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# Ibuprofen ## Overview Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that provides analgesic, anti-inflammatory, and antipyretic effects. ## Primary Indications * Pain (mild to moderate) * Fever * Inflammatory conditions (e.g., rheumatoid arthritis, osteoarthritis) * Dysmenorrhea * Patent ductus arteriosus (PDA) in neonates ## Adult Dosing * **Pain/Fever:** 200-400 mg every 4-6 hours as needed. Maximum daily dose: 1200 mg (over-the-counter); 2400-3200 mg (prescription, under medical supervision for specific inflammatory conditions). * **Dysmenorrhea:** 200-400 mg every 4-6 hours as needed. Maximum daily dose: 1200 mg. * **Rheumatoid Arthritis/Osteoarthritis:** 400-800 mg three to four times daily. Maximum daily dose: 3200 mg. ## Pediatric Dosing * **Pain/Fever:** 5-10 mg/kg/dose orally every 6-8 hours. Maximum daily dose: 40 mg/kg or 2400 mg, whichever is less. * Infants: Generally for age 6 months and older. * **Patent Ductus Arteriosus (PDA):** Dosing varies significantly based on gestational and postnatal age. Typically, a total of three doses are administered intravenously: * **Dose 1:** 10 mg/kg. * **Dose 2 & 3:** 5 mg/kg each, given 24 and 48 hours after the first dose, respectively. * Dosing adjustments may be necessary based on renal function and infant's clinical status. Neonatal intensive care unit (NICU) protocols should be followed. ## Dose Adjustments * **Renal Impairment:** Use with caution. May need to reduce dose or increase dosing interval, especially in severe impairment. Monitor renal function closely. * **Hepatic Impairment:** Use with caution. May need to reduce dose. Monitor liver function. ## 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 peptic ulceration or gastrointestinal bleeding. * Severe heart failure. * Third trimester of pregnancy. ## Adverse Effects * **Gastrointestinal:** Dyspepsia, nausea, abdominal pain, diarrhea, constipation, gastrointestinal bleeding, perforation. * **Cardiovascular:** Hypertension, edema, myocardial infarction, stroke (risk increased with higher doses and longer duration of use). * **Renal:** Renal insufficiency, acute kidney injury, interstitial nephritis. * **Hematologic:** Anemia, prolonged bleeding time. * **Dermatologic:** Rash, pruritus. * **Other:** Dizziness, headache, tinnitus. ## Key Drug Interactions * **Anticoagulants (e.g., warfarin) and Antiplatelets (e.g., aspirin, clopidogrel):** Increased risk of bleeding. * **Corticosteroids:** Increased risk of gastrointestinal ulceration and bleeding. * **ACE Inhibitors and Angiotensin Receptor Blockers (ARBs):** May reduce antihypertensive effect and increase risk of renal impairment. * **Diuretics:** May reduce diuretic effect and increase risk of renal impairment. * **Lithium, Methotrexate:** Ibuprofen can increase serum levels of these drugs, leading to toxicity. * **SSRIs:** Increased risk of bleeding. ## Monitoring * Signs and symptoms of gastrointestinal bleeding or ulceration. * Blood pressure. * Renal function (serum creatinine, BUN). * Liver function (LFTs), especially with chronic use or in patients with hepatic impairment. * Signs of fluid retention or edema. * For PDA treatment in neonates: urine output, fluid balance, renal function, platelet count, and bilirubin levels. ## Clinical Pearls * Administer with food or milk to minimize gastrointestinal upset. * Lowest effective dose for the shortest duration should be used to minimize risk of adverse events, particularly cardiovascular and gastrointestinal events. * Risk of cardiovascular thrombotic events, myocardial infarction, and stroke may be increased with NSAID use. * NSAIDs can cause renal papillary necrosis and other renal injury. * Use cautiously in patients with pre-existing renal disease, heart failure, dehydration, or elderly patients. * For PDA closure in neonates, ibuprofen is an alternative to indomethacin, but efficacy and side effect profiles can differ. --- *Please verify the current prescribing information and consult with a healthcare professional before making any medication decisions.*