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# Ibuprofen (Nurofen, Advil, Motrin)
## Overview
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that possesses analgesic, anti-inflammatory, and antipyretic properties. It works by inhibiting cyclooxygenase (COX) enzymes, thereby reducing prostaglandin synthesis.
## Primary Indications
* Pain relief (mild to moderate)
* Inflammation reduction (e.g., arthritis)
* Fever reduction
## Adult Dosing
* **Pain/Fever:** 200-400 mg every 4-6 hours as needed. Maximum daily dose: 1200 mg for over-the-counter (OTC) use. For prescription use, up to 2400-3200 mg daily in divided doses may be used under medical supervision for inflammatory conditions.
* **Inflammation:** 400-800 mg three to four times daily. Maximum daily dose: 3200 mg under medical supervision.
## Pediatric Dosing
Dosing is typically weight-based. Consult product labeling or a pediatrician for precise dosing.
* **Fever/Pain:** 5-10 mg/kg per dose every 6-8 hours.
* Infants 6 months to 11 years: Do not exceed 4 doses in 24 hours.
* Maximum daily dose for children up to 12 years: 40 mg/kg or 2400 mg, whichever is less.
* **Rheumatic diseases:** Doses may be higher and require specialist management.
## Dose Adjustments
No specific dose adjustment is generally required for hepatic or renal impairment, but caution is advised. Ibuprofen should be used at the lowest effective dose and for the shortest duration necessary to reduce the risk of renal adverse effects, particularly in patients with pre-existing renal disease, heart failure, dehydration, or those taking diuretics or ACE inhibitors.
## Contraindications
* Known hypersensitivity to ibuprofen, aspirin, or other NSAIDs.
* History of bronchospasm, asthma, rhinitis, or urticaria following aspirin or NSAID use.
* Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery.
* Active gastrointestinal bleeding or ulcer disease.
* Severe heart failure.
* Third trimester of pregnancy.
## Adverse Effects
* **Gastrointestinal:** Nausea, vomiting, dyspepsia, abdominal pain, diarrhea, constipation, GI bleeding, perforation, ulceration.
* **Cardiovascular:** Increased risk of myocardial infarction and stroke.
* **Renal:** Renal impairment, interstitial nephritis, papillary necrosis.
* **Hepatic:** Elevated liver enzymes, hepatitis.
* **Other:** Dizziness, headache, rash, fluid retention, edema, tinnitus.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Aspirin:** May reduce the cardioprotective effects of low-dose aspirin; consider administering ibuprofen at least 8 hours before or 30 minutes after aspirin.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **Diuretics, ACE inhibitors, ARBs:** May reduce antihypertensive efficacy and increase risk of renal dysfunction.
* **Lithium:** Increased serum lithium levels.
* **Methotrexate:** Increased risk of methotrexate toxicity.
* **Selective Serotonin Reuptake Inhibitors (SSRIs):** Increased risk of GI bleeding.
## Monitoring
* Monitor for signs and symptoms of GI bleeding or ulceration.
* Monitor renal function, especially in high-risk patients.
* Monitor blood pressure, particularly when used long-term.
* Assess for signs of cardiovascular events.
## Clinical Pearls
* Take with food or milk to minimize GI upset.
* Use the lowest effective dose for the shortest duration necessary.
* Avoid concomitant use with other NSAIDs or aspirin unless specifically indicated and managed.
* Patients with asthma, particularly aspirin-sensitive asthma, should use with caution.
* Consider risks versus benefits in elderly patients and those with cardiovascular disease, renal impairment, or GI history.
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**Disclaimer:** This information is intended for clinical use and does not substitute for professional medical advice. Always verify current prescribing information and consult with a qualified healthcare provider before making any treatment decisions.
