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# Ibuprofen
## Overview
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) used for its analgesic, anti-inflammatory, and antipyretic properties.
## Primary Indications
* Pain relief (mild to moderate)
* Inflammation
* Fever reduction
## Adult Dosing
* **Pain/Inflammation:** 400 mg to 800 mg every 6 to 8 hours as needed. Maximum daily dose: 3200 mg.
* **Fever:** 200 mg to 400 mg every 4 to 6 hours as needed. Maximum daily dose: 1200 mg.
## Pediatric Dosing
Dosing is typically based on weight. Consult current institutional guidelines or a pediatrician for precise dosing.
* **Fever/Pain:** 5 mg/kg/dose every 6-8 hours, or 10 mg/kg/dose every 6-8 hours for higher fever/pain.
* Maximum single dose for infants and children: 40 mg/kg, not to exceed 400 mg.
* Maximum daily dose for infants and children: 40 mg/kg, not to exceed 2400 mg.
* **Rheumatoid Arthritis:** 30 mg/kg/day to 40 mg/kg/day divided into 3-4 doses.
## Dose Adjustments
No specific dose adjustment is generally recommended for hepatic or renal impairment, but caution is advised due to potential for NSAID-induced renal toxicity. Patients with severe renal impairment may require dose reduction or avoidance.
## Contraindications
* Hypersensitivity to ibuprofen 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.
* Late pregnancy (third trimester).
## Adverse Effects
Common: Nausea, vomiting, dyspepsia, abdominal pain, diarrhea, constipation, dizziness, headache.
Serious: Gastrointestinal bleeding, ulceration, perforation; cardiovascular thrombotic events (myocardial infarction, stroke); renal failure; hepatic failure; 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.
* **ACE inhibitors, ARBs, Diuretics:** Reduced antihypertensive effect and increased risk of renal impairment.
* **Lithium:** Increased lithium levels and toxicity.
* **Methotrexate:** Increased risk of methotrexate toxicity.
## Monitoring
* Monitor for signs and symptoms of gastrointestinal bleeding.
* Monitor renal function (BUN, creatinine) especially in patients with risk factors.
* Monitor blood pressure, particularly with chronic use.
* Monitor for signs of cardiovascular events.
## 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 concomitant use with other NSAIDs.
* Consider gastroprotective agents (e.g., PPIs) in patients at high risk for GI complications.
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*Disclaimer: This information is intended for educational purposes and does not substitute for professional medical advice. Always consult the most current prescribing information and healthcare provider for any medical decisions.*
