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## Ibuprofen
### Overview
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that exhibits analgesic, anti-inflammatory, and antipyretic properties.
### Primary Indications
* Pain (mild to moderate)
* Fever
* Inflammation
### Adult Dosing
* **Analgesia/Antipyresis:** 200-800 mg every 4-6 hours as needed. Maximum daily dose: 3200 mg.
* **Inflammation:** 400-800 mg every 6-8 hours. Maximum daily dose: 3200 mg.
### Pediatric Dosing
Dosing is typically based on weight. Consult current pediatric dosing guidelines or protocols for specific recommendations, as they can vary.
* **Analgesia/Antipyresis:** 5-10 mg/kg/dose every 6-8 hours as needed. Maximum daily dose: 40 mg/kg or 2400 mg, whichever is less.
### Dose Adjustments
No specific dose adjustments are typically required for hepatic or renal impairment, but caution and monitoring are advised, especially in patients with severe dysfunction. Elderly patients may be more susceptible to adverse effects.
### Contraindications
* Hypersensitivity to ibuprofen, aspirin, or other NSAIDs.
* History of bronchospasm, asthma, rhinitis, or urticaria precipitated by NSAIDs.
* Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery.
* Active gastrointestinal (GI) bleeding or a history of recurrent GI ulceration/bleeding.
* Severe heart failure, renal failure, or hepatic failure.
* Third trimester of pregnancy.
### Adverse Effects
Common adverse effects include nausea, vomiting, dyspepsia, abdominal pain, diarrhea, constipation, headache, dizziness, and rash. Serious adverse effects include GI bleeding, perforation, ulceration, cardiovascular thrombotic events (myocardial infarction, stroke), renal toxicity, hepatic toxicity, hypersensitivity reactions, and exacerbation of heart failure.
### Key Drug Interactions
* **Anticoagulants (e.g., warfarin), antiplatelets (e.g., aspirin, clopidogrel):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **Selective Serotonin Reuptake Inhibitors (SSRIs) and Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs):** Increased risk of GI bleeding.
* **Diuretics and antihypertensives:** May reduce the efficacy of these agents and increase the risk of renal toxicity.
* **Lithium:** Increased serum lithium levels.
* **Methotrexate:** Increased risk of methotrexate toxicity.
### Monitoring
* Monitor for signs and symptoms of GI bleeding (e.g., melena, hematemesis).
* Assess for cardiovascular risk factors and monitor for signs of thrombotic events.
* Evaluate renal and hepatic function, particularly in patients with pre-existing organ dysfunction or those on long-term therapy.
* Monitor blood pressure.
### Clinical Pearls
* Ibuprofen is best absorbed when taken with food or milk to minimize GI upset.
* Use the lowest effective dose for the shortest duration necessary to minimize risks.
* Caution is advised in patients with pre-existing cardiovascular disease, hypertension, asthma, or GI disorders.
* Avoid concurrent use with other NSAIDs or aspirin unless specifically indicated and managed.
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*Disclaimer: This information is intended for healthcare professionals and is not a substitute for professional medical advice. Always verify current prescribing information and consult with a qualified healthcare provider for any medical concerns or before making any decisions related to your health or treatment.*
