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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 management (mild to moderate)
* Inflammation (e.g., arthritis, musculoskeletal injuries)
* Fever reduction
## Adult Dosing
* **Pain/Inflammation:** 400 mg to 800 mg every 6 to 8 hours as needed.
* Maximum daily dose: 3200 mg. However, for non-prescription use, maximum daily dose is typically 1200 mg.
* **Rheumatoid Arthritis:** 400 mg to 800 mg three to four times daily.
* Maximum daily dose: 3200 mg.
## Pediatric Dosing
* **Fever/Pain:** 5 mg/kg to 10 mg/kg orally every 6 to 8 hours as needed.
* Maximum dose: 40 mg/kg/day or 400 mg per dose, whichever is less.
* Infants: Generally recommended for infants 6 months and older.
## Dose Adjustments
* **Renal Impairment:** Use with caution; may require dose reduction in severe impairment. Monitor renal function.
* **Hepatic Impairment:** Use with caution; may require dose reduction. Monitor liver function.
## Contraindications
* Hypersensitivity to ibuprofen, aspirin, or other NSAIDs.
* History of bronchospasm, 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 peptic ulceration or gastrointestinal bleeding.
* Severe heart failure.
* Third trimester of pregnancy.
## Adverse Effects
* **Common:** Gastrointestinal upset (nausea, vomiting, dyspepsia, abdominal pain), diarrhea, constipation, dizziness, headache.
* **Serious:** Gastrointestinal bleeding and perforation, myocardial infarction, stroke, hypertension, renal toxicity, hepatotoxicity, hypersensitivity reactions (including Stevens-Johnson syndrome/toxic epidermal necrolysis), exacerbation of heart failure.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin, DOACs):** Increased risk of bleeding.
* **Aspirin (low-dose):** May reduce the cardioprotective effect of low-dose aspirin; administer ibuprofen at least 30 minutes after or 8 hours before aspirin.
* **Corticosteroids:** Increased risk of gastrointestinal bleeding.
* **Diuretics, ACE inhibitors, ARBs:** May reduce antihypertensive effect and increase risk of renal toxicity.
* **Lithium, Methotrexate:** Increased serum levels and toxicity.
* **SSRIs/SNRIs:** Increased risk of gastrointestinal bleeding.
## Monitoring
* Signs and symptoms of GI bleeding or ulceration.
* Renal function (serum creatinine, BUN), especially in patients with pre-existing renal disease or those at risk.
* Liver function tests, especially with chronic use or in patients with liver disease.
* Blood pressure, particularly in patients with hypertension.
* Signs of cardiovascular events (chest pain, shortness of breath, weakness, slurred speech).
## Clinical Pearls
* Administer with food or milk to minimize gastrointestinal upset.
* Use the lowest effective dose for the shortest duration necessary to minimize risks.
* Ibuprofen carries a black box warning regarding cardiovascular and gastrointestinal risks.
* Avoid in patients with significant cardiovascular disease or those at high risk for cardiovascular events unless benefits clearly outweigh risks.
* Consider concurrent gastroprotective therapy (e.g., PPI) for patients at high risk of GI complications.
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*Disclaimer: This information is intended for educational purposes and should not substitute for current prescribing information or clinical judgment. Always consult the most recent product monograph or other authoritative sources before making treatment decisions.*
