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# Ibuprofen
## Overview
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that inhibits cyclooxygenase (COX) enzymes, reducing the synthesis of prostaglandins. This results in analgesic, anti-inflammatory, and antipyretic effects.
## Primary Indications
* Pain (mild to moderate)
* Fever
* Inflammation associated with conditions like rheumatoid arthritis and osteoarthritis
## Adult Dosing
* **Pain/Fever:** 200-400 mg orally every 4-6 hours as needed. Maximum daily dose: 1200 mg.
* **Inflammation:** 400-800 mg orally twice to four times daily. Maximum daily dose: 3200 mg under medical supervision for specific inflammatory conditions.
## Pediatric Dosing
Dosing is typically based on weight. Consult product labeling or pediatric dosing guidelines.
* **Fever/Pain:** 5-10 mg/kg/dose orally every 6-8 hours. Maximum daily dose: 40 mg/kg or 400 mg, whichever is less.
* **Infants < 6 months:** Use is generally not recommended due to potential risks; consult a pediatrician.
## Dose Adjustments
No specific dose adjustments are typically needed for renal or hepatic impairment, but caution is advised, and the lowest effective dose should be used.
## Contraindications
* Hypersensitivity to ibuprofen, aspirin, or other NSAIDs.
* History of bronchospasm, asthma, rhinitis, or urticaria precipitated by aspirin or other NSAIDs.
* Perioperative pain in the context of coronary artery bypass graft (CABG) surgery.
* Active gastrointestinal bleeding or history of GI bleeding/perforation with prior NSAID use.
* Severe renal or hepatic impairment.
* Severe heart failure.
## Adverse Effects
Common adverse effects include gastrointestinal upset (nausea, vomiting, diarrhea, dyspepsia), dizziness, and headache. Serious adverse effects include:
* Gastrointestinal bleeding, ulceration, and perforation.
* Cardiovascular thrombotic events (myocardial infarction, stroke).
* Renal toxicity.
* Hepatic toxicity.
* Hypersensitivity reactions.
## 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.
* **Diuretics and Antihypertensives:** May reduce their efficacy and increase risk of renal toxicity.
* **Lithium and Methotrexate:** Increased serum levels and toxicity.
* **Other NSAIDs:** Increased risk of adverse effects.
## Monitoring
* Monitor for signs and symptoms of gastrointestinal bleeding.
* Monitor renal and hepatic function, especially with long-term use or in patients with pre-existing impairment.
* Monitor blood pressure.
* Assess pain and fever relief.
## Clinical Pearls
* Administer with food or milk to minimize gastrointestinal upset.
* Use the lowest effective dose for the shortest duration necessary to minimize risks.
* Be aware of the increased risk of cardiovascular events and gastrointestinal bleeding, especially with higher doses and prolonged use.
* Avoid concomitant use with aspirin for cardioprotection unless specifically directed by a healthcare provider, as ibuprofen can interfere with aspirin's antiplatelet effect.
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*Disclaimer: This information is intended for clinical use and is not a substitute for professional medical advice. Always verify the most current prescribing information with official drug references before making clinical decisions.*
