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# Ibuprofen (Nurofen, Advil, Motrin)
## Overview
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that possesses analgesic, anti-inflammatory, and antipyretic properties. It works by inhibiting cyclooxygenase (COX) enzymes, thereby reducing prostaglandin synthesis.
## Primary Indications
* Pain relief (mild to moderate)
* Fever reduction
* Inflammation management (e.g., arthritis)
## Adult Dosing
* **Analgesia/Antipyresis:** 200 mg to 400 mg every 4 to 6 hours as needed.
* **Inflammation:** 400 mg to 800 mg every 6 to 8 hours.
* **Maximum Daily Dose:** 3200 mg.
## Pediatric Dosing
Dosing is typically based on weight and is recommended every 6 to 8 hours. Specific dosing guidelines can vary by formulation (e.g., suspension, chewable).
* **General guideline for analgesia/antipyresis:** 5 mg/kg to 10 mg/kg per dose.
* **Maximum daily dose:** 40 mg/kg or 4000 mg, whichever is less.
* *Note: Always consult current pediatric dosing guidelines or local protocols for precise pediatric dosing based on age and weight.*
## Dose Adjustments
* **Renal Impairment:** Use with caution. In mild to moderate impairment, dose reduction may be considered. Avoid in severe renal impairment.
* **Hepatic Impairment:** Use with caution. In mild to moderate impairment, dose reduction may be considered. Avoid in severe hepatic impairment.
## Contraindications
* Hypersensitivity to ibuprofen, aspirin, or other NSAIDs.
* History of asthma, urticaria, or other 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 history of recurrent gastrointestinal bleeding.
* Severe heart failure.
* Third trimester of pregnancy.
## Adverse Effects
* **Common:** Nausea, dyspepsia, heartburn, abdominal pain, diarrhea, constipation, dizziness, headache.
* **Serious:**
* **Cardiovascular:** Increased risk of myocardial infarction, stroke, hypertension, heart failure.
* **Gastrointestinal:** Ulceration, bleeding, perforation.
* **Renal:** Acute kidney injury, interstitial nephritis.
* **Hepatic:** Liver enzyme elevations, hepatitis.
* **Hypersensitivity:** Anaphylaxis, Stevens-Johnson syndrome, toxic epidermal necrolysis.
* **Hematologic:** Increased bleeding risk.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin, direct oral anticoagulants):** Increased risk of bleeding.
* **Antiplatelets (e.g., aspirin, clopidogrel):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of gastrointestinal bleeding.
* **Diuretics (e.g., furosemide, hydrochlorothiazide):** Decreased efficacy of diuretics; increased risk of nephrotoxicity.
* **Lithium:** Increased serum lithium levels.
* **Methotrexate:** Increased risk of methotrexate toxicity.
* **Other NSAIDs (including aspirin):** Increased risk of adverse effects.
* **Selective Serotonin Reuptake Inhibitors (SSRIs) / Serotonin Norepinephrine Reuptake Inhibitors (SNRIs):** Increased risk of gastrointestinal bleeding.
* **ACE inhibitors and Angiotensin II Receptor Blockers (ARBs):** Reduced antihypertensive effect; increased risk of nephrotoxicity.
## Monitoring
* Monitor for signs and symptoms of gastrointestinal bleeding (e.g., melena, hematemesis).
* Monitor for cardiovascular events (e.g., chest pain, shortness of breath).
* Assess renal and hepatic function, especially with prolonged use or in patients with risk factors.
* Monitor blood pressure.
## 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 adverse effects.
* Patients with asthma, particularly those with aspirin-sensitive asthma, should use ibuprofen with extreme caution or avoid it altogether.
* Ibuprofen can mask signs of infection.
* Consider gastroprotective agents (e.g., proton pump inhibitors) in patients at high risk for gastrointestinal complications.
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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 clinical guidelines before making any treatment decisions. Dosing and recommendations may vary based on individual patient factors, institutional protocols, and evolving medical knowledge.*
