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## Ibuprofen
### Overview
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that inhibits cyclooxygenase (COX) enzymes, reducing prostaglandin synthesis. It possesses analgesic, anti-inflammatory, and antipyretic properties.
### Primary Indications
* Mild to moderate pain (e.g., headache, dental pain, menstrual cramps, muscle aches)
* Fever reduction
* Inflammation associated with conditions like arthritis
### Adult Dosing
* **Pain and Fever:** 200-400 mg every 4-6 hours as needed. Maximum: 1200 mg/day for over-the-counter use; up to 3200 mg/day under medical supervision for specific inflammatory conditions.
* **Inflammatory Conditions (e.g., Rheumatoid Arthritis):** 400-800 mg every 6-8 hours. Maximum: 3200 mg/day.
### Pediatric Dosing
Dosing is typically based on weight. Always use the lowest effective dose for the shortest duration necessary.
* **Fever and Pain:** 5-10 mg/kg/dose every 6-8 hours.
* Infants 6 months to < 12 years: Maximum daily dose is generally 40 mg/kg.
* The specific maximum daily dose may vary by indication and prescriber preference; consult local protocols.
* **Suspension:** Available in concentrations such as 100 mg/5 mL.
### Dose Adjustments
No dose adjustment is generally required for renal or hepatic impairment, but caution is advised. Use the lowest effective dose and monitor for adverse effects.
### Contraindications
* Hypersensitivity to ibuprofen, aspirin, or other NSAIDs
* History of bronchospasm, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs
* Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery
### Adverse Effects
Common: Gastrointestinal upset (nausea, dyspepsia, diarrhea), dizziness, headache.
Serious: Increased risk of cardiovascular thrombotic events (myocardial infarction, stroke), gastrointestinal bleeding, ulceration, perforation, renal toxicity, hepatic impairment, hypersensitivity reactions, and bronchospasm.
### Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of gastrointestinal bleeding.
* **Other NSAIDs and Aspirin:** Increased risk of adverse effects, particularly gastrointestinal.
* **ACE Inhibitors and ARBs:** Reduced antihypertensive effect; increased risk of renal impairment.
* **Diuretics:** Reduced diuretic and antihypertensive effect; increased risk of renal impairment.
* **Lithium:** Increased lithium levels.
* **Methotrexate:** Increased risk of methotrexate toxicity.
### Monitoring
* Signs and symptoms of gastrointestinal bleeding or ulceration.
* Renal function (BUN, creatinine) with long-term use or in at-risk patients.
* Liver function tests with long-term use or in patients with hepatic impairment.
* Blood pressure.
### Clinical Pearls
* Administer with food or milk to minimize gastrointestinal upset.
* Use the lowest effective dose for the shortest duration needed to control symptoms.
* Avoid in patients with active peptic ulcer disease or a history of NSAID-induced GI bleeding.
* Caution in patients with heart failure, hypertension, or risk factors for cardiovascular disease.
* Concomitant use of ibuprofen with aspirin for cardioprotection should be carefully considered; ibuprofen may interfere with aspirin's antiplatelet effect. If concurrent use is necessary, take ibuprofen at least 8 hours before or 30 minutes after aspirin.
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**Disclaimer:** This information is intended for educational purposes and does not substitute for professional medical advice. Always consult the most current prescribing information and relevant guidelines before making any treatment decisions.
