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## Ibuprofen
### Overview
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that inhibits prostaglandin synthesis. It is used for its analgesic, anti-inflammatory, and antipyretic properties.
### Primary Indications
* Pain relief (mild to moderate)
* Fever reduction
* Inflammation reduction (e.g., arthritis)
### Adult Dosing
* **Analgesia/Antipyresis:** 200 mg to 400 mg orally every 4 to 6 hours as needed. Maximum daily dose: 1200 mg.
* **Inflammation (e.g., Rheumatoid Arthritis):** 400 mg to 800 mg orally every 6 to 8 hours. Maximum daily dose: 2400 mg (typically reserved for severe cases under specialist supervision).
### Pediatric Dosing
Dosing is weight-based and typically every 6 to 8 hours. Consult product labeling or local protocol for precise dosing.
* **Age 6 months to 12 years:** 5 mg/kg to 10 mg/kg orally every 6 to 8 hours.
* Maximum single dose: 400 mg.
* Maximum daily dose: 40 mg/kg or 2400 mg, whichever is less.
* **Infants younger than 6 months:** Use is generally not recommended due to potential risks.
### Dose Adjustments
* **Renal Impairment:** Use with caution. Mild to moderate impairment may not require adjustment, but monitor closely. Avoid in severe renal impairment.
* **Hepatic Impairment:** Use with caution. Avoid in severe hepatic impairment.
### 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.
* Active gastrointestinal bleeding or history of GI ulceration/bleeding.
* Severe heart failure, renal failure, or hepatic failure.
### Adverse Effects
Common: Nausea, vomiting, dyspepsia, abdominal pain, diarrhea, constipation, dizziness, headache.
Serious: Gastrointestinal bleeding/perforation, cardiovascular thrombotic events (MI, stroke), renal impairment, hypersensitivity reactions, bronchospasm, hepatic injury.
### Key Drug Interactions
* **Anticoagulants (e.g., warfarin) and Antiplatelets (e.g., aspirin, clopidogrel):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **ACE Inhibitors, ARBs, Diuretics:** May decrease antihypertensive effect and increase risk of renal impairment.
* **Lithium:** May increase lithium levels.
* **Methotrexate:** May increase methotrexate toxicity.
### Monitoring
* Signs and symptoms of GI bleeding (melena, hematemesis).
* Renal function (BUN, creatinine), especially in patients with pre-existing renal disease or those at risk.
* Blood pressure.
* 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, including aspirin (unless low-dose aspirin for cardioprotection, in which case ibuprofen should be taken at least 8 hours before or 30 minutes after aspirin).
* Ibuprofen is available over-the-counter (OTC) and by prescription. OTC doses are typically lower than prescription doses.
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**Disclaimer:** This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant clinical guidelines for definitive guidance. Dosing and recommendations may vary based on patient-specific factors and local protocols.
