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# Ibuprofen (Nurofen, Advil, Motrin)
## Overview
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that inhibits prostaglandin synthesis. It possesses analgesic, anti-inflammatory, and antipyretic properties.
## Primary Indications
* Pain relief (mild to moderate)
* Fever reduction
* Inflammation management (e.g., arthritis)
## Adult Dosing
* **Analgesia/Antipyresis:** 200 mg to 400 mg orally every 4 to 6 hours as needed. Maximum daily dose: 1200 mg (over-the-counter) or up to 3200 mg under medical supervision.
* **Inflammation:** 400 mg to 800 mg orally every 6 to 8 hours. Maximum daily dose: 3200 mg.
## Pediatric Dosing
Dosing is typically based on weight. Consult a pediatrician or local protocol for precise dosing.
* **Analgesia/Antipyresis:** 5 mg/kg to 10 mg/kg orally every 6 to 8 hours. Maximum dose per administration: 400 mg. Maximum daily dose: 40 mg/kg or 4000 mg, whichever is less.
* **Rheumatic Diseases:** 30 mg/kg to 40 mg/kg per day in divided doses every 6 to 8 hours.
## Dose Adjustments
No dose adjustment is typically required for renal or hepatic impairment in mild cases. However, caution and potential dose reduction are advised in moderate to severe impairment, as NSAIDs can exacerbate renal dysfunction.
## 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 ulcer disease.
## Adverse Effects
* **Common:** Nausea, vomiting, dyspepsia, abdominal pain, diarrhea, constipation, dizziness, headache.
* **Serious:** Gastrointestinal bleeding, ulceration, perforation, myocardial infarction, stroke, hypertension, renal failure, hepatic failure, hypersensitivity reactions, bronchospasm, Stevens-Johnson syndrome, toxic epidermal necrolysis.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of gastrointestinal ulceration and bleeding.
* **Selective Serotonin Reuptake Inhibitors (SSRIs) / Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs):** Increased risk of bleeding.
* **Other NSAIDs/Aspirin:** Increased risk of gastrointestinal toxicity, renal toxicity, and additive pharmacodynamic effects.
* **ACE inhibitors/ARBs/Diuretics:** Reduced antihypertensive efficacy and increased risk of renal impairment.
* **Lithium:** Increased serum lithium levels.
* **Methotrexate:** Increased methotrexate toxicity.
## Monitoring
* Signs and symptoms of gastrointestinal bleeding (e.g., melena, hematemesis).
* Renal function (especially in patients with pre-existing renal disease, dehydration, or concomitant nephrotoxic agents).
* Blood pressure.
* Liver function tests if prolonged use or hepatic dysfunction is suspected.
* Signs of hypersensitivity reactions.
## Clinical Pearls
* Administer with food or milk to minimize gastrointestinal upset.
* Use the lowest effective dose for the shortest duration necessary.
* Consider gastroprotection (e.g., proton pump inhibitor) in patients at high risk for gastrointestinal events.
* Avoid in patients with severe heart failure.
* Dosing for pediatric patients should be carefully calculated based on weight and age.
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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 clinical guidelines before making treatment decisions.*
