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# Ibuprofen
## Overview
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) used for pain relief, fever reduction, and inflammation management.
## Primary Indications
* Pain (mild to moderate)
* Fever
* Inflammation (e.g., arthritis)
## Adult Dosing
* **Analgesia/Antipyresis:** 200-400 mg orally every 4-6 hours as needed. Maximum daily dose: 1200 mg.
* **Rheumatoid Arthritis/Osteoarthritis:** 400-800 mg orally twice to three times daily. Maximum daily dose: 2400 mg (for specific inflammatory conditions under physician supervision).
## Pediatric Dosing
* **Analgesia/Antipyresis:** 5-10 mg/kg orally every 6-8 hours as needed.
* Maximum single dose: 400 mg.
* Maximum daily dose: 40 mg/kg or 2400 mg, whichever is less.
* Use in infants < 6 months should be at the discretion of a healthcare provider due to potential risks.
## Dose Adjustments
No dose adjustment is typically needed for renal or hepatic impairment unless severe. However, caution and lower doses are recommended in patients with moderate impairment.
## Contraindications
* Known hypersensitivity to ibuprofen, aspirin, or other NSAIDs.
* History of bronchospasm, asthma, rhinitis, or urticaria precipitated by aspirin or other NSAIDs.
* Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery.
* Active gastrointestinal bleeding or history of GI bleeding/perforation related to prior NSAID use.
* Severe heart failure.
* Third trimester of pregnancy.
## Adverse Effects
* **Common:** Nausea, vomiting, diarrhea, constipation, dyspepsia, abdominal pain, dizziness, headache.
* **Serious:** Gastrointestinal bleeding/ulceration, myocardial infarction, stroke, renal failure, hepatic failure, hypersensitivity reactions (including anaphylaxis), Stevens-Johnson syndrome, toxic epidermal necrolysis, increased blood pressure.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Aspirin (low-dose):** May decrease the cardioprotective effect of aspirin.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **Diuretics:** Reduced diuretic efficacy; increased risk of renal toxicity.
* **Lithium:** Increased serum lithium levels.
* **Methotrexate:** Increased risk of methotrexate toxicity.
* **Other NSAIDs (including COX-2 inhibitors):** Increased risk of adverse effects, particularly GI and renal.
* **Selective Serotonin Reuptake Inhibitors (SSRIs):** Increased risk of GI bleeding.
## Monitoring
* Renal function (especially in elderly, dehydrated, or those with pre-existing renal disease).
* Liver function (periodic checks, especially with long-term use).
* Blood pressure.
* Signs and symptoms of GI bleeding.
* Signs and symptoms of cardiovascular events.
## Clinical Pearls
* Administer with food or milk to minimize gastrointestinal upset.
* Use the lowest effective dose for the shortest duration necessary.
* Be aware of cumulative NSAID exposure from multiple sources.
* Patients with asthma may be at higher risk for NSAID-induced bronchospasm.
* Consider gastroprotection (e.g., PPI) for patients at high risk for GI complications.
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***Disclaimer:** This information is intended for healthcare professionals. Always consult the current prescribing information and relevant clinical guidelines before making any treatment decisions. Dosing and recommendations may vary based on patient-specific factors and local protocols.*
