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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 cyclooxygenase-2 (COX-2) enzymes, reducing prostaglandin synthesis. It possesses analgesic, antipyretic, and anti-inflammatory properties. ## Primary Indications * Mild-to-moderate pain (headache, dental pain, dysmenorrhea). * Fever reduction. * Inflammatory conditions (osteoarthritis, rheumatoid arthritis). ## Adult Dosing * **Analgesia/Antipyretic:** 200–400 mg orally every 4–6 hours as needed. * **Maximum Daily Dose (OTC):** 1,200 mg/day (unless directed by a physician up to 3,200 mg/day for chronic inflammation). ## Pediatric Dosing * **Fever/Pain:** 5–10 mg/kg/dose orally every 6–8 hours. * **Maximum Daily Dose:** 40 mg/kg/day or a maximum of 4 doses per 24 hours. * **Note:** Not recommended for infants <6 months old without clinical consultation. ## Dose Adjustments * **Hepatic Impairment:** Reduce dose in mild-to-moderate impairment; avoid in severe disease. * **Renal Impairment:** Avoid or exercise extreme caution in patients with CrCl <30 mL/min due to risk of acute renal failure. ## Contraindications * Known hypersensitivity to ibuprofen, aspirin, or other NSAIDs (risk of anaphylaxis/angioedema). * History of GI bleeding or perforation related to previous NSAID therapy. * Active peptic ulcer disease. * Perioperative pain management in the setting of coronary artery bypass graft (CABG) surgery. * Late-term pregnancy (third trimester; risk of premature closure of the ductus arteriosus). ## Adverse Effects * **GI:** Dyspepsia, nausea, abdominal pain, increased risk of ulceration or GI bleeding. * **Renal:** Fluid retention, edema, decreased GFR, interstitial nephritis. * **Cardiovascular:** Hypertension, increased risk of myocardial infarction and stroke with chronic high-dose use. ## Key Drug Interactions * **Anticoagulants (e.g., Warfarin):** Increased risk of bleeding. * **Antiplatelets (e.g., Aspirin, Clopidogrel):** Increased GI toxicity; Ibuprofen may interfere with the cardioprotective effects of low-dose aspirin. * **ACE Inhibitors/ARBs/Diuretics:** Increased risk of renal impairment (the "triple whammy"). * **Lithium/Methotrexate:** Ibuprofen can decrease the clearance of these drugs, leading to toxicity. ## Monitoring * Monitor for signs of GI bleeding (melena, hematemesis). * Renal function (BUN/SCr) in long-term therapy or high-risk patients. * Blood pressure monitoring, particularly in hypertensive patients. ## Clinical Pearls * **Administration:** Take with food or milk to minimize gastrointestinal irritation. * **Hydration:** Ensure adequate patient hydration to mitigate renal insult. * **OTC Confusion:** Ensure patients are not taking multiple products containing NSAIDs simultaneously (e.g., cold/flu remedies) to avoid overdose. * **Cardiovascular Risk:** Use the lowest effective dose for the shortest duration possible to minimize cardiovascular and gastrointestinal risks. *** **Disclaimer:** This information is for educational purposes and does not replace professional clinical judgment. Dosing protocols may vary by institution and patient-specific factors. Always verify current prescribing information through local pharmacy resources, clinical guidelines, or the manufacturer’s package insert before administration.