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# Ibuprofen
## Overview
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that reduces inflammation, pain, and fever.
## Primary Indications
* Pain relief (mild to moderate)
* Fever reduction
* Inflammation (e.g., arthritis)
## Adult Dosing
* **Pain/Fever:** 200-400 mg every 4-6 hours as needed. Maximum daily dose: 1200 mg (OTC), 3200 mg (prescription).
* **Inflammation:** 400-800 mg three times daily. Maximum daily dose: 2400-3200 mg.
## Pediatric Dosing
Dosing varies by age and weight. Specific protocols should be followed. Generally:
* **Fever/Pain:** 5-10 mg/kg/dose every 6-8 hours.
* Maximum single dose: 40 mg/kg (not to exceed adult single dose).
* Maximum daily dose: 40 mg/kg (not to exceed adult daily dose).
* Do not administer to infants under 6 months of age without physician direction.
## Dose Adjustments
No dose adjustment is typically needed for hepatic or renal impairment, but caution is advised. Monitor renal function, especially in patients with pre-existing renal disease or those at risk for renal toxicity.
## Contraindications
* Hypersensitivity to ibuprofen, aspirin, or other NSAIDs.
* History of bronchospasm, asthma, rhinitis, or urticaria following aspirin or NSAID use.
* Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery.
* Active gastrointestinal bleeding or a history of GI bleeding/perforation related to prior NSAID use.
* Severe heart failure.
* Severe hepatic or renal impairment.
* Third trimester of pregnancy.
## Adverse Effects
Common: Nausea, vomiting, diarrhea, constipation, abdominal pain, headache, dizziness, rash.
Serious: Gastrointestinal bleeding, ulceration, perforation; cardiovascular thrombotic events (MI, stroke); renal failure; hepatic failure; hypersensitivity reactions; bronchospasm; exacerbation of asthma.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Aspirin:** May reduce cardioprotective effects of low-dose aspirin; increased risk of GI toxicity.
* **Corticosteroids:** Increased risk of GI bleeding and ulceration.
* **Diuretics & Antihypertensives:** May reduce antihypertensive effects and increase risk of renal impairment.
* **Lithium:** Increased lithium levels.
* **Methotrexate:** Increased methotrexate toxicity.
* **Selective Serotonin Reuptake Inhibitors (SSRIs):** Increased risk of bleeding.
## Monitoring
* Signs and symptoms of GI bleeding (e.g., melena, hematemesis).
* Renal function (BUN, creatinine), especially in at-risk patients.
* Hepatic function (LFTs) with prolonged use or pre-existing liver disease.
* Blood pressure.
* Signs of cardiovascular events.
## Clinical Pearls
* Administer with food or milk to minimize gastrointestinal upset.
* Use the lowest effective dose for the shortest duration necessary to minimize risks.
* Caution in elderly patients, those with a history of GI disease, cardiovascular disease, or renal impairment.
* Avoid in patients with aspirin-exacerbated respiratory disease.
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*Disclaimer: This information is for educational purposes only and does not substitute for professional medical advice. Always consult the current prescribing information and a healthcare professional for specific treatment decisions.*
