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# Ibuprofen
## Overview
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that exhibits analgesic, anti-inflammatory, and antipyretic properties. It works by inhibiting cyclooxygenase (COX) enzymes, thereby reducing prostaglandin synthesis.
## Primary Indications
* Pain relief (mild to moderate)
* Inflammation (e.g., arthritis)
* Fever reduction
## Adult Dosing
* **Pain/Fever:** 200 mg to 400 mg orally every 4 to 6 hours as needed. Maximum daily dose: 1200 mg.
* **Inflammation:** 400 mg to 800 mg orally every 6 to 8 hours. Maximum daily dose: 3200 mg (under medical supervision for conditions like rheumatoid arthritis).
## Pediatric Dosing
* **Fever/Pain:** 5 mg/kg/dose orally every 6 to 8 hours for children 6 months and older. Maximum dose: 40 mg/kg/day or 400 mg per dose.
* **Inflammation:** 10 mg/kg/dose orally every 6 to 8 hours. Maximum dose: 40 mg/kg/day or 400 mg per dose.
* **Note:** Dosing may vary by formulation and specific indication. Consult product labeling or local protocols.
## Dose Adjustments
* **Renal Impairment:** Use with caution. Monitor renal function. Dose reduction may be necessary in severe impairment.
* **Hepatic Impairment:** Use with caution. Monitor liver function. Dose reduction may be necessary.
* **Elderly:** Increased risk of adverse effects; consider lower doses.
## Contraindications
* Hypersensitivity to ibuprofen, aspirin, or other NSAIDs.
* History of 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, renal failure, or hepatic failure.
* Third trimester of pregnancy.
## Adverse Effects
Common: Nausea, dyspepsia, diarrhea, rash, dizziness.
Serious: Gastrointestinal bleeding, ulceration, perforation; cardiovascular thrombotic events (MI, stroke); renal failure; hepatic injury; bronchospasm; hypersensitivity reactions.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Antiplatelets (e.g., aspirin, clopidogrel):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **ACE inhibitors, ARBs, diuretics:** Reduced antihypertensive effect and increased risk of renal impairment.
* **Lithium:** Increased lithium levels and toxicity.
* **Methotrexate:** Increased methotrexate toxicity.
## Monitoring
* Signs and symptoms of GI bleeding or ulceration.
* Renal function (BUN, creatinine) especially in those with pre-existing renal disease or on concomitant nephrotoxic agents.
* Liver function tests (LFTs) in patients with hepatic impairment or on long-term therapy.
* Blood pressure.
* Signs of cardiovascular events.
## Clinical Pearls
* Administer with food or milk to minimize GI upset.
* Lowest effective dose for the shortest duration necessary should be used to minimize risks.
* Risk of cardiovascular events and GI bleeding increases with dose and duration of use.
* Consider alternative analgesics if significant cardiovascular or GI risk factors are present.
* For pediatric use, ensure accurate weight-based dosing.
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*This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant literature before making clinical decisions.*
