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# Ibuprofen (Nurofen, Advil, Motrin)
## Overview
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that exhibits analgesic, anti-inflammatory, and antipyretic properties. It works by inhibiting cyclooxygenase (COX) enzymes, thereby reducing prostaglandin synthesis.
## Primary Indications
* Pain (mild to moderate)
* Fever
* Inflammatory conditions (e.g., rheumatoid arthritis, osteoarthritis)
* Dysmenorrhea
## Adult Dosing
* **Pain/Fever:** 200 mg to 400 mg orally every 4 to 6 hours as needed.
* **Inflammatory Conditions:** 400 mg to 800 mg orally three to four times daily.
* **Maximum Daily Dose:** 3200 mg (though lower doses are typically effective and preferred for chronic use).
## Pediatric Dosing
Dosing is typically based on weight. Consult product labeling or local protocols for precise dosing.
* **Fever/Pain:** 5 mg/kg to 10 mg/kg orally every 6 to 8 hours.
* **Maximum Daily Dose:** 40 mg/kg/day, not to exceed the adult maximum.
* **Infants < 6 months:** Use with caution and under medical supervision due to potential risks.
## Dose Adjustments
No specific dose adjustments are typically required for hepatic or renal impairment, but caution and lower doses are advised in patients with severe impairment. Monitor closely for adverse effects.
## Contraindications
* Hypersensitivity to ibuprofen, aspirin, or other NSAIDs.
* History of asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs.
* Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery.
* Active gastrointestinal bleeding or perforation.
* Severe heart failure.
* Third trimester of pregnancy.
## Adverse Effects
* **Common:** Nausea, vomiting, dyspepsia, abdominal pain, constipation, diarrhea, dizziness, headache.
* **Serious:** Gastrointestinal bleeding, ulceration, perforation; cardiovascular thrombotic events (MI, stroke); renal toxicity; hepatic toxicity; hypersensitivity reactions; Stevens-Johnson syndrome; toxic epidermal necrolysis.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin) and Antiplatelets (e.g., aspirin, clopidogrel):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of gastrointestinal adverse effects.
* **ACE Inhibitors, ARBs, Beta-blockers:** May reduce antihypertensive efficacy and increase risk of renal impairment.
* **Diuretics:** May reduce diuretic efficacy and increase risk of renal impairment.
* **Lithium:** Increased lithium levels and toxicity.
* **Methotrexate:** Increased methotrexate levels and toxicity.
## Monitoring
* **Renal function:** Especially in patients with pre-existing renal disease or those taking concurrent nephrotoxic agents.
* **Hepatic function:** Particularly with long-term use or in patients with liver disease.
* **Signs of GI bleeding:** Melena, hematemesis, abdominal pain.
* **Blood pressure:** NSAIDs can increase blood pressure.
## Clinical Pearls
* Use the lowest effective dose for the shortest duration necessary to minimize risks.
* Administer with food or milk to reduce gastrointestinal upset.
* Avoid concomitant use with other NSAIDs or aspirin (unless for cardioprotection at low dose and discussed with prescriber).
* Consider the increased risk of cardiovascular and gastrointestinal events, especially in elderly patients or those with risk factors.
* Discontinue use at the first sign of rash, allergic reaction, or gastrointestinal bleeding.
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*This information is intended for healthcare professionals and is not a substitute for professional medical advice. Always consult the most current prescribing information and relevant guidelines before making any treatment decisions.*
