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## Ibuprofen
### Overview
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that provides analgesic, anti-inflammatory, and antipyretic effects.
### Primary Indications
* Pain (mild to moderate)
* Fever
* Inflammatory conditions (e.g., rheumatoid arthritis, osteoarthritis)
* Dysmenorrhea
* Closure of patent ductus arteriosus (PDA) in premature infants
### Adult Dosing
* **Pain/Fever:** 200-400 mg every 4-6 hours as needed. Maximum daily dose: 1200 mg for OTC use; up to 2400-3200 mg/day in divided doses for prescription use under medical supervision, depending on indication and patient response.
* **Inflammatory Conditions:** 400-800 mg every 6-8 hours. Maximum daily dose: 3200 mg.
* **Dysmenorrhea:** 400 mg every 4-6 hours as needed. Maximum daily dose: 1200 mg.
### Pediatric Dosing
* **Fever/Pain:** 5-10 mg/kg/dose every 6-8 hours. Maximum daily dose: 40 mg/kg or 2400 mg, whichever is less. Dosing should not exceed adult maximums.
* **Closure of PDA:** Typically administered intravenously in neonatal intensive care units. Dosing is highly specific and depends on gestational age and postnatal age. Common regimens include a 3-dose course (e.g., 10 mg/kg, 5 mg/kg, 5 mg/kg) separated by 24-48 hours, but variations exist. Consult neonatal protocols.
### Dose Adjustments
* **Renal Impairment:** Use with caution. Dose reduction may be necessary in mild to moderate impairment. Avoid in severe renal impairment.
* **Hepatic Impairment:** Use with caution. Dose reduction may be necessary in mild to moderate impairment. Avoid in severe hepatic impairment.
* **Elderly:** Increased risk of adverse effects. Consider lower doses and shorter duration of therapy.
### 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, dyspepsia, abdominal pain, rash, dizziness, headache.
Serious: Gastrointestinal bleeding/perforation, cardiovascular thrombotic events (MI, stroke), renal toxicity, hepatic toxicity, hypersensitivity reactions, exacerbation of asthma.
### Key Drug Interactions
* **Anticoagulants (e.g., warfarin) and Antiplatelets (e.g., aspirin, clopidogrel):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of gastrointestinal ulceration and bleeding.
* **ACE Inhibitors, ARBs, Diuretics:** May decrease antihypertensive effect and increase risk of renal impairment.
* **Lithium, Methotrexate:** Increased serum levels and toxicity.
* **SSRIs:** Increased risk of bleeding.
### Monitoring
* Signs and symptoms of gastrointestinal bleeding (e.g., melena, hematemesis).
* Renal function (serum creatinine, BUN).
* Liver function (LFTs).
* Blood pressure.
* Signs of cardiovascular events.
### Clinical Pearls
* Administer with food or milk to minimize gastrointestinal upset.
* Use the lowest effective dose for the shortest duration necessary to minimize risks.
* Avoid concurrent use with other NSAIDs, including aspirin (unless low-dose for cardioprotection, discuss with provider).
* Dehydration can increase the risk of renal toxicity. Ensure adequate hydration.
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*This information is intended for healthcare professionals and does not replace the need to consult the most current prescribing information and clinical guidelines.*
