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# Ibuprofen
## Overview
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that reduces inflammation, pain, and fever by inhibiting cyclooxygenase (COX) enzymes.
## Primary Indications
* Pain relief (mild to moderate)
* Fever reduction
* Inflammation (e.g., arthritis)
## Adult Dosing
* **Pain/Fever:** 200-400 mg every 4-6 hours as needed.
* Maximum daily dose: 1200 mg for over-the-counter (OTC) use.
* Maximum daily dose for prescription use: 3200 mg, typically in divided doses (e.g., 800 mg TID), under medical supervision.
* **Inflammation:** 400-800 mg TID-QID, not to exceed 3200 mg daily.
## 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).
* Dosing for infants under 6 months of age should be at the discretion of a healthcare provider due to potential risks.
* **Kawasaki Disease:** Dosing varies significantly based on the phase of treatment and specific clinical guidelines. Refer to institutional protocols.
## Dose Adjustments
* **Renal Impairment:** Use with caution. Mild to moderate impairment may not require adjustment, but severe impairment warrants caution or avoidance.
* **Hepatic Impairment:** Use with caution. Mild to moderate impairment may require dose reduction. Severe impairment is generally a contraindication.
* **Geriatric:** Use lowest effective dose; increased risk of gastrointestinal bleeding and renal toxicity.
## Contraindications
* Hypersensitivity to ibuprofen, aspirin, or other NSAIDs.
* History of bronchospasm, asthma, rhinitis, or urticaria following NSAID or aspirin use.
* Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery.
* Active gastrointestinal bleeding or ulceration.
* Severe heart failure, renal failure, or hepatic failure.
## Adverse Effects
* **Common:** Nausea, dyspepsia, abdominal pain, dizziness, headache.
* **Serious:**
* Gastrointestinal (GI) bleeding, ulceration, perforation.
* Cardiovascular (CV) thrombotic events (MI, stroke).
* Renal toxicity (acute kidney injury).
* Hepatic toxicity.
* Hypersensitivity reactions (anaphylaxis, Stevens-Johnson syndrome).
* Fluid retention and edema.
* Exacerbation of heart failure.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin, DOACs):** Increased risk of bleeding.
* **Aspirin (low-dose):** May diminish cardioprotective effects of aspirin; increased GI risk.
* **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 lithium levels.
* **Methotrexate:** Increased methotrexate toxicity.
## Monitoring
* **GI Symptoms:** Monitor for signs and symptoms of GI bleeding (e.g., melena, hematemesis).
* **Renal Function:** Assess baseline and periodic renal function (SCr, BUN), especially in high-risk patients.
* **Hepatic Function:** Assess baseline and periodic hepatic function (LFTs) in patients with liver disease or on long-term therapy.
* **Blood Pressure:** Monitor blood pressure, particularly in patients with hypertension.
* **Signs of CV events:** Counsel patients on recognizing and reporting symptoms of MI or stroke.
## Clinical Pearls
* Ibuprofen should be used at the lowest effective dose for the shortest duration necessary to minimize risks.
* Administer with food or milk to reduce GI upset.
* Avoid concomitant use with other NSAIDs.
* In pediatric patients, use an appropriate dosing device to ensure accurate administration.
* Be aware of the increased risk of serious CV and GI events, especially with prolonged use or higher doses.
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*Disclaimer: This information is intended for healthcare professionals. Always verify current prescribing information and consult with appropriate resources before making clinical decisions.*
