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# Ibuprofen
## Overview
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that reduces inflammation, pain, and fever.
## Primary Indications
* Pain relief (e.g., headache, dental pain, menstrual cramps, muscle aches)
* Fever reduction
* Inflammation associated with conditions like arthritis
## Adult Dosing
* **Pain/Fever:** 200 mg to 400 mg every 4 to 6 hours as needed. Do not exceed 1200 mg per 24 hours without medical supervision.
* **Inflammation:** 400 mg to 800 mg every 6 to 8 hours. Maximum daily dose is typically 2400 mg to 3200 mg, depending on the specific indication and physician's discretion, often under specialist supervision.
## Pediatric Dosing
Dosing is based on weight.
* **Pain/Fever:** 5 mg/kg to 10 mg/kg per dose every 6 to 8 hours.
* For children 6 months and older.
* Maximum single dose: 400 mg.
* Maximum daily dose: 40 mg/kg or 1200 mg, whichever is less.
* **Note:** Specific product concentrations (e.g., infant drops, children's suspension) should be carefully checked for accurate measurement.
## Dose Adjustments
* **Renal Impairment:** Use with caution and potentially reduced doses. Monitor renal function. Avoid in severe renal impairment.
* **Hepatic Impairment:** Use with caution. Monitor liver function. Avoid in severe hepatic impairment.
## Contraindications
* Known hypersensitivity to ibuprofen or other NSAIDs.
* History of bronchospasm, asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs.
* Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery.
* Active gastrointestinal bleeding or history of GI bleeding/perforation with prior NSAID use.
* Severe heart failure.
* Late pregnancy (third trimester).
## Adverse Effects
Common: Nausea, vomiting, diarrhea, constipation, dyspepsia, dizziness, headache.
Serious:
* **Cardiovascular:** Increased risk of myocardial infarction, stroke, and hypertension.
* **Gastrointestinal:** GI bleeding, ulceration, perforation. Risk increases with dose and duration.
* **Renal:** Acute kidney injury, interstitial nephritis.
* **Hepatic:** Elevated liver enzymes, hepatitis.
* **Hypersensitivity:** Rash, angioedema, anaphylaxis, Stevens-Johnson syndrome, toxic epidermal necrolysis.
* **Hematologic:** Anemia, bleeding time prolongation.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin, direct oral anticoagulants):** Increased risk of bleeding.
* **Aspirin (low-dose):** May reduce the cardioprotective effect of aspirin. Separate administration by at least 8 hours.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **Diuretics:** Reduced antihypertensive and diuretic effect. Increased risk of nephrotoxicity.
* **Lithium:** Increased lithium levels and toxicity.
* **Methotrexate:** Increased methotrexate levels and toxicity.
* **Other NSAIDs/Salicylates:** Additive toxicity, increased risk of adverse effects.
* **Selective Serotonin Reuptake Inhibitors (SSRIs)/Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs):** Increased risk of GI bleeding.
## Monitoring
* **Renal function:** Especially in patients with pre-existing renal disease, dehydration, or those on concurrent nephrotoxic agents.
* **Liver function:** Particularly with long-term use or in patients with liver disease.
* **Blood pressure:** Monitor for new or worsening hypertension.
* **Signs/symptoms of GI bleeding:** Melena, hematemesis, abdominal pain.
* **Signs/symptoms of cardiovascular events:** Chest pain, shortness of breath, weakness, slurred speech.
## Clinical Pearls
* Administer with food or milk to minimize GI upset.
* Use the lowest effective dose for the shortest duration necessary to minimize risks.
* Consider gastroprotection (e.g., proton pump inhibitor) for patients at high risk of GI complications.
* Avoid in patients with inflammatory bowel disease flares.
* NSAIDs can mask signs of infection.
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*Disclaimer: This information is intended for clinical use and does not substitute for comprehensive drug reference materials. Always verify current prescribing information, product monographs, and institutional protocols before dispensing or administering medications.*
