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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)
* Inflammation
* Fever
## Adult Dosing
* **Analgesia/Antipyresis:** 200-400 mg every 4-6 hours as needed.
* **Anti-inflammatory:** 400-800 mg three to four times daily.
* **Maximum Daily Dose:** Generally 3200 mg, but lower limits (e.g., 2400 mg) are often recommended for chronic use or in certain patient populations. Individual dosing should be guided by clinical response and tolerability.
## Pediatric Dosing
Dosing is typically weight-based. Consult current pediatric dosing guidelines for precise recommendations.
* **Analgesia/Antipyresis:** 5-10 mg/kg/dose every 6-8 hours.
* **Maximum Daily Dose:** 40 mg/kg/day.
* **Infants < 6 months:** Use with caution and under medical supervision due to potential risks.
## Dose Adjustments
* **Renal Impairment:** Use with caution. Dose reduction may be necessary in severe renal impairment.
* **Hepatic Impairment:** Use with caution. Dose reduction may be necessary in severe hepatic impairment.
## Contraindications
* Hypersensitivity to ibuprofen, aspirin, or other NSAIDs.
* History of bronchospasm, asthma, rhinitis, urticaria, or angioedema 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
Common: Gastrointestinal upset (nausea, dyspepsia, diarrhea), dizziness, headache.
Serious: Cardiovascular thrombotic events (MI, stroke), GI bleeding, ulceration, perforation, renal toxicity, hepatotoxicity, hypersensitivity reactions, fluid retention, hypertension.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin) & Antiplatelets (e.g., aspirin, clopidogrel):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **ACE inhibitors, ARBs, Diuretics:** Decreased antihypertensive efficacy, increased risk of renal impairment.
* **Lithium:** Increased lithium levels.
* **Methotrexate:** Increased methotrexate toxicity.
* **Other NSAIDs/Salicylates:** Increased risk of adverse effects.
## Monitoring
* **Renal function:** Especially in patients with pre-existing renal disease, dehydration, or those on concomitant nephrotoxic agents.
* **Hepatic function:** Particularly with long-term use or in patients with liver disease.
* **Blood pressure:** NSAIDs can increase blood pressure.
* **Signs of GI bleeding:** Stool occult blood, abdominal pain.
* **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.
* Ibuprofen has a relatively shorter half-life compared to other NSAIDs, requiring more frequent dosing.
* Consider risk factors for GI bleeding (age >65, history of ulcers, concurrent anticoagulants/corticosteroids) and cardiovascular events.
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*Disclaimer: This information is for educational purposes only and does not substitute for professional medical advice. Always consult the most current prescribing information and your healthcare provider for any questions regarding medication use.*
