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## Ibuprofen
### Overview
Ibuprofen is a non-steroidal 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 (mild to moderate)
* Fever
* Inflammatory conditions (e.g., rheumatoid arthritis, osteoarthritis)
* Primary dysmenorrhea
### 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 3 times daily.
* **Primary Dysmenorrhea:** 400 mg orally every 4 to 6 hours as needed.
**Maximum Daily Dose:** 3200 mg for inflammatory conditions; 1200 mg for pain and fever unless directed otherwise by a physician.
### Pediatric Dosing
Dosing is typically based on weight. Consult current institutional guidelines or product labeling for precise dosing.
* **Fever/Pain:** 5 mg/kg to 10 mg/kg orally every 6 to 8 hours.
* **Maximum Pediatric Dose:** Not to exceed adult maximum daily dose.
### Dose Adjustments
* **Renal Impairment:** Use with caution. Dose reduction may be necessary in severe impairment. Monitor renal function.
* **Hepatic Impairment:** Use with caution. Dose reduction may be necessary in severe impairment. Monitor liver function.
### Contraindications
* Hypersensitivity to ibuprofen, aspirin, or other NSAIDs.
* History of bronchospasm, asthma, rhinitis, or urticaria after taking aspirin or other NSAIDs.
* Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery.
* Active gastrointestinal bleeding or ulceration.
* Severe heart failure.
* Severe renal impairment.
* Third trimester of pregnancy.
### Adverse Effects
* **Common:** Nausea, vomiting, dyspepsia, abdominal pain, diarrhea, constipation, dizziness, headache.
* **Serious:** Gastrointestinal bleeding, ulceration, perforation; cardiovascular thrombotic events (myocardial infarction, stroke); renal toxicity; hepatic toxicity; hypersensitivity reactions; Stevens-Johnson syndrome/toxic epidermal necrolysis.
### Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of gastrointestinal ulceration and bleeding.
* **SSRIs/SNRIs:** Increased risk of bleeding.
* **Lithium:** Increased lithium levels and toxicity.
* **Methotrexate:** Increased methotrexate toxicity.
* **ACE inhibitors, ARBs, Beta-blockers:** Reduced antihypertensive efficacy, increased risk of renal impairment.
* **Diuretics:** Reduced diuretic efficacy, increased risk of renal impairment.
### Monitoring
* Renal function (BUN, creatinine)
* Liver function (LFTs)
* Complete blood count (CBC)
* Signs and symptoms of gastrointestinal bleeding
* Blood pressure
### Clinical Pearls
* Administer with food or milk to minimize gastrointestinal upset.
* Use the lowest effective dose for the shortest duration necessary to minimize risks.
* Caution in patients with a history of cardiovascular disease, hypertension, asthma, or gastrointestinal disorders.
* Avoid concurrent use with other NSAIDs or salicylates.
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*This information is intended for clinical use and does not substitute for professional medical advice. Always verify current prescribing information with official drug compendia and institutional protocols.*
