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# Ibuprofen (Nurofen, Advil, Motrin)
## Overview
Ibuprofen is a non-steroidal anti-inflammatory drug (NSAID) that works by inhibiting cyclooxygenase (COX) enzymes, reducing the production of prostaglandins. This leads to analgesic, anti-inflammatory, and antipyretic effects.
## Primary Indications
* Pain relief (mild to moderate)
* Fever reduction
* Inflammation management (e.g., arthritis)
## Adult Dosing
* **Pain/Fever:** 200 mg to 400 mg every 4 to 6 hours as needed.
* **Inflammation:** 400 mg to 800 mg every 6 to 8 hours as needed.
* **Maximum Daily Dose:** 3200 mg per day for short-term use. Higher doses may be used under strict medical supervision for specific inflammatory conditions.
## Pediatric Dosing
Dosing is typically based on weight.
* **Fever/Pain:** 5 mg/kg to 10 mg/kg per dose every 6 to 8 hours as needed.
* **Maximum Daily Dose:** 40 mg/kg per day.
* **Infants:** Generally not recommended for pain/fever in infants under 6 months of age without physician guidance due to safety concerns.
## Dose Adjustments
* **Renal Impairment:** Use with caution. May require dose reduction; monitor renal function closely. Avoid in severe renal impairment.
* **Hepatic Impairment:** Use with caution. May require dose reduction; monitor liver function. Avoid in severe hepatic impairment.
## Contraindications
* Hypersensitivity to ibuprofen, aspirin, or other NSAIDs.
* History of asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs.
* Peri-operative pain in the setting of coronary artery bypass graft (CABG) surgery.
* Active gastrointestinal bleeding or history of peptic ulcer disease.
* Severe heart failure.
* Severe renal or hepatic impairment.
* Third trimester of pregnancy.
## Adverse Effects
* **Gastrointestinal:** Dyspepsia, nausea, abdominal pain, heartburn, GI bleeding, ulceration, perforation.
* **Cardiovascular:** Increased risk of myocardial infarction and stroke (especially at higher doses and with prolonged use). Hypertension.
* **Renal:** Renal papillary necrosis, interstitial nephritis, renal failure.
* **Hematologic:** Anemia, prolonged bleeding time.
* **Dermatologic:** Rash, pruritus.
* **Other:** Headache, dizziness, tinnitus, fluid retention, edema.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Antiplatelets (e.g., aspirin, clopidogrel):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **Diuretics:** Reduced diuretic effect; increased risk of renal impairment.
* **Lithium:** Increased serum lithium levels.
* **Methotrexate:** Increased methotrexate toxicity.
* **ACE Inhibitors & Angiotensin Receptor Blockers (ARBs):** May increase risk of renal impairment; reduced antihypertensive effect.
## Monitoring
* Signs and symptoms of GI bleeding (e.g., melena, hematemesis).
* Renal function (BUN, creatinine).
* Liver function (LFTs).
* Blood pressure.
* Signs of fluid retention or edema.
## Clinical Pearls
* Administer with food or milk to minimize GI upset.
* Use the lowest effective dose for the shortest duration necessary to minimize risks.
* Consider gastroprotective agents (e.g., PPIs) in patients at high risk for GI complications.
* Caution in patients with pre-existing cardiovascular disease, hypertension, or risk factors for these conditions.
* Avoid concomitant use with other NSAIDs or aspirin unless specifically indicated and with caution.
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*This information is intended for clinical use and is not a substitute for professional medical advice. Always consult the most current prescribing information and relevant literature before making clinical decisions.*
