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# Ibuprofen
## Overview
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) used for its analgesic, anti-inflammatory, and antipyretic properties.
## Primary Indications
* Pain (mild to moderate)
* Inflammation
* Fever
## Adult Dosing
* **Analgesia/Antipyresis:** 200 mg to 400 mg every 4 to 6 hours as needed.
* **Rheumatoid Arthritis/Osteoarthritis:** 400 mg to 800 mg three to four times daily.
**Maximum Daily Dose:** 3200 mg for all indications. Doses higher than 2400 mg daily should be reserved for patients who have not responded to lower doses and for whom the benefits are judged to outweigh the risks.
## Pediatric Dosing
Dosing is typically based on weight. Consult product labeling or local protocol for precise dosing.
* **Analgesia/Antipyresis:** 5 mg/kg to 10 mg/kg every 6 to 8 hours as needed.
* **Maximum Single Dose:** 40 mg/kg/day or 400 mg, whichever is less.
**Note:** Generally not recommended for infants less than 6 months of age due to potential risks.
## Dose Adjustments
* **Renal Impairment:** Use with caution. Dose reduction may be necessary in severe impairment. Monitor renal function.
* **Hepatic Impairment:** Use with caution. Dose reduction may be necessary in severe impairment. Monitor liver function.
* **Elderly:** Use with caution, especially at higher doses, due to increased risk of adverse effects.
## 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.
* Known NSAID-induced ulcerative disease or gastrointestinal bleeding.
* Severe heart failure.
* Severe renal impairment.
* Severe hepatic impairment.
* Pregnancy in the third trimester.
## Adverse Effects
* **Gastrointestinal:** Dyspepsia, nausea, vomiting, abdominal pain, diarrhea, constipation, occult blood loss, peptic ulceration, perforation.
* **Cardiovascular:** Increased risk of myocardial infarction, stroke, hypertension.
* **Renal:** Renal insufficiency, acute kidney injury.
* **Hematologic:** Anemia, bruising, prolonged bleeding time.
* **Hepatic:** Elevated liver enzymes, hepatitis.
* **Dermatologic:** Rash, pruritus.
* **Other:** Dizziness, headache, tinnitus, hypersensitivity reactions.
## Key Drug Interactions
* **ACE inhibitors/ARBs/Diuretics:** May reduce antihypertensive effect and increase risk of renal dysfunction.
* **Anticoagulants (e.g., Warfarin) and Antiplatelets (e.g., Aspirin, Clopidogrel):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of gastrointestinal ulceration and bleeding.
* **Lithium:** May increase lithium levels.
* **Methotrexate:** May increase methotrexate levels and toxicity.
* **SSRIs:** Increased risk of gastrointestinal bleeding.
## Monitoring
* Renal function (serum creatinine, BUN).
* Liver function (transaminases).
* Blood pressure.
* Signs and symptoms of gastrointestinal bleeding.
* Signs and symptoms of cardiovascular events.
## Clinical Pearls
* Administer with food or milk to minimize gastrointestinal upset.
* Lowest effective dose should be used for the shortest duration necessary to minimize risks.
* Avoid concomitant use with other NSAIDs, including aspirin (unless for cardioprotection at low doses, with caution).
* Consider gastroprotection (e.g., PPI) for patients at high risk of GI complications.
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**Disclaimer:** This information is intended for healthcare professionals. Always consult the most current prescribing information and product labeling for complete details before making any treatment decisions. Local protocols and institutional guidelines may also apply.
