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# Ibuprofen ## Overview Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that inhibits cyclooxygenase (COX) enzymes, reducing prostaglandin synthesis. It possesses analgesic, anti-inflammatory, and antipyretic properties. ## Primary Indications * Pain (mild to moderate) * Fever * Inflammatory conditions (e.g., rheumatoid arthritis, osteoarthritis) ## Adult Dosing * **Analgesia/Antipyresis:** 200 mg to 400 mg PO every 4 to 6 hours as needed. * Maximum: 1200 mg per day for over-the-counter use. * Maximum: 2400 mg to 3200 mg per day for prescription use, depending on indication and clinical judgment. * **Inflammatory Conditions:** 400 mg to 800 mg PO every 6 to 8 hours. * Maximum: 3200 mg per day. ## Pediatric Dosing * **Analgesia/Antipyresis:** 5 mg/kg to 10 mg/kg PO every 6 to 8 hours. * Maximum single dose: 40 mg/kg or 400 mg. * Maximum daily dose: 40 mg/kg or 2400 mg (whichever is less). * Dosing is generally for children 6 months and older. ## Dose Adjustments * No dose adjustment is typically required for hepatic or renal impairment, but caution is advised, and lowest effective dose should be used. Monitor for signs of toxicity. ## Contraindications * Hypersensitivity to ibuprofen, aspirin, or other NSAIDs. * History of bronchospasm, asthma, rhinitis, or urticaria precipitated by aspirin or other NSAIDs. * Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery. * Advanced renal disease. * Severe heart failure. * Third trimester of pregnancy. ## Adverse Effects * **Common:** Nausea, vomiting, dyspepsia, abdominal pain, diarrhea, constipation, dizziness, headache. * **Serious:** Gastrointestinal bleeding/ulceration, cardiovascular thrombotic events (MI, stroke), renal toxicity, hypertension, hypersensitivity reactions, hepatic dysfunction, fluid retention, edema. ## Key Drug Interactions * **Anticoagulants (e.g., warfarin) and Antiplatelets (e.g., aspirin, clopidogrel):** Increased risk of bleeding. * **Corticosteroids:** Increased risk of GI ulceration and bleeding. * **ACE inhibitors, ARBs, Diuretics:** Decreased antihypertensive effect, increased risk of renal dysfunction. * **Lithium:** Increased serum lithium levels. * **Methotrexate:** Increased risk of methotrexate toxicity. ## Monitoring * Signs and symptoms of GI bleeding (melena, hematemesis). * Renal function (BUN, creatinine). * Liver function tests (ALT, AST). * Blood pressure. * 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 concurrent use with other NSAIDs. * For pediatric use, consult specific product labeling for age and weight restrictions and dosing devices. *** *Please verify the current prescribing information for the most up-to-date dosing, indications, and safety information.*