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# Ibuprofen
## Overview
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that provides analgesic, anti-inflammatory, and antipyretic effects.
## Primary Indications
* Mild to moderate pain (e.g., headache, toothache, menstrual cramps, muscle aches)
* Fever
* Inflammatory conditions (e.g., rheumatoid arthritis, osteoarthritis)
## Adult Dosing
* **Analgesia/Antipyresis:** 200 mg to 400 mg orally every 4 to 6 hours as needed. Maximum daily dose: 1200 mg.
* **Inflammatory Conditions:** 400 mg to 800 mg orally three to four times daily. Maximum daily dose: 2400 mg (or 3200 mg in some cases of severe rheumatoid arthritis under close medical supervision).
## Pediatric Dosing
Dosing is typically based on weight. Always confirm specific recommendations based on local protocols and product labeling.
* **Analgesia/Antipyresis:** 5 mg/kg to 10 mg/kg orally every 6 to 8 hours as needed.
* Maximum single dose: 400 mg.
* Maximum daily dose: 40 mg/kg, not to exceed 2400 mg.
* For infants younger than 6 months, consult a pediatrician due to potential risks.
## Dose Adjustments
* No dose adjustment is generally required for renal or hepatic impairment, but caution is advised. In severe impairment, dose reduction may be considered.
## Contraindications
* Hypersensitivity to ibuprofen, aspirin, 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.
* Advanced renal disease.
* Active gastrointestinal bleeding or ulceration.
## Adverse Effects
* **Common:** Nausea, vomiting, diarrhea, constipation, dyspepsia, abdominal pain, dizziness, headache.
* **Serious:** Gastrointestinal bleeding, ulceration, perforation; cardiovascular thrombotic events (myocardial infarction, stroke); renal failure; hepatic failure; exacerbation of asthma; hypersensitivity reactions; hypertension.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Aspirin (low-dose):** May reduce the cardioprotective effect of aspirin; concurrent use generally not recommended unless advised by a healthcare provider.
* **Corticosteroids:** Increased risk of gastrointestinal adverse effects.
* **Diuretics and Antihypertensives:** May decrease their efficacy and increase the risk of renal toxicity.
* **Lithium:** Increased lithium levels.
* **Methotrexate:** Increased methotrexate toxicity.
* **Selective Serotonin Reuptake Inhibitors (SSRIs) and Serotonin Norepinephrine Reuptake Inhibitors (SNRIs):** Increased risk of bleeding.
## Monitoring
* **Renal function:** Especially in elderly patients, those with pre-existing renal disease, or those taking concomitant nephrotoxic agents.
* **Hepatic function:** Particularly in patients with liver disease.
* **Blood pressure:** NSAIDs can cause or worsen hypertension.
* **Signs of gastrointestinal bleeding:** Stool guaiac, abdominal pain, melena.
## Clinical Pearls
* Administer with food or milk to minimize gastrointestinal upset.
* Use the lowest effective dose for the shortest duration necessary to minimize risks.
* Ibuprofen carries a boxed warning for cardiovascular thrombotic events and gastrointestinal bleeding/ulceration.
* For pediatric fever, the American Academy of Pediatrics generally recommends acetaminophen or ibuprofen.
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*This information is intended for healthcare professionals. Always consult the current prescribing information and relevant guidelines for complete details and to ensure patient safety.*
