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## Ibuprofen (Nurofen, Advil, Motrin)
### Overview
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) used for pain relief, fever reduction, and inflammation management.
### Primary Indications
* Pain (mild to moderate)
* Fever
* Inflammation (e.g., arthritis, musculoskeletal injuries)
* Dysmenorrhea
### Adult Dosing
* **Pain/Fever:** 200 mg to 400 mg PO every 4 to 6 hours as needed.
* **Inflammation:** 400 mg to 800 mg PO every 6 to 8 hours.
* **Maximum Daily Dose:** 3200 mg PO for short-term use under medical supervision. For over-the-counter use, the maximum is typically 1200 mg per day.
### Pediatric Dosing
Dosing is weight-based and should be calculated precisely. Consult specific pediatric dosing guidelines or product labeling for accurate administration.
* **Fever/Pain:** 5 mg/kg to 10 mg/kg PO every 6 to 8 hours.
* **Maximum Daily Dose:** 40 mg/kg/day (or 2400 mg/day, whichever is less).
### Dose Adjustments
No dose adjustment is typically required for renal or hepatic impairment, but caution is advised. In patients with severe renal or hepatic impairment, dose reduction may be necessary, and monitoring for adverse effects is crucial.
### Contraindications
* Hypersensitivity to ibuprofen, aspirin, or other NSAIDs.
* History of bronchospasm, asthma, rhinitis, or urticaria precipitated by NSAIDs.
* Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery.
* Active gastrointestinal bleeding or ulcer disease.
* Severe heart failure.
### Adverse Effects
Common: Nausea, vomiting, dyspepsia, heartburn, abdominal pain, diarrhea, constipation, dizziness, headache.
Serious: Gastrointestinal bleeding/perforation, cardiovascular thrombotic events (MI, stroke), renal failure, hepatic failure, hypersensitivity reactions, exacerbation of asthma, fluid retention, edema.
### Key Drug Interactions
* **Anticoagulants (e.g., warfarin, DOACs):** Increased risk of bleeding.
* **Aspirin (low-dose):** May reduce the cardioprotective effect of aspirin; administer ibuprofen at least 30 minutes after or 8 hours before aspirin.
* **Corticosteroids:** Increased risk of gastrointestinal ulceration and bleeding.
* **SSRIs/SNRIs:** Increased risk of bleeding.
* **Diuretics/ACE Inhibitors/ARBs:** Reduced antihypertensive effect; increased risk of renal impairment.
* **Lithium/Methotrexate:** Increased serum concentrations and potential for toxicity.
### Monitoring
* Monitor for signs and symptoms of gastrointestinal bleeding (e.g., melena, hematemesis).
* Assess renal function (BUN, creatinine) especially in patients with pre-existing renal disease or those on concomitant nephrotoxic agents.
* Monitor liver function tests (LFTs) if used long-term or in patients with hepatic impairment.
* Monitor blood pressure, especially in patients with hypertension.
* Assess for signs of cardiovascular events.
### Clinical Pearls
* Administer with food or milk to minimize gastrointestinal upset.
* Use the lowest effective dose for the shortest duration necessary.
* Risk of cardiovascular events and gastrointestinal bleeding increases with dose and duration of use.
* Discontinue ibuprofen if any signs of adverse reactions occur.
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*Disclaimer: This information is intended for educational purposes only and does not constitute medical advice. Always verify current prescribing information and consult with a qualified healthcare professional before making any decisions related to drug therapy.*
