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# Ibuprofen (Nurofen, Advil, Motrin)
## Overview
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that works by inhibiting cyclooxygenase (COX) enzymes, reducing the synthesis of prostaglandins. This results in analgesic, anti-inflammatory, and antipyretic effects.
## Primary Indications
* Pain (mild to moderate)
* Fever
* Inflammation (e.g., rheumatoid arthritis, osteoarthritis)
* Dysmenorrhea
## Adult Dosing
* **Pain/Fever:** 200-400 mg every 4-6 hours as needed.
* **Inflammation:** 400-800 mg every 6-8 hours as needed.
* **Maximum Daily Dose:** 3200 mg (though doses above 1200 mg/day are generally reserved for inflammatory conditions under medical supervision).
## Pediatric Dosing
Dosing is based on weight and indication. Always use the calibrated dosing device provided. Consult product labeling or a pediatrician for precise 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.
## Dose Adjustments
No specific dose adjustments are typically required for hepatic or renal impairment, but caution is advised, and lower doses may be considered, especially in patients with severe impairment.
## Contraindications
* Known hypersensitivity to ibuprofen, aspirin, or other NSAIDs.
* History of bronchospasm, asthma, rhinitis, or urticaria triggered by aspirin or other NSAIDs.
* Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery.
* Active gastrointestinal (GI) bleeding or history of recurrent peptic ulceration/hemorrhage.
* Severe heart failure.
* Third trimester of pregnancy.
## Adverse Effects
Common: Nausea, vomiting, diarrhea, constipation, abdominal pain, dyspepsia, dizziness, headache.
Serious: Gastrointestinal bleeding, ulceration, perforation; cardiovascular thrombotic events (MI, stroke); renal failure; hypertension; hepatic dysfunction; hypersensitivity reactions; fluid retention; edema.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin) and Antiplatelets (e.g., aspirin, clopidogrel):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **Selective Serotonin Reuptake Inhibitors (SSRIs):** Increased risk of GI bleeding.
* **Lithium:** Increased serum lithium levels.
* **Methotrexate:** Increased risk of methotrexate toxicity.
* **ACE Inhibitors and ARBs:** Reduced antihypertensive effect, increased risk of renal impairment.
* **Diuretics:** Reduced diuretic effect, increased risk of renal impairment.
## Monitoring
* Monitor for signs and symptoms of GI bleeding (e.g., melena, hematemesis).
* Monitor for signs of cardiovascular events.
* Monitor renal function (BUN, creatinine), especially in patients with pre-existing renal disease or those on concomitant nephrotoxic agents.
* Monitor blood pressure.
* Monitor for signs of hypersensitivity reactions.
## Clinical Pearls
* Administer with food or milk to minimize GI upset.
* Lowest effective dose for the shortest duration necessary should be used to minimize risks.
* Risk of cardiovascular events and GI bleeding increases with dose and duration of use.
* Avoid use in patients with dehydration or hypovolemia.
* Discontinue use immediately if any signs of serious adverse events occur.
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*Disclaimer: This information is intended for healthcare professionals. Always consult the most current prescribing information and local protocols for definitive guidance.*
