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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 (mild to moderate)
* Inflammation (e.g., arthritis)
* Fever
## Adult Dosing
* **Pain and Fever:** 200-400 mg every 4-6 hours as needed. Maximum daily dose: 1200 mg for over-the-counter (OTC) use. Prescription doses can be higher.
* **Inflammation:** 400-800 mg three times daily. Maximum daily dose: 3200 mg (under medical supervision).
* Doses should be taken with food or milk to minimize gastrointestinal upset.
## Pediatric Dosing
* **Fever and Pain:** 5-10 mg/kg/dose every 6-8 hours. Maximum daily dose: 40 mg/kg or 2400 mg, whichever is less.
* For children under 2 years of age, consult a pediatrician.
* Dosing is typically based on weight.
* Dosing suspensions are common; ensure accurate measurement with the provided device.
## Dose Adjustments
* **Renal Impairment:** Use with caution. Reduced doses may be necessary in severe impairment. Monitor renal function.
* **Hepatic Impairment:** Use with caution. Reduced doses may be necessary in severe impairment. Monitor liver function.
* Elderly patients: Increased risk of adverse effects; consider lower doses.
## 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.
* Active gastrointestinal bleeding or history of ulceration/bleeding with previous NSAID use.
* Severe heart failure, severe renal impairment, severe hepatic impairment.
* Third trimester of pregnancy.
## Adverse Effects
* **Common:** Dyspepsia, nausea, vomiting, abdominal pain, constipation, diarrhea, rash, dizziness, headache.
* **Serious:** Gastrointestinal bleeding/perforation, myocardial infarction, stroke, hypertension, renal failure, hepatic failure, anaphylaxis, Stevens-Johnson syndrome, toxic epidermal necrolysis.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin, heparin, DOACs):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of gastrointestinal ulceration/bleeding.
* **Selective Serotonin Reuptake Inhibitors (SSRIs) / Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs):** Increased risk of bleeding.
* **ACE inhibitors, Angiotensin II Receptor Blockers (ARBs), Diuretics:** May reduce antihypertensive effects and increase risk of renal impairment.
* **Lithium:** May increase lithium levels.
* **Methotrexate:** May increase methotrexate levels and toxicity.
## Monitoring
* Signs and symptoms of gastrointestinal bleeding (e.g., melena, hematemesis).
* Renal function (e.g., serum creatinine, BUN).
* Liver function (e.g., AST, ALT).
* Blood pressure.
* Signs of hypersensitivity reactions.
## Clinical Pearls
* Use the lowest effective dose for the shortest duration necessary to minimize risks.
* Advise patients to avoid concomitant use with other NSAIDs or aspirin (unless specifically directed by a healthcare provider).
* Risk of cardiovascular thrombotic events, myocardial infarction, and stroke may increase with duration of use and in patients with known cardiovascular disease or risk factors.
* NSAIDs can cause fluid retention and edema; use with caution in patients with heart failure.
**Disclaimer:** This information is intended for healthcare professionals and should not replace professional medical advice. Always consult the most current prescribing information and relevant guidelines before making any treatment decisions.
