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# Ibuprofen
## Overview
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that provides analgesic, anti-inflammatory, and antipyretic effects.
## Primary Indications
* Pain (mild to moderate)
* Fever
* Inflammatory conditions (e.g., rheumatoid arthritis, osteoarthritis)
## Adult Dosing
* **Pain/Fever:** 200-400 mg every 4-6 hours as needed. Maximum daily dose: 1200 mg for over-the-counter (OTC) use; up to 2400-3200 mg/day under medical supervision for inflammatory conditions.
* **Inflammatory Conditions:** 400-800 mg three to four times daily. Maximum daily dose: 3200 mg.
## Pediatric Dosing
* **Fever/Pain:** 5-10 mg/kg/dose every 6-8 hours. Maximum daily dose: 40 mg/kg or 2400 mg (whichever is less).
* For children aged 6 months to 12 years.
* Use the lowest effective dose.
* **Inflammatory Conditions:** Dosing is individualized and typically requires higher doses under specialist supervision.
## Dose Adjustments
* **Renal Impairment:** Use with caution. Lower doses may be appropriate. Monitor renal function.
* **Hepatic Impairment:** Use with caution. Lower doses may be appropriate. Monitor liver function.
## 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.
* Severe heart failure.
* Third trimester of pregnancy.
## Adverse Effects
* **Common:** Nausea, vomiting, dyspepsia, abdominal pain, diarrhea, constipation, dizziness, headache.
* **Serious:** Gastrointestinal bleeding, ulceration, perforation; cardiovascular thrombotic events (MI, stroke); renal failure; hepatic injury; hypersensitivity reactions; exacerbation of asthma.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin), Antiplatelets (e.g., aspirin, clopidogrel):** Increased risk of bleeding.
* **ACE inhibitors, ARBs, Diuretics:** Reduced antihypertensive effect, increased risk of renal impairment.
* **Lithium, Methotrexate:** Increased serum levels and toxicity.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **SSRIs:** Increased risk of GI bleeding.
## Monitoring
* Signs and symptoms of GI bleeding (e.g., melena, hematemesis).
* Renal function (BUN, creatinine).
* Liver function tests (LFTs).
* Blood pressure.
* 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 serious adverse effects.
* Ibuprofen can mask signs of infection.
* Caution in patients with a history of peptic ulcer disease, inflammatory bowel disease, heart failure, hypertension, or impaired renal/hepatic function.
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*This information is intended for healthcare professionals. Always consult the most current prescribing information and local protocols for definitive guidance.*
