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# Ibuprofen (Nurofen, Advil, Motrin)
## Overview
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that reduces inflammation, pain, and fever by inhibiting cyclooxygenase (COX) enzymes.
## Primary Indications
* Pain relief (mild to moderate)
* Fever reduction
* Inflammation reduction (e.g., arthritis)
## Adult Dosing
* **Pain/Fever:** 200-400 mg every 4-6 hours as needed. Maximum OTC dose: 1200 mg/day. Prescription doses can be higher, up to 2400-3200 mg/day divided into 3-4 doses, under medical supervision for specific conditions (e.g., rheumatoid arthritis).
* **Inflammation:** Typically higher doses (e.g., 400-800 mg three times daily) are used under medical supervision.
## Pediatric Dosing
* **Fever/Pain:** 5-10 mg/kg/dose every 6-8 hours.
* Maximum daily dose: 40 mg/kg/day or 2400 mg/day, whichever is less.
* Do not exceed 10 days for pain or 3 days for fever without consulting a healthcare provider.
* Concentrations vary by product (e.g., 100 mg/5 mL suspension, 50 mg/1.25 mL infant drops). Always verify product concentration.
## Dose Adjustments
* **Renal Impairment:** Use with caution. Lower doses may be necessary. Avoid in severe renal impairment.
* **Hepatic Impairment:** Use with caution. Lower doses may be necessary. Avoid in severe hepatic impairment.
* **Elderly:** Increased risk of adverse effects. Consider lower doses and monitor closely.
## Contraindications
* Hypersensitivity to ibuprofen, aspirin, or other NSAIDs.
* History of bronchospasm, asthma, rhinitis, or urticaria precipitated by aspirin or other NSAIDs.
* Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery.
* Active gastrointestinal bleeding or history of GI bleeding/perforation with prior NSAID use.
* Severe heart failure.
* Third trimester of pregnancy.
## Adverse Effects
* **Common:** Nausea, vomiting, dyspepsia, heartburn, diarrhea, constipation, abdominal pain, dizziness, headache.
* **Serious:**
* **Cardiovascular:** Increased risk of myocardial infarction, stroke, and hypertension.
* **Gastrointestinal:** Ulceration, bleeding, perforation.
* **Renal:** Acute kidney injury, interstitial nephritis.
* **Hepatic:** Hepatotoxicity.
* **Dermatologic:** Severe skin reactions (e.g., Stevens-Johnson syndrome, toxic epidermal necrolysis).
* **Hematologic:** Increased bleeding risk, anemia.
* **Respiratory:** Bronchospasm (especially in asthmatics).
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin, DOACs):** Increased risk of bleeding.
* **Antiplatelets (e.g., aspirin, clopidogrel):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **SSRIs/SNRIs:** Increased risk of GI bleeding.
* **ACE Inhibitors/ARBs/Diuretics:** Reduced antihypertensive effect; increased risk of renal impairment.
* **Lithium:** Increased lithium levels.
* **Methotrexate:** Increased methotrexate toxicity.
* **Other NSAIDs/Salicylates:** Increased risk of adverse effects.
## Monitoring
* **Renal function:** Baseline and periodically, especially in patients with pre-existing renal disease, dehydration, or those on concomitant nephrotoxic agents.
* **Hepatic function:** Baseline and periodically, especially in patients with liver disease.
* **Blood pressure:** Monitor for potential increases.
* **Signs/symptoms of GI bleeding:** Melena, hematemesis, abdominal pain.
* **Signs/symptoms of cardiovascular events:** Chest pain, shortness of breath, weakness, slurred speech.
## Clinical Pearls
* Use the lowest effective dose for the shortest duration necessary to minimize risks.
* Administer with food or milk to reduce GI upset.
* Caution in patients with heart failure, hypertension, renal impairment, hepatic impairment, asthma, or a history of GI issues.
* Avoid concurrent use with other NSAIDs, including aspirin (unless low-dose aspirin for cardioprotection, in which case administer ibuprofen at least 30 minutes before or 8 hours after aspirin).
* Inform patients about the risks of GI bleeding, cardiovascular events, and kidney problems.
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*Disclaimer: This information is intended for healthcare professionals and does not replace individual clinical judgment. Always consult the most current prescribing information and institutional protocols before administering any medication.*
