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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 (mild to moderate)
* Fever
* Inflammation (e.g., arthritis)
### Adult Dosing
* **Pain/Fever:** 200 mg to 400 mg orally every 4 to 6 hours as needed.
* **Rheumatoid Arthritis/Osteoarthritis:** 400 mg to 800 mg orally three times daily.
* **Maximum Daily Dose:** 3200 mg orally for chronic use; 2400 mg orally for acute use.
### Pediatric Dosing
Dosing is weight-based. Consult product labeling or local protocols for specific formulations and precise dosing.
* **Fever/Pain:** 5 mg/kg to 10 mg/kg orally every 6 to 8 hours.
* **Maximum Daily Dose:** 40 mg/kg or 2400 mg, whichever is less.
### Dose Adjustments
* **Renal Impairment:** Use with caution. Dose reduction may be necessary in severe impairment.
* **Hepatic Impairment:** Use with caution. Dose reduction may be necessary in severe impairment.
### Contraindications
* Hypersensitivity to ibuprofen, aspirin, or other NSAIDs.
* History of bronchospasm, asthma, rhinitis, or urticaria after taking aspirin or other NSAIDs.
* Peri-operative pain in the setting of coronary artery bypass graft (CABG) surgery.
* Active peptic ulceration or gastrointestinal bleeding.
* Severe renal or hepatic impairment.
* Third trimester of pregnancy.
### Adverse Effects
* **Common:** Nausea, vomiting, dyspepsia, diarrhea, constipation, abdominal pain, dizziness, headache.
* **Serious:** Gastrointestinal bleeding/perforation, myocardial infarction, stroke, hypertension, renal failure, hepatic failure, Stevens-Johnson syndrome, anaphylaxis.
### Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **SSRIs/SNRIs:** Increased risk of GI bleeding.
* **ACE inhibitors/ARBs:** Reduced antihypertensive effect, increased risk of renal impairment.
* **Diuretics:** Reduced diuretic effect, increased risk of renal impairment.
* **Lithium:** Increased lithium levels.
* **Methotrexate:** Increased methotrexate toxicity.
### Monitoring
* **GI:** Assess for signs/symptoms of bleeding (e.g., melena, hematemesis).
* **Renal/Hepatic Function:** Monitor via blood tests, especially with prolonged use or in patients with risk factors.
* **Cardiovascular:** Monitor blood pressure.
### Clinical Pearls
* Administer with food or milk to minimize GI upset.
* Lowest effective dose for the shortest duration should be used.
* Risk of serious cardiovascular thrombotic events, myocardial infarction, and stroke may increase with duration of use and in patients with pre-existing cardiovascular disease.
* Risk of serious GI adverse events (e.g., bleeding, ulceration, perforation) can occur at any time and without warning.
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*Please verify current prescribing information and consult with a healthcare professional for personalized medical advice.*
