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# Ibuprofen (Nurofen, Advil, Motrin)
## Overview
Ibuprofen is a non-selective nonsteroidal anti-inflammatory drug (NSAID) that inhibits cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2) enzymes, reducing prostaglandin synthesis. It possesses analgesic, antipyretic, and anti-inflammatory properties.
## Primary Indications
* Mild to moderate pain
* Fever
* Dysmenorrhea
* Osteoarthritis and Rheumatoid Arthritis
## Adult Dosing
* **Analgesia:** 200–400 mg orally every 4–6 hours as needed. Maximum 1,200 mg/day (OTC) or 3,200 mg/day (Rx under physician supervision).
* **Inflammatory conditions:** 400–800 mg orally every 6–8 hours. Maximum 3,200 mg/day.
## Pediatric Dosing (Weight-based preferred)
* **Pain/Fever:** 5–10 mg/kg/dose every 6–8 hours as needed.
* **Maximum Daily Dose:** 40 mg/kg/day, not to exceed 4 doses in 24 hours.
* *Note:* Minimum age for OTC use is typically 6 months.
## Dose Adjustments
* **Renal Impairment:** Avoid or use with extreme caution in stage 4-5 chronic kidney disease.
* **Hepatic Impairment:** Use with caution; monitor for signs of liver dysfunction. Dose reduction may be required.
## Contraindications
* History of asthma, urticaria, or allergic-type reactions to aspirin or other NSAIDs (NSAID hypersensitivity).
* Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery.
* Active peptic ulcer disease or history of GI bleeding.
* Severe heart failure or severe renal impairment.
## Adverse Effects
* **GI:** Dyspepsia, nausea, occult blood loss, gastric ulcers.
* **Renal:** Fluid retention, edema, acute kidney injury (in high-risk patients).
* **CV:** Increased risk of thrombotic events (myocardial infarction, stroke).
* **Hematologic:** Inhibition of platelet aggregation (reversible).
## Key Drug Interactions
* **Anticoagulants (e.g., Warfarin, Apixaban):** Increased risk of bleeding.
* **Antihypertensives (ACE inhibitors/ARBs/Diuretics):** Potential for drug-induced renal impairment and decreased antihypertensive efficacy ("triple whammy").
* **Lithium:** May increase serum lithium concentrations.
* **Methotrexate:** May increase methotrexate toxicity.
* **Other NSAIDs/Aspirin:** Increased risk of GI toxicity.
## Monitoring
* **Renal:** Monitor serum creatinine and BUN in patients with baseline renal risk.
* **GI:** Monitor for signs of occult bleeding (e.g., melena, unexplained anemia).
* **Blood Pressure:** Monitor for fluid retention and hypertension, especially in patients with existing CV disease.
## Clinical Pearls
* **Administration:** Take with food or milk to minimize gastric irritation.
* **Hydration:** Ensure adequate patient hydration to reduce the risk of NSAID-associated nephrotoxicity, particularly in pediatric patients or those taking diuretics.
* **Patient Counseling:** Advise patients to avoid "doubling up" with other products containing ibuprofen or other NSAIDs.
* **Pregnancy:** Avoid after 20 weeks gestation due to the risk of fetal renal dysfunction leading to oligohydramnios and premature closure of the ductus arteriosus.
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*Disclaimer: This summary is for educational purposes and does not replace professional clinical judgment. Always verify current prescribing information, institutional protocols, and local regulatory guidelines before administering medication.*
