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# Ibuprofen (Nurofen, Advil, Motrin)
## Overview
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) used for its analgesic, anti-inflammatory, and antipyretic properties.
## Primary Indications
* Pain management (mild to moderate)
* Fever reduction
* Inflammation associated with conditions like arthritis, musculoskeletal injuries.
## Adult Dosing
* **Pain and Fever:** 200 mg to 400 mg PO every 4 to 6 hours as needed.
* **Inflammation (e.g., Rheumatoid Arthritis):** 400 mg to 800 mg PO every 6 to 8 hours.
* **Maximum Daily Dose:** 3200 mg/day for chronic use, but typically limited to 1200 mg/day for over-the-counter use. Higher doses require prescription and close monitoring.
## Pediatric Dosing
* **Pain and Fever:** 5 mg/kg to 10 mg/kg PO every 6 to 8 hours.
* **Maximum Daily Dose:** 40 mg/kg/day or 2400 mg/day, whichever is less.
* Dosing is typically based on weight and is available in liquid formulations for younger children.
## Dose Adjustments
* **Renal Impairment:** Use with caution. May require dose reduction and increased monitoring, especially in severe renal impairment.
* **Hepatic Impairment:** Use with caution. May require dose reduction and increased monitoring, especially in severe hepatic impairment.
## 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.
* Active gastrointestinal bleeding or ulceration.
## Adverse Effects
* **Common:** Nausea, vomiting, dyspepsia, abdominal pain, diarrhea, constipation.
* **Serious:** Gastrointestinal bleeding, ulceration, perforation, myocardial infarction, stroke, renal failure, hepatic failure, hypersensitivity reactions.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin, heparin, DOACs):** Increased risk of bleeding.
* **Aspirin (low-dose):** May reduce the cardioprotective effect of aspirin. Ibuprofen should be taken at least 8 hours before or 30 minutes after low-dose aspirin.
* **Corticosteroids:** Increased risk of gastrointestinal bleeding.
* **Diuretics, ACE inhibitors, ARBs:** May reduce antihypertensive effect and increase risk of renal impairment.
* **Lithium:** Increased serum lithium levels.
* **Methotrexate:** Increased risk of methotrexate toxicity.
## Monitoring
* Signs and symptoms of gastrointestinal bleeding (e.g., melena, hematemesis).
* Renal function (e.g., serum creatinine, BUN), especially in patients with pre-existing renal disease or those taking concomitant nephrotoxic agents.
* Blood pressure, particularly in patients with hypertension.
* Signs of cardiovascular events (e.g., chest pain, shortness of breath).
## Clinical Pearls
* Administer with food or milk to minimize gastrointestinal upset.
* Use the lowest effective dose for the shortest duration necessary to minimize risks.
* Consider gastroprotection (e.g., PPI) for patients at high risk for GI complications.
* Avoid in patients with a history of NSAID-induced asthma.
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*Disclaimer: This information is for educational purposes only and does not substitute for professional medical advice. Always consult with a qualified healthcare provider to ensure the information is accurate and appropriate for your specific situation. Review the official prescribing information for the most up-to-date and comprehensive details.*
