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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 (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 every 4–6 hours as needed.
* **Maximum Daily Dose (OTC):** 1200 mg/day.
* **Maximum Daily Dose (Prescription):** 3200 mg/day under medical supervision.
## Pediatric Dosing
* **Fever/Pain:** 5–10 mg/kg/dose every 6–8 hours.
* **Maximum Single Dose:** 400 mg.
* **Maximum Daily Dose:** 40 mg/kg/day (up to 1200 mg).
* *Note:* Avoid use in infants under 6 months old unless directed by a pediatrician.
## Dose Adjustments
* **Renal Impairment:** Use with extreme caution. Avoid in severe renal impairment (CrCl <30 mL/min).
* **Hepatic Impairment:** Reduce dose or avoid in severe hepatic disease; use lowest effective dose for shortest duration.
* **Geriatric Patients:** Increased risk for GI adverse events; use the lowest effective dose for the shortest duration.
## Contraindications
* History of asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs.
* Active GI bleeding or peptic ulcer disease.
* Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery.
* Severe heart failure.
* Third trimester of pregnancy (risk of premature closure of the ductus arteriosus).
## Adverse Effects
* **Common:** Dyspepsia, nausea, abdominal pain, dizziness.
* **Serious:** Gastrointestinal ulceration/bleeding, myocardial infarction (MI), stroke, acute kidney injury, fluid retention/hypertension.
## Key Drug Interactions
* **Anticoagulants/Antiplatelets (e.g., Warfarin, SSRIs):** Increased risk of GI bleeding.
* **ACE Inhibitors/ARBs/Diuretics:** Reduced antihypertensive effect and increased risk of acute kidney injury secondary to altered renal hemodynamics.
* **Methotrexate:** Increased risk of toxicity due to decreased renal clearance.
* **Lithium:** Increased serum lithium levels.
## Monitoring
* Renal function (BUN/SCr) in patients on chronic therapy or those with existing risk factors.
* Blood pressure monitoring.
* Signs/symptoms of GI bleeding (melena, hematemesis).
* Monitor CBC and liver enzymes for long-term use.
## Clinical Pearls
* **Administration:** Take with food or milk to minimize gastrointestinal upset.
* **Cardiovascular Risk:** All NSAIDs (except aspirin) increase the risk of serious CV thrombotic events.
* **Dosing Protocols:** Local hospital or pediatric weight-based protocols may vary; always verify current institutional guidelines for dosing calculations.
* **Hydration:** Maintain adequate fluid intake to mitigate potential renal risks.
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**Disclaimer:** This information is for educational purposes and does not substitute for professional medical judgment. Always verify current prescribing information, package inserts, and local clinical protocols before administering or recommending medication.
