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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 (mild to moderate)
* Fever reduction
* Inflammation associated with conditions like arthritis, musculoskeletal injuries, and dysmenorrhea.
## Adult Dosing
* **Analgesia/Antipyresis:** 200-400 mg every 4-6 hours as needed. Maximum daily dose: 1200 mg without physician supervision. Higher doses (up to 2400-3200 mg/day) may be used for inflammatory conditions under strict medical supervision.
* **Inflammatory Conditions (e.g., rheumatoid arthritis):** 400-800 mg twice or three times daily. Maximum daily dose: 3200 mg.
## Pediatric Dosing
* **Analgesia/Antipyresis:** 5-10 mg/kg/dose every 6-8 hours. Maximum daily dose: 40 mg/kg or 2400 mg, whichever is less. Dosing is weight-based.
* For infants 6-11 months: 5 mg/kg/dose.
* For children 1-12 years: 5-10 mg/kg/dose.
* **Kawasaki Disease:** Dosing varies and is often guided by specific institutional protocols, typically starting with higher doses for anti-inflammatory effects and then reducing for antiplatelet effects. Consult specific guidelines.
## Dose Adjustments
No specific dose adjustments are typically required for renal or hepatic impairment, but caution is advised due to potential for worsening renal function and hepatotoxicity. Use the lowest effective dose for the shortest duration.
## Contraindications
* Hypersensitivity to ibuprofen, aspirin, or other NSAIDs.
* History of bronchospasm, asthma, rhinitis, or urticaria precipitated by NSAIDs.
* Perioperative pain in the context of coronary artery bypass graft (CABG) surgery.
* Active gastrointestinal bleeding or a history of peptic ulcer disease/hemorrhage.
* Severe renal, hepatic, or heart failure.
* Third trimester of pregnancy.
## Adverse Effects
Common: Nausea, vomiting, diarrhea, constipation, dyspepsia, abdominal pain, rash, dizziness, headache.
Serious: Gastrointestinal bleeding, ulceration, perforation, cardiovascular thrombotic events (MI, stroke), renal papillary necrosis, acute kidney injury, hepatic failure, Stevens-Johnson syndrome, anaphylaxis.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin, DOACs):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of gastrointestinal ulceration and bleeding.
* **SSRIs/SNRIs:** Increased risk of bleeding.
* **ACE inhibitors, ARBs, Diuretics:** Reduced antihypertensive effect; increased risk of renal impairment.
* **Lithium, Methotrexate:** Increased serum levels and toxicity.
## Monitoring
* Signs and symptoms of gastrointestinal bleeding (melena, hematemesis).
* Renal function (BUN, creatinine), especially in patients with pre-existing renal disease or those on concomitant nephrotoxic agents.
* Liver function tests, particularly with long-term use or in patients with hepatic impairment.
* Blood pressure, especially when used for chronic pain or inflammatory conditions.
## Clinical Pearls
* Administer with food or milk to minimize gastrointestinal upset.
* Use the lowest effective dose for the shortest duration necessary to reduce the risk of serious adverse events.
* Risk of cardiovascular thrombotic events and serious gastrointestinal events increases with dose and duration of use.
* Should be avoided in patients with aspirin-sensitive asthma.
**Disclaimer:** This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant clinical guidelines for complete details and to verify dosing and safety before initiating treatment.
