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## Ibuprofen
### Overview
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) with analgesic, antipyretic, and anti-inflammatory properties. It inhibits cyclooxygenase (COX) enzymes, thereby reducing prostaglandin synthesis.
### Primary Indications
* Pain relief (mild to moderate)
* Fever reduction
* Inflammation associated with conditions such as arthritis, musculoskeletal injuries, and dysmenorrhea
### Adult Dosing
* **Analgesia/Antipyresis:** 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. Doses exceeding 2400 mg/day should be reserved for patients with severe inflammatory conditions and should be administered under close medical supervision.
### Pediatric Dosing
Dosing is based on weight and indication. Consult specific pediatric guidelines or product labeling for precise dosing. Generally:
* **Fever/Pain:** 5 mg/kg to 10 mg/kg orally every 6 to 8 hours. Do not exceed 40 mg/kg/day.
* **Kawasaki Disease (initiation):** Consult specific treatment protocols.
### Dose Adjustments
No specific dose adjustments are typically required for renal or hepatic impairment, but caution is advised, and lower doses may be considered, especially in severe impairment. Monitor for adverse effects.
### Contraindications
* Hypersensitivity to ibuprofen, aspirin, or other NSAIDs.
* History of bronchospasm, asthma, rhinitis, urticaria, or other allergic-type reactions after taking aspirin or other NSAIDs.
* Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery.
* Active gastrointestinal (GI) bleeding, ulceration, or perforation.
* Severe heart failure.
* Third trimester of pregnancy.
### Adverse Effects
* **Common:** Nausea, vomiting, diarrhea, constipation, abdominal pain, dyspepsia, dizziness, headache.
* **Serious:** GI bleeding, ulceration, perforation; cardiovascular thrombotic events (MI, stroke); renal failure; hepatic failure; hypersensitivity reactions; bronchospasm.
### Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **SSRIs/SNRIs:** Increased risk of GI bleeding.
* **ACE inhibitors, ARBs, Beta-blockers:** Reduced antihypertensive effect; increased risk of renal impairment.
* **Diuretics:** Reduced diuretic effect; increased risk of renal impairment.
* **Lithium:** Increased serum lithium levels.
* **Methotrexate:** Increased methotrexate toxicity.
### Monitoring
* **GI symptoms:** Monitor for signs and symptoms of GI bleeding or ulceration.
* **Renal function:** Monitor serum creatinine and BUN, especially in patients with pre-existing renal disease or those at risk.
* **Hepatic function:** Monitor liver enzymes, especially in patients with hepatic impairment or those on long-term therapy.
* **Cardiovascular risk:** Assess and monitor for signs of cardiovascular events.
* **Blood pressure:** Monitor, especially when used with antihypertensives.
### Clinical Pearls
* Administer with food or milk to minimize GI upset.
* Use the lowest effective dose for the shortest duration necessary.
* Patients with a history of GI issues should use with caution and consider gastroprotection.
* NSAIDs can mask signs of infection.
* Consider risk factors for cardiovascular events and GI bleeding before initiating therapy.
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*This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant clinical guidelines for definitive guidance. Dosing recommendations may vary based on specific product formulations and local protocols.*
