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# Ibuprofen
## Overview
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) used for pain relief, fever reduction, and reducing inflammation.
## Primary Indications
* Mild to moderate pain (e.g., headache, dental pain, menstrual cramps, muscle aches)
* Fever
* Inflammatory conditions (e.g., arthritis)
## Adult Dosing
* **Pain and Fever:** 200 mg to 400 mg every 4 to 6 hours as needed.
* **Inflammatory Conditions:** 400 mg to 800 mg three to four times daily.
* **Maximum Daily Dose:** 3200 mg. Higher doses are generally reserved for specific inflammatory conditions under close medical supervision.
## Pediatric Dosing
Dosing is typically based on weight. **Always use the provided dosing device for liquid formulations.**
* **Fever and Pain:** 5 mg/kg to 10 mg/kg orally every 6 to 8 hours.
* **Maximum Single Dose:** 400 mg.
* **Maximum Daily Dose:** 40 mg/kg, not to exceed 2400 mg.
* **Infants younger than 6 months:** Use is generally not recommended due to potential risks, consult a pediatrician.
## Dose Adjustments
No specific dose adjustments are typically required for hepatic or renal impairment, however, caution and monitoring are advised. Use the lowest effective dose for the shortest duration necessary, especially in patients with renal impairment.
## Contraindications
* Known 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 history of recurrent ulceration/hemorrhage.
* Severe heart failure.
* Third trimester of pregnancy.
## Adverse Effects
* **Gastrointestinal:** Dyspepsia, nausea, abdominal pain, diarrhea, constipation, peptic ulceration, GI bleeding.
* **Cardiovascular:** Increased risk of thrombotic events (myocardial infarction, stroke), hypertension, edema.
* **Renal:** Renal impairment, interstitial nephritis, papillary necrosis.
* **Hepatic:** Elevated liver enzymes, hepatic dysfunction.
* **Dermatologic:** Rash, pruritus.
* **Other:** Dizziness, headache, tinnitus.
## 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.
* **Diuretics and Antihypertensives:** May decrease antihypertensive effect and increase risk of renal damage.
* **Lithium, Methotrexate:** May increase serum levels and toxicity.
* **Other NSAIDs:** Increased risk of adverse effects.
## Monitoring
* Signs and symptoms of GI bleeding or ulceration.
* Renal function (especially in patients with pre-existing renal disease, dehydration, or concomitant use of nephrotoxic agents).
* Blood pressure.
* Signs of fluid retention or edema.
## Clinical Pearls
* Administer with food or milk to minimize GI upset.
* Use the lowest effective dose for the shortest duration necessary to reduce the risk of serious cardiovascular and gastrointestinal events.
* Consider risks versus benefits in patients with a history of cardiovascular disease, hypertension, renal impairment, or gastric issues.
* Avoid concomitant use with other NSAIDs.
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*Please verify current prescribing information for the most up-to-date details before making any clinical decisions.*
