroidal anti-inflammatory drug (NSAID) that inhibits cyclooxygenase-1 and -2 (COX-1 and COX-2) enzymes, leading to decreased prostaglandin synthesis. It provides analgesic, antipyretic, and anti-inflammatory effects.
## Primary Indications
* Mild-to-moderate pain.
* Fever reduction.
* Inflammatory conditions (e.g., rheumatoid arthritis, osteoarthritis).
* Dysmenorrhea.
* Patent ductus arteriosus (IV form; specialized).
## Adult Dosing
* **Analgesia/Antipyretic:** 200–400 mg orally every 4–6 hours as needed.
* **Maximum Dose:** 1200 mg/day (OTC labeling) to 3200 mg/day (prescription under medical supervision).
* **Administration:** Take with food or milk to minimize GI irritation.
## Pediatric Dosing
* **Fever/Pain:** 5–10 mg/kg/dose orally every 6–8 hours.
* **Maximum Recommended Dose:** 40 mg/kg/day or 400 mg per dose.
* **Minimum Age:** Not recommended for infants <6 months unless directed by a physician.
## Dose Adjustments
* **Renal Impairment:** Use with caution in CrCl <30 mL/min. Avoid in severe renal failure.
* **Hepatic Impairment:** Monitor closely; dosage reduction may be required in severe impairment.
* **Geriatric:** Start at the lower end of the dosing range due to increased risk of GI toxicity and renal decline.
## Contraindications
* History of asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs.
* Peri-operative pain in the setting of coronary artery bypass graft (CABG) surgery.
* Active GI bleeding or peptic ulcer disease.
* Severe heart failure.
## Adverse Effects
* **GI:** Dyspepsia, abdominal pain, nausea, ulceration, or bleeding.
* **Renal:** Increased serum creatinine, edema, fluid retention.
* **Cardiovascular:** Hypertension, increased risk of myocardial infarction and stroke (long-term use).
* **Hematologic:** Increased risk of bleeding due to inhibition of platelet aggregation.
## Key Drug Interactions
* **Anticoagulants/Antiplatelets (e.g., Warfarin, Clopidogrel):** Increased risk of major bleeding.
* **ACE Inhibitors/ARBs/Diuretics:** Potentiates nephrotoxicity and reduces antihypertensive efficacy.
* **Lithium:** May increase serum lithium concentrations to toxic levels.
* **Methotrexate:** Increases risk of methotrexate toxicity.
* **Aspirin:** May interfere with the cardioprotective effects of low-dose aspirin; space doses appropriately (take ibuprofen at least 30 minutes after or 8 hours before aspirin).
## Monitoring
* Renal function (BUN/SCr) and blood pressure during long-term therapy.
* Signs of GI bleeding or occult stool blood.
* Complete blood count (CBC) if long-term use is required.
## Clinical Pearls
* Therapeutic anti-inflammatory doses for chronic conditions usually require 1200–3200 mg/day; patients may not see significant inflammation reduction at OTC doses.
* Encourage adequate hydration to protect renal function.
* Avoid use during the third trimester of pregnancy (risk of premature closure of the ductus arteriosus and oligohydramnios).
* Always confirm pediatric dosing based on weight, not age, when possible.
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**Disclaimer:** This information is for educational purposes only. Drug information is subject to change. Always consult current prescribing literature (e.g., package insert) and local hospital protocols, or contact a licensed pharmacist for clinical verification before administering medications.
