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# Ibuprofen
## Overview
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that exhibits analgesic, anti-inflammatory, and antipyretic properties.
## Primary Indications
* Pain (mild to moderate)
* Fever
* Inflammatory conditions (e.g., rheumatoid arthritis, osteoarthritis)
* Dysmenorrhea
## Adult Dosing
* **Pain and Fever:** 200-400 mg orally every 4-6 hours as needed. Maximum daily dose: 1200 mg.
* **Inflammatory Conditions:** 400-800 mg orally every 6-8 hours. Maximum daily dose: 2400 mg (requires medical supervision).
* **Dysmenorrhea:** 200-400 mg orally every 4-6 hours as needed. Maximum daily dose: 1200 mg.
## Pediatric Dosing
* **Fever and Pain:** 5-10 mg/kg orally every 6-8 hours. Maximum daily dose: 40 mg/kg or 2400 mg, whichever is less. For infants younger than 6 months, consult specific guidelines.
* **Kawasaki Disease:** Dosing varies widely and is typically guided by rheumatology specialists.
## Dose Adjustments
* **Renal Impairment:** Use with caution. Reduced doses may be necessary. Avoid in severe renal impairment.
* **Hepatic Impairment:** Use with caution. Reduced doses may be necessary. Avoid in severe hepatic impairment.
## Contraindications
* Hypersensitivity to ibuprofen, aspirin, or other NSAIDs.
* History of bronchospasm, asthma, rhinitis, or urticaria triggered by aspirin or other NSAIDs.
* Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery.
* Active gastrointestinal bleeding or ulceration.
* Severe heart failure.
* Third trimester of pregnancy.
## Adverse Effects
* **Common:** Nausea, vomiting, diarrhea, constipation, dyspepsia, abdominal pain, headache, dizziness.
* **Serious:** Gastrointestinal bleeding, ulceration, perforation; cardiovascular thrombotic events (MI, stroke); renal impairment; hepatic injury; fluid retention; edema; hypertension; hypersensitivity reactions.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of gastrointestinal ulceration and bleeding.
* **Selective Serotonin Reuptake Inhibitors (SSRIs) and Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs):** Increased risk of bleeding.
* **Lithium:** Increased lithium levels and potential for toxicity.
* **Methotrexate:** Increased methotrexate toxicity.
* **Other NSAIDs and Salicylates:** Increased risk of adverse effects.
* **Diuretics and Antihypertensives:** May decrease their efficacy and increase risk of renal damage.
## Monitoring
* Signs and symptoms of gastrointestinal bleeding (melena, hematemesis).
* Renal function (BUN, creatinine).
* Liver function (AST, ALT).
* Blood pressure.
* Signs of fluid retention (edema).
## Clinical Pearls
* Administer with food or milk to minimize gastrointestinal upset.
* The lowest effective dose for the shortest duration should be used to minimize the risk of serious cardiovascular and gastrointestinal adverse events.
* Consideration should be given to cardiovascular risk factors before initiating chronic therapy.
* Avoid concomitant use with other NSAIDs, including aspirin (unless low-dose aspirin for cardioprotection).
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*Disclaimer: This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant literature for complete details before making clinical decisions.*
