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# Ibuprofen
## Overview
Ibuprofen is a non-steroidal 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 (mild to moderate)
* Fever
* Inflammation (e.g., arthritis)
* Dysmenorrhea
## Adult Dosing
* **Analgesia/Antipyresis:** 200-400 mg every 4-6 hours as needed. Maximum daily dose is 1200 mg without medical supervision, and up to 2400-3200 mg daily in divided doses for specific conditions under medical supervision.
* **Rheumatoid Arthritis/Osteoarthritis:** 400-800 mg three to four times daily. Maximum daily dose is typically 2400 mg.
## Pediatric Dosing
* **Analgesia/Antipyresis:** 5-10 mg/kg/dose every 6-8 hours. Maximum daily dose is 40 mg/kg or 2400 mg, whichever is less. For younger infants (under 6 months), use is generally not recommended due to potential for renal and GI toxicity, but may be considered under strict medical supervision.
## Dose Adjustments
Dose adjustments are not typically required for hepatic or renal impairment, but caution and potentially lower doses are advised in patients with moderate impairment. Ibuprofen should be used with extreme caution or avoided in severe renal or hepatic disease.
## Contraindications
* Hypersensitivity to ibuprofen, aspirin, or other NSAIDs.
* History of bronchospasm, asthma, rhinitis, or urticaria precipitated by aspirin or other NSAIDs.
* Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery.
* Active gastrointestinal bleeding or history of GI perforation or ulceration.
* Severe heart failure.
* Pregnancy (third trimester).
## Adverse Effects
Common: Nausea, vomiting, diarrhea, constipation, dyspepsia, dizziness, headache.
Serious: Gastrointestinal bleeding/perforation, renal toxicity (including interstitial nephritis, papillary necrosis), cardiovascular thrombotic events (MI, stroke), exacerbation of asthma, hypersensitivity reactions, hepatotoxicity.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin), antiplatelets (e.g., clopidogrel), SSRIs:** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **ACE inhibitors, ARBs, Beta-blockers:** Reduced antihypertensive effect and increased risk of renal impairment.
* **Diuretics:** Reduced diuretic efficacy and increased risk of nephrotoxicity.
* **Lithium, Methotrexate:** Increased serum levels and toxicity.
* **Other NSAIDs, Aspirin:** Increased risk of adverse effects, particularly GI.
## Monitoring
* Signs and symptoms of GI bleeding (e.g., melena, hematemesis).
* Renal function (especially in patients with pre-existing renal disease, dehydration, or those on concomitant nephrotoxic agents).
* Blood pressure.
* Signs of cardiovascular events.
## Clinical Pearls
* Administer with food or milk to minimize gastrointestinal upset.
* Use the lowest effective dose for the shortest duration necessary.
* Caution is advised in elderly patients due to increased risk of adverse effects.
* Patients with a history of asthma should be monitored closely for bronchospasm.
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*This information is intended for healthcare professionals. It is crucial to consult the most current prescribing information and relevant clinical guidelines before making any treatment decisions. Dosing and recommendations may vary based on patient-specific factors and local protocols.*
