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# Ibuprofen (Nurofen, Advil, Motrin)
## Overview
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) with analgesic, anti-inflammatory, and antipyretic properties. It works by inhibiting cyclooxygenase (COX) enzymes, thereby reducing prostaglandin synthesis.
## Primary Indications
* Pain (mild to moderate)
* Inflammation
* Fever
## Adult Dosing
* **Analgesia/Antipyresis:** 200-400 mg every 4-6 hours as needed. Maximum daily dose: 1200 mg. For specific conditions like acute musculoskeletal injuries, doses up to 800 mg every 8 hours may be used, not exceeding 3200 mg/day under strict medical supervision.
* **Rheumatoid Arthritis/Osteoarthritis:** 400-800 mg 3 times daily. Maximum daily dose: 3200 mg.
## Pediatric Dosing
* **Analgesia/Antipyresis:** 5-10 mg/kg/dose orally every 6-8 hours. Do not exceed 4 doses in 24 hours. Maximum daily dose: 40 mg/kg or 2400 mg, whichever is less.
* *Infants 6 months and older:* Dosing is weight-based.
* *Formulations vary:* Dosage must be calculated based on available concentration (e.g., 100 mg/5 mL liquid).
## Dose Adjustments
No dose adjustment is typically required for renal or hepatic impairment, but caution is advised. Use the lowest effective dose for the shortest duration necessary.
## 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 perforation.
* Severe heart failure.
* Third trimester of pregnancy.
## Adverse Effects
* **Common:** Dyspepsia, nausea, vomiting, abdominal pain, diarrhea, constipation, headache, dizziness.
* **Serious:** Gastrointestinal bleeding/perforation, myocardial infarction, stroke, renal failure, exacerbation of heart failure, hypersensitivity reactions, Stevens-Johnson syndrome, toxic epidermal necrolysis.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Aspirin (low-dose):** May decrease cardioprotective effects of aspirin.
* **Corticosteroids:** Increased risk of gastrointestinal bleeding.
* **Diuretics:** Reduced efficacy, increased risk of nephrotoxicity.
* **Lithium:** Increased serum lithium levels.
* **Methotrexate:** Increased risk of methotrexate toxicity.
* **Other NSAIDs:** Additive adverse effects.
* **SSRIs/SNRIs:** Increased risk of gastrointestinal bleeding.
## Monitoring
* **GI symptoms:** Assess for signs of bleeding or ulceration.
* **Renal function:** Monitor BUN, creatinine, especially in patients with pre-existing renal disease or those on concurrent nephrotoxic agents.
* **Hepatic function:** Monitor liver enzymes in patients with hepatic impairment.
* **Blood pressure:** NSAIDs can cause fluid retention and hypertension.
## Clinical Pearls
* Administer with food or milk to minimize gastrointestinal upset.
* Use the lowest effective dose for the shortest duration necessary to minimize risks.
* Caution in elderly patients due to increased risk of adverse effects.
* Ibuprofen is often preferred over aspirin for fever and pain in children due to a lower risk of Reye's syndrome.
**Disclaimer:** This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant clinical guidelines for complete details and to ensure patient safety.
