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# Ibuprofen
## Overview
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that inhibits prostaglandin synthesis. It possesses analgesic, anti-inflammatory, and antipyretic properties.
## Primary Indications
* Pain relief (mild to moderate)
* Fever reduction
* Inflammation reduction (e.g., arthritis)
## Adult Dosing
* **Pain/Fever:** 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
* **Fever/Pain:** 5 mg/kg to 10 mg/kg orally every 6 to 8 hours.
* **Maximum Pediatric Dose:** 40 mg/kg per day, not to exceed the adult maximum daily dose.
* **Age Restriction:** Generally not recommended for infants under 6 months of age due to potential for gastrointestinal and renal issues. Consult specific guidelines for neonatal use.
## Dose Adjustments
Dose adjustments are generally not required in patients with renal or hepatic impairment, but caution is advised. Lower doses may be appropriate in elderly patients or those with underlying comorbidities.
## Contraindications
* Hypersensitivity to ibuprofen, aspirin, or other NSAIDs.
* History of bronchospasm, asthma, rhinitis, or urticaria following aspirin or NSAID use.
* Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery.
* Active gastrointestinal bleeding or ulceration.
* Severe renal or hepatic impairment.
* Third trimester of pregnancy.
## Adverse Effects
* **Common:** Nausea, vomiting, diarrhea, constipation, abdominal pain, dyspepsia, dizziness, headache.
* **Serious:** Gastrointestinal bleeding, ulceration, perforation; cardiovascular thrombotic events (MI, stroke); renal failure; hepatic injury; hypersensitivity reactions; exacerbation of asthma.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin) and Antiplatelets (e.g., aspirin, clopidogrel):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of gastrointestinal ulceration and bleeding.
* **ACE Inhibitors and ARBs:** May reduce antihypertensive effect and increase risk of renal impairment.
* **Diuretics:** May reduce diuretic effect and increase risk of renal impairment.
* **Lithium:** Increased serum lithium levels.
* **Methotrexate:** Increased methotrexate toxicity.
## Monitoring
* Signs and symptoms of gastrointestinal bleeding or ulceration.
* Renal function (especially in dehydrated patients, elderly, or those with pre-existing renal disease).
* Hepatic function (periodic monitoring may be considered with long-term use).
* Blood pressure (NSAIDs can increase 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.
* Avoid concurrent use with other NSAIDs.
* Consider gastroprotection (e.g., PPI) in patients at high risk for GI complications.
* Pediatric dosing should be based on weight.
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**Disclaimer:** This information is intended for healthcare professionals. Always consult the most current prescribing information and institutional protocols before initiating or modifying therapy.
