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# Ibuprofen
## Overview
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that exhibits analgesic, anti-inflammatory, and antipyretic properties. It works by reversibly inhibiting cyclooxygenase (COX) enzymes, thereby reducing prostaglandin synthesis.
## Primary Indications
* Pain relief (mild to moderate)
* Fever reduction
* Inflammation management (e.g., arthritis)
## Adult Dosing
* **Pain/Fever:** 200-400 mg every 4-6 hours as needed. Maximum daily dose: 1200 mg for over-the-counter (OTC) use; up to 3200 mg under medical supervision for inflammatory conditions, typically divided every 6-8 hours.
* **Inflammatory Conditions (e.g., rheumatoid arthritis):** 400-800 mg three to four times daily. Maximum daily dose: 3200 mg.
## Pediatric Dosing
* **Fever/Pain:** 5-10 mg/kg per dose every 6-8 hours.
* Maximum single dose: 400 mg.
* Maximum daily dose: 40 mg/kg or 2400 mg, whichever is less.
* For infants < 6 months, use is generally not recommended due to potential risks, consult with a pediatrician.
## Dose Adjustments
No specific dose adjustments are routinely recommended for renal or hepatic impairment, but caution and close monitoring are advised due to potential for organ toxicity. Higher doses are associated with increased risk.
## Contraindications
* Hypersensitivity to ibuprofen, aspirin, or other NSAIDs.
* History of bronchospasm, asthma, urticaria, or allergic-type reactions after taking NSAIDs or aspirin.
* Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery.
* Late pregnancy (third trimester).
## Adverse Effects
* **Common:** Nausea, vomiting, diarrhea, constipation, abdominal pain, dyspepsia, dizziness, headache.
* **Serious:** Gastrointestinal bleeding, ulceration, perforation; cardiovascular thrombotic events (myocardial infarction, stroke); renal failure; hepatic failure; hypersensitivity reactions (including anaphylaxis); bronchospasm.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Aspirin (low-dose):** May reduce the cardioprotective effect of aspirin.
* **Corticosteroids:** Increased risk of gastrointestinal bleeding and ulceration.
* **Diuretics:** Reduced diuretic effect and increased risk of nephrotoxicity.
* **Lithium:** Increased serum lithium levels and risk of toxicity.
* **Methotrexate:** Increased risk of methotrexate toxicity.
* **Other NSAIDs (including COX-2 inhibitors):** Increased risk of adverse effects.
## Monitoring
* **GI Bleeding/Ulceration:** Monitor for signs and symptoms (e.g., melena, hematemesis, abdominal pain).
* **Renal Function:** Monitor serum creatinine and BUN, especially in patients with pre-existing renal disease or those on long-term therapy.
* **Hepatic Function:** Monitor liver enzymes, especially in patients with liver disease.
* **Cardiovascular Risk:** Assess risk factors for cardiovascular events.
* **Blood Pressure:** NSAIDs can cause new-onset hypertension or exacerbate existing hypertension.
## Clinical Pearls
* Administer with food or milk to minimize gastrointestinal upset.
* Use the lowest effective dose for the shortest duration necessary to minimize risks.
* Be aware of the increased risk of cardiovascular and gastrointestinal events, particularly with higher doses and prolonged use.
* Ibuprofen can mask signs of infection.
* For pediatric use, ensure accurate weight-based dosing to avoid overdose.
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**Disclaimer:** This information is intended for educational purposes and does not substitute for professional medical advice. Always consult with a qualified healthcare provider and refer to the most current prescribing information for definitive guidance.
