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## Ibuprofen (Nurofen, Advil, Motrin)
### Overview
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that provides analgesic, anti-inflammatory, and antipyretic effects.
### Primary Indications
* Pain relief (e.g., headache, dental pain, menstrual cramps, muscle aches)
* Fever reduction
* Inflammation associated with conditions like arthritis
### Adult Dosing
* **Pain and Fever:** 200-400 mg orally every 4-6 hours as needed.
* **Inflammation:** 400-800 mg orally every 6-8 hours.
* **Maximum Daily Dose:** 3200 mg. However, for over-the-counter (OTC) use, the maximum daily dose is typically 1200 mg. Prescribed doses higher than 1200 mg/day should be closely monitored.
### Pediatric Dosing
Dosing is typically based on weight.
* **Fever and Pain:** 5-10 mg/kg orally every 6-8 hours as needed.
* **Maximum Daily Dose:** 40 mg/kg or 2400 mg, whichever is less. Doses exceeding 40 mg/kg/day are generally reserved for specific inflammatory conditions and require careful monitoring.
* **Infants < 6 months:** Use is generally not recommended due to potential risks; consult with a pediatrician.
### Dose Adjustments
No specific dose adjustments are typically required for hepatic or renal impairment, but caution is advised, and the lowest effective dose should be used. Patients with severe impairment should be closely monitored.
### 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 peptic ulceration or gastrointestinal bleeding.
* Severe heart failure.
* Severe renal or hepatic impairment.
### Adverse Effects
* **Common:** Nausea, vomiting, dyspepsia, abdominal pain, diarrhea, constipation, dizziness, headache.
* **Serious:** Gastrointestinal bleeding, ulceration, perforation; cardiovascular thrombotic events (myocardial infarction, stroke); renal toxicity; hepatic injury; hypersensitivity reactions; exacerbation of asthma.
### Key Drug Interactions
* **Anticoagulants (e.g., warfarin) and Antiplatelets (e.g., aspirin, clopidogrel):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of gastrointestinal bleeding and ulceration.
* **ACE inhibitors, ARBs, Beta-blockers:** May decrease antihypertensive effect and increase risk of renal toxicity.
* **Diuretics:** May decrease diuretic efficacy and increase risk of renal toxicity.
* **Lithium, Methotrexate:** Increased serum concentrations and toxicity.
### Monitoring
* Monitor for signs and symptoms of gastrointestinal bleeding (e.g., melena, hematemesis).
* Assess renal function (BUN, creatinine) especially in patients with pre-existing renal disease or those taking concomitant nephrotoxic agents.
* Monitor blood pressure, particularly with chronic use or in patients with hypertension.
* Assess for cardiovascular risk factors and symptoms of cardiovascular events.
### Clinical Pearls
* Administer with food or milk to minimize gastrointestinal upset.
* Use the lowest effective dose for the shortest duration necessary.
* Ibuprofen is often considered a preferred NSAID in pediatrics for fever and pain due to its established safety profile and efficacy.
* Patients with risk factors for GI bleeding (e.g., elderly, history of ulcers, concurrent anticoagulant use) should use with extreme caution or consider alternative agents.
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**Disclaimer:** This information is intended for clinical use and is not a substitute for professional medical advice. Always consult the most current prescribing information and relevant guidelines for complete details before making any treatment decisions.
