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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 (e.g., headache, dental pain, menstrual cramps, muscle aches)
* Fever reduction
* Inflammation reduction (e.g., arthritis)
* Patent ductus arteriosus (PDA) closure in preterm infants
## Adult Dosing
* **Pain and Fever:** 200-400 mg orally every 4-6 hours as needed. Maximum daily dose: 1200 mg (prescription strength) or 1200 mg (OTC, though higher doses may be used under medical supervision).
* **Inflammation (e.g., Rheumatoid Arthritis):** 400-800 mg orally twice to four times daily. Maximum daily dose: 2400 mg (prescription strength) under medical supervision.
## Pediatric Dosing
* **Pain and Fever:** 5-10 mg/kg orally every 6-8 hours. Maximum daily dose: 40 mg/kg or 2400 mg, whichever is less. Dosing is typically initiated with 10 mg/kg for higher fever or significant pain.
* **Patent Ductus Arteriosus (PDA) in Preterm Infants:** Dosing varies based on gestational age and postnatal age. A typical course involves three doses of 10 mg/kg (first dose) followed by two doses of 5 mg/kg administered at 24-48 hour intervals. Consult specific neonatal protocols for precise dosing.
## Dose Adjustments
No specific dose adjustment is typically needed for renal or hepatic impairment, but caution is advised. Use the lowest effective dose for the shortest duration necessary, especially in patients with pre-existing renal or hepatic disease.
## Contraindications
* Known hypersensitivity to ibuprofen, aspirin, or other NSAIDs.
* History of bronchospasm, asthma, rhinitis, or urticaria precipitated by aspirin or other NSAIDs.
* Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery.
* Third trimester of pregnancy.
## Adverse Effects
Common adverse effects include gastrointestinal upset, nausea, vomiting, heartburn, diarrhea, constipation, dizziness, and headache. Serious risks include GI bleeding, ulceration, perforation, cardiovascular thrombotic events (MI, stroke), renal impairment, and hypersensitivity reactions.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin, rivaroxaban):** Increased risk of bleeding.
* **Other NSAIDs (including aspirin):** Increased risk of GI toxicity and bleeding.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **ACE Inhibitors, ARBs, Diuretics:** May decrease antihypertensive effect and increase risk of renal dysfunction.
* **Lithium, Methotrexate:** Increased serum levels and toxicity.
## Monitoring
* Monitor for signs and symptoms of GI bleeding (e.g., melena, hematemesis).
* Monitor for signs of cardiovascular events.
* Monitor renal function, especially in patients with risk factors.
* Monitor blood pressure.
## Clinical Pearls
* Administer with food or milk to minimize GI upset.
* Avoid concurrent use with other NSAIDs.
* Use the lowest effective dose for the shortest duration.
* In pediatric patients, precise weight measurement is crucial for accurate dosing.
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*This information is intended for clinical use and does not substitute for professional medical advice. Always consult the most current prescribing information or a drug reference for complete details.*
