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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 are responsible for prostaglandin synthesis.
### Primary Indications
* Pain (mild to moderate)
* Fever
* Inflammation associated with conditions like arthritis, dysmenorrhea, and headache.
### Adult Dosing
* **Analgesia/Antipyresis:** 200 mg to 400 mg every 4 to 6 hours as needed.
* **Inflammation:** 400 mg to 800 mg three times daily.
* **Maximum Daily Dose:** 3200 mg. Higher doses should be used with caution and under close medical supervision, typically reserved for specific inflammatory conditions.
### Pediatric Dosing
Dosing is typically based on weight.
* **Analgesia/Antipyresis:** 5 mg/kg to 10 mg/kg orally every 6 to 8 hours.
* **Maximum Daily Dose:** 40 mg/kg or 2400 mg, whichever is less.
* **Note:** Oral suspension concentrations vary by manufacturer. Always confirm the concentration before dosing. Use the lowest effective dose for the shortest duration.
### Dose Adjustments
* **Renal Impairment:** Use with caution. Consider reduced frequency or dose, especially in severe impairment. Monitor renal function.
* **Hepatic Impairment:** Use with caution. Consider reduced frequency or dose. Monitor hepatic function.
### Contraindications
* Hypersensitivity to ibuprofen, aspirin, or other NSAIDs.
* History of asthma, urticaria, or other 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 a history of recent gastrointestinal bleeding/perforation.
* Severe renal, hepatic, or heart failure.
### Adverse Effects
* **Gastrointestinal:** Dyspepsia, nausea, vomiting, abdominal pain, diarrhea, constipation, ulceration, bleeding, perforation.
* **Cardiovascular:** Increased risk of myocardial infarction and stroke, hypertension, edema.
* **Renal:** Renal papillary necrosis, interstitial nephritis, acute renal failure.
* **Dermatologic:** Rash, pruritus, Stevens-Johnson syndrome, toxic epidermal necrolysis.
* **Hematologic:** Anemia, prolonged bleeding time.
* **Other:** Dizziness, headache, tinnitus.
### Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Aspirin (low-dose):** May decrease the cardioprotective effects of aspirin. Separate administration by at least 8 hours.
* **Other NSAIDs:** Increased risk of adverse effects.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **Diuretics and Antihypertensives:** May reduce their efficacy and increase risk of renal toxicity.
* **Lithium:** May increase lithium levels.
* **Methotrexate:** May increase methotrexate toxicity.
* **SSRIs:** Increased risk of GI bleeding.
### Monitoring
* **Renal function:** Especially in patients with pre-existing renal disease, dehydration, or those on concomitant nephrotoxic drugs.
* **Hepatic function:** Especially in patients with liver disease or those on long-term therapy.
* **Blood pressure:** NSAIDs can cause or worsen hypertension.
* **Signs of GI bleeding:** Melena, hematemesis, abdominal pain.
* **Signs of cardiovascular events:** Chest pain, shortness of breath.
### Clinical Pearls
* Take with food or milk to minimize gastrointestinal upset.
* Use the lowest effective dose for the shortest duration necessary to minimize risks.
* Patients with asthma may be at increased risk for bronchospasm.
* Consider
