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# Ibuprofen
## Overview
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) used for its analgesic, anti-inflammatory, and antipyretic properties.
## Primary Indications
* Pain relief (mild to moderate)
* Fever reduction
* Inflammation reduction (e.g., arthritis)
## Adult Dosing
* **Pain/Fever:** 200-400 mg every 4-6 hours as needed.
* **Inflammation:** 400-800 mg 3 times daily.
* **Maximum Daily Dose:** 3200 mg (prescription strength); 1200 mg (over-the-counter).
## Pediatric Dosing
* **Dosing is weight-based.**
* **Fever/Pain:** 5-10 mg/kg/dose every 6-8 hours as needed.
* **Maximum Daily Dose:** 40 mg/kg/day or 2400 mg/day (whichever is less).
* **Note:** Specific formulations (e.g., infant drops, children's suspension) and concentrations should be carefully reviewed. Dosing varies significantly by age and weight, and consultation with specific pediatric guidelines or a pediatrician is recommended.
## Dose Adjustments
* **Renal Impairment:** Use with caution. Lower doses may be necessary. Monitor renal function.
* **Hepatic Impairment:** Use with caution. Lower doses may be necessary. Monitor liver function.
* **Elderly:** Increased risk of adverse effects. Consider lower doses and shorter durations.
## Contraindications
* Hypersensitivity to ibuprofen, aspirin, or other NSAIDs.
* History of asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs.
* Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery.
* Advanced renal disease.
* Active gastrointestinal bleeding or ulceration.
* Third trimester of pregnancy.
## Adverse Effects
* **Common:** Nausea, vomiting, dyspepsia, abdominal pain, constipation, diarrhea, rash.
* **Serious:** Gastrointestinal bleeding/perforation, cardiovascular thrombotic events (MI, stroke), renal failure, hepatic failure, hypersensitivity reactions, exacerbation of asthma, Stevens-Johnson syndrome/toxic epidermal necrolysis.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin, rivaroxaban):** Increased risk of bleeding.
* **Antiplatelets (e.g., aspirin, clopidogrel):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **ACE inhibitors, ARBs, Diuretics:** May reduce antihypertensive effect and increase risk of renal impairment.
* **Lithium:** Increased lithium levels.
* **Methotrexate:** Increased methotrexate toxicity.
* **Other NSAIDs:** Increased risk of adverse effects.
## Monitoring
* Signs and symptoms of GI bleeding (e.g., melena, hematemesis).
* Renal function (serum creatinine, BUN), especially in patients with risk factors.
* Liver function tests, especially with prolonged use or in patients with hepatic impairment.
* Blood pressure.
* Signs of cardiovascular events.
## Clinical Pearls
* Take with food or milk to minimize GI upset.
* Use the lowest effective dose for the shortest duration necessary.
* Risk of cardiovascular events and GI bleeding increases with dose and duration of use.
* Avoid concurrent use with other NSAIDs.
* Consider gastroprotective agents (e.g., PPIs) in patients at high risk for GI complications.
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*This information is intended for clinical use and does not replace the need to consult current prescribing information and local protocols.*
