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# Ibuprofen
## Overview
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) used for the relief of pain, fever, and inflammation.
## Primary Indications
* Mild to moderate pain (e.g., headache, dental pain, menstrual cramps, muscle aches)
* Fever
* Inflammation (e.g., arthritis)
* Closure of patent ductus arteriosus (PDA) in premature infants
## Adult Dosing
* **Pain and Fever:** 200-400 mg every 4-6 hours as needed. Maximum daily dose is 1200 mg for over-the-counter (OTC) use and 3200 mg under medical supervision.
* **Inflammation:** 400-800 mg every 6-8 hours. Maximum daily dose is 3200 mg.
* **Rheumatic Diseases:** Doses may vary and should be individualized.
## Pediatric Dosing
* **Pain and Fever:** 5-10 mg/kg/dose every 6-8 hours. Maximum daily dose is typically 40 mg/kg or 2400 mg, whichever is less. Dosing should not exceed adult maximums.
* **Premature Infants (Patent Ductus Arteriosus):** Dosing varies based on gestational age and postnatal age. A common regimen is a total of 3 doses given at 24-hour intervals. The first dose is typically 10 mg/kg, followed by two doses of 5 mg/kg each. *Consult specific guidelines or product labeling for precise dosing in this population.*
## Dose Adjustments
No specific dose adjustments are generally required for renal or hepatic impairment in adults, but caution is advised, and the lowest effective dose should be used. Monitor for signs of toxicity.
## Contraindications
* Known hypersensitivity to ibuprofen, aspirin, or other NSAIDs.
* History of bronchospasm, asthma, rhinitis, or urticaria following aspirin or NSAID use.
* 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 adverse effects include gastrointestinal upset (nausea, vomiting, diarrhea, abdominal pain), dizziness, headache. Serious adverse effects can include GI bleeding, perforation, renal toxicity, cardiovascular thrombotic events (MI, stroke), hypersensitivity reactions, and fluid retention.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin) and Antiplatelets (e.g., aspirin, clopidogrel):** Increased risk of bleeding.
* **ACE Inhibitors and ARBs:** May diminish antihypertensive effect and increase risk of renal toxicity.
* **Diuretics:** May diminish diuretic effect and increase risk of renal toxicity.
* **Lithium:** Increased lithium levels and toxicity.
* **Methotrexate:** Increased methotrexate toxicity.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
## Monitoring
* Signs and symptoms of GI bleeding (e.g., melena, hematemesis).
* Renal function (BUN, creatinine), especially in patients with pre-existing renal disease or those at risk.
* 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.
* Caution in elderly patients and those with cardiovascular disease, heart failure, hypertension, renal or hepatic impairment, and a history of GI ulceration or bleeding.
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*This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant guidelines before making clinical decisions.*
