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# Ibuprofen
## Overview
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) used for pain, fever, and inflammation.
## Primary Indications
* Pain relief (mild to moderate)
* Fever reduction
* Inflammation management (e.g., arthritis)
## Adult Dosing
* **Pain/Fever:** 200-400 mg every 4-6 hours as needed. Maximum daily dose: 1200 mg.
* **Inflammation:** 400-800 mg every 6-8 hours as needed. Maximum daily dose: 3200 mg, but typically limited to 1200 mg for over-the-counter use or for chronic conditions due to GI risks. Higher doses require medical supervision.
## Pediatric Dosing
Dosing is based on weight and age. Refer to specific pediatric guidelines or consult a pediatrician.
* **Fever/Pain:** 5-10 mg/kg/dose every 6-8 hours. Maximum daily dose: 40 mg/kg or 2400 mg, whichever is less.
* Infants 6 months and older.
* Do not use in premature infants or infants with certain conditions without medical advice.
## Dose Adjustments
* **Renal Impairment:** Use with caution. May require dose reduction or avoidance in severe impairment.
* **Hepatic Impairment:** Use with caution. May require dose reduction or avoidance in severe impairment.
## 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
* **Gastrointestinal:** Dyspepsia, nausea, abdominal pain, ulceration, bleeding, perforation.
* **Cardiovascular:** Increased risk of myocardial infarction, stroke, and hypertension.
* **Renal:** Acute kidney injury, fluid retention.
* **Hematologic:** Increased bleeding risk.
* **Hypersensitivity:** Rash, pruritus, bronchospasm, anaphylaxis.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin, DOACs):** Increased bleeding risk.
* **Aspirin (low-dose):** May diminish cardioprotective effects of aspirin.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **Diuretics and Antihypertensives:** May reduce efficacy and increase risk of renal toxicity.
* **Lithium:** Increased lithium levels.
* **Methotrexate:** Increased methotrexate toxicity.
* **Other NSAIDs (including COX-2 inhibitors):** Increased risk of adverse effects.
## Monitoring
* Monitor for signs and symptoms of GI bleeding.
* Monitor blood pressure.
* Assess renal and hepatic function, especially in patients with pre-existing conditions or those on long-term therapy.
* Monitor for signs of cardiovascular events.
## Clinical Pearls
* Administer with food or milk to minimize GI upset.
* Use the lowest effective dose for the shortest duration necessary to reduce the risk of adverse events.
* Caution in elderly patients and those with cardiovascular disease, renal impairment, or a history of GI bleeding.
* Avoid in the third trimester of pregnancy due to potential risks to the fetus.
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*Disclaimer: This information is intended for healthcare professionals. Always consult the most current prescribing information and product literature before making clinical decisions.*
