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Ibuprofen (Nurofen, Advil, Motrin)
## Overview
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that reduces inflammation, pain, and fever.
## Primary Indications
* Pain (mild to moderate)
* Fever
* Inflammation (e.g., arthritis)
## Adult Dosing
* **Pain/Fever:** 200 mg to 400 mg every 4 to 6 hours as needed.
* **Inflammation:** 400 mg to 800 mg three to four times daily.
* **Maximum Daily Dose:** 3200 mg.
## Pediatric Dosing
* **Fever/Pain:** 5 mg/kg to 10 mg/kg per dose every 6 to 8 hours.
* **Maximum Daily Dose:** 40 mg/kg/day or 2400 mg/day, whichever is less.
* Dosing is typically based on weight. Do not exceed the recommended dose or frequency.
## Dose Adjustments
No specific dose adjustment is generally required for hepatic or renal impairment, but caution is advised, and the lowest effective dose should be used. Consider dose reduction in elderly patients due to increased risk of adverse effects.
## Contraindications
* Hypersensitivity to ibuprofen, aspirin, or other NSAIDs.
* History of bronchospasm, asthma, rhinitis, 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 (GI) bleeding or history of GI bleeding/perforation with previous NSAID use.
* Severe heart failure.
* Third trimester of pregnancy.
## Adverse Effects
* **Common:** Dyspepsia, nausea, abdominal pain, constipation, diarrhea, dizziness, headache.
* **Serious:** GI bleeding/ulceration, cardiovascular thrombotic events (MI, stroke), renal failure, hepatic failure, hypertension, fluid retention/edema, hypersensitivity reactions, Stevens-Johnson syndrome, toxic epidermal necrolysis.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin), Antiplatelets (e.g., clopidogrel), SSRIs, SNRIs:** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of GI ulceration/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
* Monitor for signs of GI bleeding (melena, hematemesis).
* Monitor for signs of cardiovascular events.
* Assess renal and hepatic function, especially in patients with pre-existing disease or those on long-term therapy.
* Monitor blood pressure.
## Clinical Pearls
* Administer with food or milk to minimize GI upset.
* Use the lowest effective dose for the shortest duration necessary.
* Avoid concomitant use with other NSAIDs or aspirin (unless specifically indicated for cardioprotection and under guidance).
* Be aware of the increased risk of cardiovascular events and GI bleeding, particularly with higher doses and prolonged use.
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*Disclaimer: This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant clinical guidelines before making treatment decisions.*
