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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 prostaglandin synthesis.
## Primary Indications
* Pain (mild to moderate)
* Fever
* Inflammation (e.g., arthritis)
* Dysmenorrhea
## Adult Dosing
* **Pain/Fever:** 200-400 mg every 4-6 hours as needed. Maximum daily dose: 1200 mg for over-the-counter (OTC) use; up to 2400 mg or 3200 mg per day may be used under medical supervision for inflammatory conditions, depending on formulation and clinical judgment.
* **Inflammatory Conditions:** 400-800 mg three to four times daily. Maximum daily dose: 2400 mg or 3200 mg, depending on formulation and indication, under medical supervision.
## Pediatric Dosing
* **Fever/Pain:** 5-10 mg/kg/dose every 6-8 hours.
* Infants 6 months to 11 years: Maximum daily dose is typically 40 mg/kg/day.
* Higher doses (up to 10 mg/kg/dose) may be considered for more severe pain or inflammation under medical supervision.
* **Rheumatoid Arthritis:** 20-50 mg/kg/day divided into 3-4 doses. Maximum daily dose: 2400 mg.
Dosing for infants under 6 months is generally not recommended due to potential for renal toxicity, unless specifically advised by a physician.
## Dose Adjustments
No dose adjustment is typically required for hepatic or renal impairment, but caution is advised, especially in moderate to severe impairment. Consider lowest effective dose and monitor renal function.
## Contraindications
* Hypersensitivity to ibuprofen, aspirin, or other NSAIDs.
* History of bronchospasm, 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 ulceration.
* Severe heart failure, renal impairment, or hepatic impairment.
## Adverse Effects
Common: Nausea, vomiting, dyspepsia, abdominal pain, diarrhea, constipation, dizziness, headache.
Serious: Gastrointestinal bleeding/perforation, myocardial infarction, stroke, hypertension, renal failure, hypersensitivity reactions, Stevens-Johnson syndrome.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of gastrointestinal bleeding.
* **SSRIs/SNRIs:** Increased risk of bleeding.
* **ACE inhibitors/ARBs/Diuretics:** May reduce antihypertensive effect and increase risk of renal dysfunction.
* **Lithium:** May increase serum lithium levels.
* **Methotrexate:** May increase methotrexate toxicity.
## Monitoring
* Signs and symptoms of gastrointestinal bleeding (melena, hematemesis).
* Renal function (BUN, creatinine), especially in patients with risk factors.
* Blood pressure.
* Signs of hypersensitivity reactions.
## Clinical Pearls
* Administer with food or milk to minimize gastrointestinal upset.
* Use the lowest effective dose for the shortest duration necessary.
* Caution in elderly patients and those with pre-existing cardiovascular, renal, or hepatic disease.
* Avoid concomitant use with other NSAIDs.
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*This information is intended for healthcare professionals. Always consult the most current prescribing information and local protocols for definitive guidance.*
