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# Ibuprofen
## Overview
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) used for pain relief, fever reduction, and inflammation management.
## Primary Indications
* Pain (mild to moderate)
* Fever
* Inflammation (e.g., arthritis)
* Dysmenorrhea
## Adult Dosing
* **Pain/Fever:** 200-400 mg orally every 4-6 hours as needed. Maximum dose: 1200 mg/day. Higher doses (up to 2400 mg/day) may be used under medical supervision for inflammatory conditions.
* **Inflammatory Conditions:** 400-800 mg orally two to three times daily. Maximum dose: 3200 mg/day (typically divided into 3-4 doses).
## Pediatric Dosing
Dosing is based on weight and indication. Always use an appropriate measuring device for liquid formulations.
* **Fever/Pain:** 5-10 mg/kg/dose orally every 6-8 hours as needed.
* Maximum dose: 40 mg/kg/day.
* Typical pediatric concentrations are 100 mg/5 mL (suspension) or 50 mg/1.25 mL (infant drops).
* **Juvenile Idiopathic Arthritis:** 30-50 mg/kg/day orally divided into 3-4 doses. Maximum dose: 2400 mg/day.
## Dose Adjustments
No dose adjustment is typically needed for renal or hepatic impairment, but caution is advised, and lowest effective dose should be used. Monitor for signs of organ damage.
## Contraindications
* Known hypersensitivity to ibuprofen or other NSAIDs.
* History of bronchospasm, asthma, 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 ulcer disease.
* Severe heart failure.
* Last trimester of pregnancy.
## Adverse Effects
* **Common:** Nausea, vomiting, diarrhea, constipation, dyspepsia, abdominal pain, dizziness, headache.
* **Serious:** Gastrointestinal bleeding and perforation, myocardial infarction, stroke, renal failure, hypertension, hypersensitivity reactions, Stevens-Johnson syndrome, toxic epidermal necrolysis.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin, apixaban):** Increased risk of bleeding.
* **Other NSAIDs and Aspirin:** Increased risk of gastrointestinal toxicity and other adverse effects.
* **Corticosteroids:** Increased risk of gastrointestinal bleeding.
* **ACE Inhibitors, ARBs, Diuretics:** Reduced antihypertensive effect and increased risk of renal impairment.
* **Lithium:** Increased lithium levels.
* **Methotrexate:** Increased methotrexate toxicity.
## Monitoring
* Signs and symptoms of gastrointestinal bleeding (e.g., melena, hematemesis).
* Renal function (serum creatinine, BUN), especially in patients with risk factors for renal impairment.
* Blood pressure.
* Signs and symptoms 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.
* Assess for risk factors for cardiovascular and gastrointestinal events before initiating therapy.
* Patients with asthma may be at increased risk of bronchospasm.
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*Please verify current prescribing information for definitive guidance.*
