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# Ibuprofen (Nurofen, Advil, Motrin)
## Overview
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that reduces inflammation, pain, and fever by inhibiting cyclooxygenase (COX) enzymes, thereby decreasing prostaglandin synthesis.
## Primary Indications
* Pain (mild to moderate)
* Fever
* Inflammatory conditions (e.g., rheumatoid arthritis, osteoarthritis)
## Adult Dosing
* **Analgesia/Antipyresis:** 200 mg to 400 mg orally every 4 to 6 hours as needed.
* **Rheumatoid Arthritis/Osteoarthritis:** 400 mg to 800 mg orally every 6 to 8 hours.
* **Maximum Daily Dose:** 3200 mg orally. Shorter durations at higher doses are generally preferred.
## Pediatric Dosing
Dosing is typically based on weight. Dosing intervals are usually every 6 to 8 hours.
* **Analgesia/Antipyresis:** 5 mg/kg/dose to 10 mg/kg/dose orally.
* **Maximum Daily Dose:** Generally 40 mg/kg/day.
* Specific dosing for children under 6 months of age should be guided by institutional protocol or a pediatrician due to potential safety concerns.
## Dose Adjustments
No dose adjustment is typically required for renal or hepatic impairment, but caution is advised, especially in severe impairment, as NSAIDs can exacerbate renal dysfunction. Monitor closely.
## 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 (GI) bleeding or history of GI bleeding/perforation with prior NSAID use.
* Severe heart failure.
* Late pregnancy (third trimester).
## Adverse Effects
Common: GI upset (nausea, vomiting, diarrhea, constipation), dizziness, headache.
Serious: GI bleeding/ulceration, cardiovascular thrombotic events (MI, stroke), renal impairment, hypertension, hypersensitivity reactions, bronchospasm.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin, DOACs):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **SSRIs/SNRIs:** Increased risk of GI bleeding.
* **ACE inhibitors, ARBs, beta-blockers:** Reduced antihypertensive effect; increased risk of renal dysfunction.
* **Diuretics:** Reduced diuretic and antihypertensive effects; increased risk of renal dysfunction.
* **Lithium:** Increased serum lithium levels.
* **Methotrexate:** Increased risk of methotrexate toxicity.
## Monitoring
* Signs and symptoms of GI bleeding (melena, hematemesis).
* Renal function (BUN, creatinine), especially in at-risk patients.
* Blood pressure.
* Signs of cardiovascular events.
* Liver function tests if prolonged use or hepatic impairment.
## 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) for patients at high risk of GI events.
* Ibuprofen can mask signs of infection.
* Avoid concomitant use with other NSAIDs.
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*Disclaimer: This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant clinical guidelines before making treatment decisions.*
