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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
* Pain relief (mild to moderate)
* Fever reduction
* Inflammation (e.g., arthritis)
* Closure of patent ductus arteriosus (PDA) in premature infants
### Adult Dosing
* **Pain/Fever:** 200-400 mg every 4-6 hours as needed. Maximum: 1200 mg/day for over-the-counter (OTC) use; up to 3200 mg/day by prescription under medical supervision for specific inflammatory conditions.
* **Inflammatory Conditions (e.g., Rheumatoid Arthritis):** 400-800 mg two to three times daily. Maximum: 3200 mg/day.
### Pediatric Dosing
* **Fever/Pain:** 5-10 mg/kg/dose every 6-8 hours. Maximum: 40 mg/kg/day or 400 mg/dose, whichever is less.
* **PDA (Premature Infants):** Dosing varies by gestational age and weight, typically administered as a three-dose course. Refer to specific neonatal guidelines.
### Dose Adjustments
* **Renal Impairment:** Use with caution. Severe impairment may require dose reduction or avoidance.
* **Hepatic Impairment:** Use with caution. Mild to moderate impairment may require dose reduction.
### 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.
* Third trimester of pregnancy.
### Adverse Effects
* **Common:** Gastrointestinal upset (nausea, dyspepsia, abdominal pain), dizziness, headache.
* **Serious:** Gastrointestinal bleeding/ulceration, cardiovascular thrombotic events (myocardial infarction, stroke), renal failure, hepatic failure, hypersensitivity reactions (including anaphylaxis), Stevens-Johnson syndrome, toxic epidermal necrolysis.
### Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Aspirin (low-dose):** May reduce the cardioprotective effects of aspirin.
* **Corticosteroids:** Increased risk of gastrointestinal ulceration and bleeding.
* **Diuretics, ACE inhibitors, ARBs:** May reduce antihypertensive effects and increase risk of renal dysfunction.
* **Lithium:** Increased serum lithium levels.
* **Methotrexate:** Increased methotrexate toxicity.
### Monitoring
* Monitor for signs and symptoms of gastrointestinal bleeding (e.g., melena, hematemesis).
* Monitor renal function, especially in patients with pre-existing renal disease or those on concomitant nephrotoxic agents.
* Monitor blood pressure, as NSAIDs can increase blood pressure.
* Assess for signs of hypersensitivity reactions.
### Clinical Pearls
* Administer with food or milk to minimize gastrointestinal upset.
* Lowest effective dose for the shortest duration should be used to minimize risks.
* Risk of cardiovascular events may increase with duration of use and higher doses.
* Ibuprofen is a reversible COX inhibitor, unlike aspirin.
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*Please verify current prescribing information for the most up-to-date details.*
