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## Ibuprofen
### Overview
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that exhibits analgesic, anti-inflammatory, and antipyretic properties.
### Primary Indications
* Mild to moderate pain
* Fever
* Inflammatory conditions (e.g., rheumatoid arthritis, osteoarthritis)
### Adult Dosing
* **Analgesia/Antipyresis:** 200 mg to 400 mg every 4 to 6 hours as needed.
* **Inflammatory Conditions:** 400 mg to 800 mg three to four times daily.
* **Maximum Daily Dose:** 3200 mg.
### Pediatric Dosing
Dosing is typically based on weight. Consult specific pediatric protocols for precise dosing.
* **Analgesia/Antipyresis:** 5 mg/kg to 10 mg/kg every 6 to 8 hours as needed.
* **Maximum single dose:** 40 mg/kg or 400 mg, whichever is less.
* **Maximum daily dose:** 40 mg/kg or 2400 mg, whichever is less.
* **Infants < 6 months:** Use is generally not recommended due to potential risks; consult with a pediatrician.
### Dose Adjustments
* **Renal Impairment:** Use with caution. Lower doses may be appropriate in mild to moderate impairment. Avoid in severe renal impairment.
* **Hepatic Impairment:** Use with caution. Lower doses may be appropriate in mild to moderate impairment. Avoid in severe hepatic impairment.
### Contraindications
* Hypersensitivity to ibuprofen, aspirin, or other NSAIDs.
* History of asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs.
* Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery.
* Third trimester of pregnancy.
### Adverse Effects
* **Gastrointestinal:** Dyspepsia, nausea, vomiting, abdominal pain, diarrhea, constipation, elevated liver enzymes, gastritis, peptic ulceration, GI bleeding, perforation.
* **Cardiovascular:** Fluid retention, edema, hypertension, increased risk of myocardial infarction and stroke (especially with chronic, high-dose use).
* **Renal:** Renal insufficiency, interstitial nephritis, papillary necrosis.
* **Hematologic:** Anemia, prolonged bleeding time.
* **Dermatologic:** Rash, pruritus.
* **Other:** Dizziness, headache, tinnitus.
### Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding. Monitor INR closely.
* **Aspirin (low-dose):** May reduce the cardioprotective effect of low-dose aspirin. Separate administration times by at least 8 hours (ibuprofen before aspirin).
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **Diuretics:** May decrease the efficacy of diuretics and increase the risk of nephrotoxicity.
* **Lithium:** May increase serum lithium levels.
* **Methotrexate:** May increase methotrexate levels and toxicity.
* **Selective Serotonin Reuptake Inhibitors (SSRIs) and Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs):** Increased risk of bleeding.
### Monitoring
* **GI Bleeding/Perforation:** Monitor for signs and symptoms (e.g., abdominal pain, melena, hematemesis).
* **Cardiovascular Risk:** Assess for signs of MI or stroke.
* **Renal Function:** Monitor BUN and creatinine, especially in patients with pre-existing renal disease or those at risk.
* **Hepatic Function:** Monitor liver enzymes in patients with hepatic impairment or those on long-term therapy.
* **Blood Pressure:** Monitor for hypertension.
### 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.
* NSAIDs carry a boxed warning for cardiovascular thrombotic events, myocardial infarction, and stroke.
* NSAIDs also carry a boxed warning for serious gastrointestinal adverse events, including bleeding, ulceration, and perforation.
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**Disclaimer:** This information is intended for clinical use and does not replace a thorough review of the current prescribing information and medical literature. Always verify current product information before making clinical decisions.
