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## Ibuprofen
### Overview
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that possesses analgesic, anti-inflammatory, and antipyretic properties. It inhibits cyclooxygenase (COX) enzymes, thereby reducing prostaglandin synthesis.
### Primary Indications
* Pain relief (mild to moderate)
* Fever reduction
* Inflammation associated with conditions like rheumatoid arthritis and osteoarthritis
### 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/day or 400 mg per dose, whichever is less.
* **Kawasaki Disease:** Specific dosing protocols apply, often higher doses for anti-inflammatory effect, and requires close monitoring. Consult specialized guidelines.
* **Infants < 6 months:** Use with caution due to potential for gastrointestinal and renal toxicity. Generally not recommended unless specifically indicated and supervised by a healthcare professional.
### Dose Adjustments
* **Renal Impairment:** Use with caution. May require dose reduction and increased monitoring, especially in patients with severe renal impairment.
* **Hepatic Impairment:** Use with caution. May require dose reduction and increased monitoring.
### Contraindications
* Hypersensitivity to ibuprofen, aspirin, or other NSAIDs.
* History of bronchospasm, asthma, rhinitis, or urticaria induced by aspirin or other NSAIDs.
* Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery.
* Active gastrointestinal bleeding or ulceration.
* Severe heart failure.
* Third trimester of pregnancy.
### Adverse Effects
* **Common:** Nausea, vomiting, dyspepsia, abdominal pain, diarrhea, constipation, dizziness, headache.
* **Serious:** Gastrointestinal bleeding, ulceration, perforation; cardiovascular thrombotic events (MI, stroke); renal toxicity; hepatic toxicity; hypersensitivity reactions; exacerbation of asthma; fluid retention and edema.
### 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.
* **Diuretics and Antihypertensives (e.g., ACE inhibitors, ARBs, beta-blockers):** Reduced antihypertensive effect; increased risk of renal toxicity.
* **Lithium:** Increased lithium levels and potential for toxicity.
* **Methotrexate:** Increased methotrexate levels and potential for toxicity.
* **Other NSAIDs:** Additive risk of adverse effects, particularly gastrointestinal and renal.
### Monitoring
* Renal function (BUN, creatinine)
* Liver function (AST, ALT)
* Complete blood count (CBC)
* Signs and symptoms of gastrointestinal bleeding
* Blood pressure
### Clinical Pearls
* Administer with food or milk to minimize gastrointestinal upset.
* The lowest effective dose should be used for the shortest duration necessary to minimize risks.
* Avoid concurrent use with other NSAIDs.
* Caution in patients with pre-existing cardiovascular disease, hypertension, renal impairment, hepatic impairment, or a history of gastrointestinal bleeding.
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*Disclaimer: This information is intended for clinical use and is not a substitute for professional medical advice. Always consult the most current prescribing information and relevant guidelines before making any treatment decisions.*
