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# Ibuprofen
## Overview
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that exhibits analgesic, anti-inflammatory, and antipyretic properties. It works by inhibiting cyclooxygenase (COX) enzymes, which reduces prostaglandin synthesis.
## Primary Indications
* Pain relief (mild to moderate)
* Fever reduction
* Inflammation management (e.g., arthritis)
* Closure of patent ductus arteriosus (PDA) in premature infants
## Adult Dosing
* **Analgesia/Antipyresis:** 200-400 mg every 4-6 hours as needed. Maximum daily dose: 1200 mg (OTC) or 3200 mg (prescription).
* **Inflammation:** 400-800 mg 2-3 times daily. Maximum daily dose: 3200 mg.
## Pediatric Dosing
* **Analgesia/Antipyresis:** 5-10 mg/kg/dose every 6-8 hours. Maximum daily dose: 40 mg/kg or 4000 mg, whichever is less. Dosing is typically not recommended for infants < 6 months of age without medical supervision due to potential risks.
* **Patent Ductus Arteriosus (Premature Infants):** Dosing regimens vary and are typically administered intravenously. A common regimen is 10 mg/kg for the first dose, followed by 5 mg/kg for two subsequent doses 24-48 hours apart, if necessary. Specific protocols should be followed.
## Dose Adjustments
* No dose adjustment is typically needed for renal or hepatic impairment, but caution is advised, and lower doses may be considered.
## Contraindications
* Hypersensitivity to ibuprofen or other NSAIDs.
* History of bronchospasm, asthma, rhinitis, or urticaria following aspirin or other NSAID use.
* Perioperative pain in the context of coronary artery bypass graft (CABG) surgery.
* Advanced renal disease.
* Severe hepatic impairment.
* Severe heart failure.
* Third trimester of pregnancy.
## Adverse Effects
Common: Nausea, vomiting, diarrhea, constipation, dyspepsia, abdominal pain, headache, dizziness.
Serious: Gastrointestinal bleeding, ulceration, perforation; cardiovascular thrombotic events (MI, stroke); renal toxicity; hepatic toxicity; hypersensitivity reactions; fluid retention and edema.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **SSRIs/SNRIs:** Increased risk of GI bleeding.
* **ACE inhibitors, ARBs, diuretics:** Reduced antihypertensive effect, increased risk of renal impairment.
* **Lithium:** Increased serum lithium levels.
* **Methotrexate:** Increased methotrexate toxicity.
## Monitoring
* Monitor for signs and symptoms of GI bleeding (e.g., melena, hematemesis).
* Assess renal function (BUN, creatinine) and hepatic function (LFTs), especially with long-term use or in patients with pre-existing conditions.
* Monitor blood pressure.
* 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 minimize risks.
* Avoid concomitant use with other NSAIDs or aspirin unless specifically indicated and monitored.
* Caution in elderly patients due to increased risk of adverse effects.
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*Please verify current prescribing information for the most up-to-date dosing and safety recommendations.*
