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# Ibuprofen (Nurofen, Advil, Motrin)
## Overview
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that provides analgesia, anti-inflammatory, and antipyretic effects.
## Primary Indications
* Mild to moderate pain
* Fever
* Inflammation associated with conditions like arthritis
## Adult Dosing
* **Pain/Fever:** 200-400 mg every 4-6 hours as needed. Maximum daily dose: 1200 mg.
* **Inflammation (e.g., arthritis):** 400-800 mg every 6-8 hours. Maximum daily dose: 2400 mg (typically reserved for rheumatologic conditions under strict monitoring).
## Pediatric Dosing
Dosing is weight-based and age-dependent. Consult product labeling or specific pediatric guidelines.
* **Fever/Pain:** 5-10 mg/kg per dose every 6-8 hours.
* Maximum daily dose: 40 mg/kg or 2400 mg, whichever is less.
* Infants: Generally 6 months and older.
## Dose Adjustments
No specific dose adjustments are typically required for hepatic or renal impairment, but caution is advised. Ibuprofen should be used with caution and potentially lower doses in elderly patients due to increased risk of adverse effects.
## Contraindications
* Hypersensitivity to ibuprofen, aspirin, or other NSAIDs.
* History of bronchospasm, asthma, rhinitis, or urticaria after taking aspirin or other NSAIDs.
* Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery.
* Active peptic ulceration or gastrointestinal bleeding.
* Severe heart failure, renal failure, or hepatic failure.
* Pregnancy (third trimester).
## Adverse Effects
* **Common:** Nausea, vomiting, dyspepsia, abdominal pain, constipation, diarrhea, rash, dizziness, headache.
* **Serious:** Gastrointestinal bleeding/perforation, myocardial infarction, stroke, renal failure, hepatic injury, hypersensitivity reactions, Stevens-Johnson syndrome, toxic epidermal necrolysis.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin, DOACs):** Increased risk of bleeding.
* **Aspirin (low-dose):** May reduce the cardioprotective effect of low-dose aspirin. Separate administration by at least 8 hours.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **Diuretics:** Reduced diuretic efficacy, increased risk of renal impairment.
* **Lithium:** Increased serum lithium levels and risk of toxicity.
* **Methotrexate:** Increased risk of methotrexate toxicity.
* **SSRIs/SNRIs:** Increased risk of GI bleeding.
* **ACE inhibitors, ARBs, Beta-blockers:** May diminish antihypertensive effect, increased risk of renal impairment.
## Monitoring
* **GI symptoms:** Monitor for signs of bleeding (melena, hematemesis).
* **Renal function:** Especially in patients with pre-existing renal disease, dehydration, or those on concomitant nephrotoxic agents.
* **Blood pressure:** NSAIDs can cause fluid retention and elevate blood pressure.
* **Hepatic function:** Monitor for signs of liver injury.
## Clinical Pearls
* Administer with food or milk to minimize GI upset.
* Use the lowest effective dose for the shortest duration necessary.
* Caution in patients with cardiovascular disease, hypertension, asthma, dehydration, or a history of GI disease.
* Avoid in the third trimester of pregnancy.
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**Disclaimer:** This information is intended for clinical use and does not replace professional judgment. Always consult the most current prescribing information and institutional protocols before initiating or modifying therapy.
