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# Ibuprofen
## Overview
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) used for its analgesic, anti-inflammatory, and antipyretic properties.
## Primary Indications
* Pain relief (e.g., headache, dental pain, menstrual cramps, muscle aches)
* Fever reduction
* Inflammation associated with conditions like arthritis
## Adult Dosing
* **Analgesia/Antipyresis:** 200-400 mg every 4-6 hours as needed.
* **Rheumatoid Arthritis:** 400-800 mg every 6-8 hours.
* **Maximum Daily Dose:** 3200 mg (under strict medical supervision for severe inflammation; typically, OTC maximum is 1200 mg/day).
## Pediatric Dosing
* **Dosing is typically weight-based:** 5-10 mg/kg per dose every 6-8 hours.
* **Maximum Daily Dose:** 40 mg/kg/day or 2400 mg/day, whichever is less.
* **Note:** For infants under 6 months, consult specific guidelines due to potential safety concerns. Dosing may vary based on formulation and indication.
## Dose Adjustments
* No dose adjustment is typically needed for renal or hepatic impairment, but caution is advised. Use the lowest effective dose for the shortest duration necessary, especially in patients with pre-existing organ dysfunction.
## Contraindications
* Hypersensitivity to ibuprofen, aspirin, or other NSAIDs.
* History of bronchospasm, asthma, rhinitis, or urticaria after taking aspirin or other NSAIDs.
* Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery.
* Active peptic ulceration or GI bleeding.
* Severe heart failure, renal failure, or hepatic failure.
## Adverse Effects
* **Common:** Nausea, vomiting, dyspepsia, abdominal pain, diarrhea, constipation, dizziness, headache.
* **Serious:**
* Gastrointestinal bleeding, ulceration, perforation.
* Cardiovascular thrombotic events (myocardial infarction, stroke).
* Renal toxicity (acute kidney injury, interstitial nephritis).
* Hepatic toxicity.
* Fluid retention and edema.
* Hypertension.
* Hypersensitivity reactions, including anaphylaxis.
* Exacerbation of asthma.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin, DOACs):** Increased risk of bleeding.
* **Aspirin (low-dose):** May reduce the cardioprotective effect of aspirin. Administer ibuprofen at least 8 hours before or 30 minutes after low-dose aspirin.
* **Corticosteroids:** Increased risk of GI bleeding and ulceration.
* **Diuretics and Antihypertensives:** May reduce their efficacy and increase the risk of renal toxicity.
* **Lithium:** Increased lithium levels and risk of toxicity.
* **Methotrexate:** Increased risk of methotrexate toxicity.
* **SSRIs/SNRIs:** Increased risk of GI bleeding.
## Monitoring
* Monitor for signs and symptoms of GI bleeding (melena, hematemesis).
* Assess for cardiovascular risk factors and monitor blood pressure.
* Monitor renal function (serum creatinine, BUN) especially in patients at risk.
* Monitor hepatic function (LFTs) if therapy is prolonged or in patients with pre-existing liver disease.
## Clinical Pearls
* Always use the lowest effective dose for the shortest duration required to minimize risks.
* Administer with food or milk to reduce gastrointestinal upset.
* Avoid concomitant use with other NSAIDs or aspirin unless specifically indicated and managed.
* Caution in elderly patients, those with pre-existing cardiovascular disease, renal impairment, hepatic impairment, or a history of GI issues.
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**Disclaimer:** This information is intended for healthcare professionals. Always consult the most current prescribing information and local protocols for definitive guidance.
