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# Ibuprofen (Nurofen, Advil, Motrin)
## Overview
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that inhibits cyclooxygenase (COX) enzymes, reducing prostaglandin synthesis. It possesses analgesic, anti-inflammatory, and antipyretic properties.
## Primary Indications
* Pain management (mild to moderate)
* Fever reduction
* Inflammation associated with conditions like arthritis
## Adult Dosing
* **Pain/Fever:** 200-400 mg orally every 4-6 hours as needed.
* **Inflammation:** 400-800 mg orally every 8 hours.
* **Maximum Daily Dose:** 3200 mg (prescription strength). Over-the-counter (OTC) products are typically limited to 1200 mg per day.
## Pediatric Dosing
Dosing is based on weight and age. Always use the provided dosing device for liquid formulations.
* **Fever/Pain:** 5-10 mg/kg/dose orally every 6-8 hours.
* **Maximum Daily Dose:** 40 mg/kg/day or 2400 mg/day, whichever is less.
* **Infants < 6 months:** Use should be generally avoided due to potential risks; consult pediatrician.
## Dose Adjustments
No dose adjustment is generally required for hepatic or renal impairment, but caution is advised, and monitoring is recommended, especially in severe impairment. The lowest effective dose should be used.
## Contraindications
* Known hypersensitivity to ibuprofen, aspirin, or other NSAIDs.
* History of bronchospasm, asthma, rhinitis, or urticaria precipitated by aspirin or other NSAIDs.
* Perioperative pain in the context of coronary artery bypass graft (CABG) surgery.
* Active peptic ulceration or gastrointestinal bleeding.
## Adverse Effects
* **Gastrointestinal:** Nausea, vomiting, dyspepsia, diarrhea, constipation, abdominal pain, potential for GI bleeding, ulceration, and perforation.
* **Cardiovascular:** Increased risk of myocardial infarction, stroke, and hypertension.
* **Renal:** Sodium and water retention, edema, acute kidney injury, interstitial nephritis.
* **Hepatic:** Elevated liver enzymes, rare cases of liver failure.
* **Hematologic:** Increased bleeding time, rare cases of anemia, thrombocytopenia, leukopenia.
* **Dermatologic:** Rash, pruritus, Stevens-Johnson syndrome, toxic epidermal necrolysis (rare).
* **Other:** Headache, dizziness, tinnitus, hypersensitivity reactions.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Antiplatelet agents (e.g., aspirin, clopidogrel):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **ACE inhibitors, ARBs, Beta-blockers:** May decrease antihypertensive efficacy and increase risk of renal dysfunction.
* **Diuretics:** May decrease diuretic efficacy and increase risk of renal dysfunction.
* **Lithium:** May increase lithium levels.
* **Methotrexate:** May increase methotrexate toxicity.
## Monitoring
* **Renal function:** Especially in patients with pre-existing renal disease, elderly, or those on concomitant nephrotoxic agents.
* **Gastrointestinal symptoms:** Monitor for signs of bleeding or ulceration.
* **Blood pressure:** Especially in patients with hypertension.
* **Signs of hypersensitivity.**
## Clinical Pearls
* Administer with food or milk to minimize GI upset.
* Use the lowest effective dose for the shortest duration necessary.
* Consider gastroprotection (e.g., PPI) in patients with increased GI risk factors.
* Avoid concomitant use with other NSAIDs.
* Ibuprofen may mask signs of infection.
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*This information is intended for healthcare professionals. Always verify current prescribing information and local protocols before administering any medication.*
