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# Ibuprofen (Nurofen, Advil, Motrin)
## Overview
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that inhibits cyclooxygenase (COX) enzymes, reducing prostaglandin synthesis. It possesses analgesic, anti-inflammatory, and antipyretic properties.
## Primary Indications
* Pain management (mild to moderate)
* Fever reduction
* Inflammatory conditions (e.g., rheumatoid arthritis, osteoarthritis)
* Dysmenorrhea
## Adult Dosing
* **Analgesia/Antipyresis:** 200 mg to 400 mg orally every 4 to 6 hours as needed.
* **Inflammation:** 400 mg to 800 mg orally every 6 to 8 hours.
* **Maximum Daily Dose:** 3200 mg orally.
## Pediatric Dosing
Dosing is weight-based and typically every 6 to 8 hours. Consult specific product labeling or local protocols for precise dosing.
* **Analgesia/Antipyresis:** 5 mg/kg to 10 mg/kg orally every 6 to 8 hours.
* **Maximum Daily Dose:** 40 mg/kg, not to exceed the adult maximum daily dose.
## Dose Adjustments
No specific dose adjustments are typically required for hepatic or renal impairment, but caution is advised, and lower doses may be considered due to potential for renal toxicity.
## Contraindications
* Hypersensitivity to ibuprofen, aspirin, or other NSAIDs.
* History of bronchospasm, asthma, rhinitis, or urticaria following NSAID or aspirin use.
* Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery.
* Active gastrointestinal bleeding or ulceration.
* Severe heart failure.
* Third trimester of pregnancy.
## Adverse Effects
Common: Dyspepsia, nausea, vomiting, abdominal pain, diarrhea, constipation, dizziness, headache.
Serious: Gastrointestinal bleeding/perforation, renal toxicity (acute kidney injury), cardiovascular thrombotic events (MI, stroke), hypersensitivity reactions, hepatic impairment.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin) and Antiplatelets (e.g., aspirin, clopidogrel):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **Diuretics and Antihypertensives (e.g., ACE inhibitors, ARBs, beta-blockers):** May reduce antihypertensive effect and increase risk of renal dysfunction.
* **Lithium:** Increased serum lithium levels.
* **Methotrexate:** Increased risk of methotrexate toxicity.
## Monitoring
* Monitor for signs and symptoms of GI bleeding (e.g., melena, hematemesis).
* Assess renal function (e.g., BUN, creatinine) especially in patients with pre-existing renal disease, dehydration, or those on concomitant nephrotoxic agents.
* Monitor blood pressure, particularly in patients with hypertension.
* Evaluate for signs of cardiovascular events.
## Clinical Pearls
* Administer with food or milk to minimize GI upset.
* Use the lowest effective dose for the shortest duration necessary to minimize risks.
* Ibuprofen can mask signs of infection.
* Avoid concurrent use with other NSAIDs.
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*Disclaimer: This information is intended for healthcare professionals and does not replace the need to consult the most current prescribing information and professional judgment.*
