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# Ibuprofen
## Overview
Ibuprofen is a non-steroidal anti-inflammatory drug (NSAID) that provides analgesia, anti-inflammatory, and antipyretic effects.
## Primary Indications
* Pain (mild to moderate)
* Fever
* Inflammation (e.g., arthritis)
* Ductus arteriosus closure in premature infants
## Adult Dosing
* **Pain/Fever:** 200-400 mg orally every 4-6 hours as needed. Maximum daily dose: 1200 mg. For higher doses (e.g., in rheumatological conditions), up to 2400-3200 mg/day divided every 6-8 hours may be used under medical supervision.
* **Pain/Fever (IV):** 400 mg IV every 6 hours as needed. Maximum daily dose: 2400 mg.
* **Inflammation:** 400-800 mg orally every 6-8 hours. Maximum daily dose: 3200 mg.
## Pediatric Dosing
* **Pain/Fever (Oral):** 5-10 mg/kg/dose orally every 6-8 hours. Maximum daily dose: 40 mg/kg/day or 2400 mg/day, whichever is less.
* **Pain/Fever (Rectal):** 5-10 mg/kg/dose rectally every 6-8 hours. Maximum daily dose: 40 mg/kg/day or 2400 mg/day, whichever is less.
* **Pain/Fever (IV):** 10 mg/kg/dose IV every 6-8 hours. Maximum daily dose: 40 mg/kg/day or 2400 mg/day, whichever is less.
* **Premature Infants (Ductus Arteriosus Closure):** A specific IV regimen is used, typically 10 mg/kg for the first dose, followed by 5 mg/kg for two subsequent doses 24-48 hours apart. Consult specific guidelines for exact timing and dosing.
## Dose Adjustments
* **Renal Impairment:** Use with caution. Doses may need to be reduced in severe renal impairment.
* **Hepatic Impairment:** Use with caution. Doses may need to be reduced in severe hepatic impairment.
## Contraindications
* Hypersensitivity to ibuprofen, aspirin, or other NSAIDs.
* History of bronchospasm, asthma, rhinitis, or urticaria with NSAID use.
* Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery.
* Active peptic ulceration or gastrointestinal bleeding.
* Severe heart failure, renal failure, or hepatic failure.
* Third trimester of pregnancy.
## Adverse Effects
Common: Nausea, vomiting, diarrhea, constipation, abdominal pain, dizziness, headache.
Serious: Gastrointestinal bleeding and perforation, renal toxicity, cardiovascular thrombotic events, myocardial infarction, stroke, exacerbation of heart failure, hypersensitivity reactions, liver toxicity, severe skin reactions.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Aspirin:** May decrease the cardioprotective effects of low-dose aspirin.
* **Corticosteroids:** Increased risk of gastrointestinal ulceration and bleeding.
* **Diuretics and Antihypertensives:** May reduce their efficacy and increase risk of renal toxicity.
* **Lithium:** Increased lithium levels and toxicity.
* **Methotrexate:** Increased methotrexate levels and toxicity.
## Monitoring
* Renal function (SCr, BUN)
* Liver function (LFTs)
* Complete blood count (CBC)
* Signs and symptoms of gastrointestinal bleeding
* Blood pressure
## Clinical Pearls
* Administer with food or milk to minimize gastrointestinal upset.
* Lowest effective dose for the shortest duration should be used to minimize risks.
* NSAIDs carry a boxed warning for cardiovascular thrombotic events, myocardial infarction, and stroke.
* Avoid in patients with aspirin-exacerbated respiratory disease.
* In premature infants, monitor for signs of necrotizing enterocolitis, renal dysfunction, and gastrointestinal bleeding.
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*This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant clinical guidelines for complete details and to ensure patient safety. Dosing may vary based on individual patient factors and local protocols.*
