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# Ibuprofen
## Overview
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) used for its analgesic, anti-inflammatory, and antipyretic properties.
## Primary Indications
* Pain (mild to moderate)
* Fever
* Inflammatory conditions (e.g., rheumatoid arthritis, osteoarthritis)
* Dysmenorrhea
## Adult Dosing
* **Pain and Fever:** 200-400 mg every 4-6 hours as needed. Maximum daily dose: 1200 mg.
* **Inflammatory Conditions:** 400-800 mg every 6-8 hours as needed. Maximum daily dose: 2400 mg (under strict medical supervision).
* **Dysmenorrhea:** 200-400 mg every 4-6 hours as needed. Maximum daily dose: 1200 mg.
## Pediatric Dosing
Dosing is typically based on weight. Consult product labeling or local protocol for precise dosing.
* **Fever and Pain:** 5-10 mg/kg per dose every 6-8 hours. Maximum daily dose: 40 mg/kg or 2400 mg, whichever is less.
* **Juvenile Idiopathic Arthritis:** 30-50 mg/kg/day in divided doses every 6-8 hours. Maximum daily dose: 2400 mg.
## Dose Adjustments
No dose adjustment is typically required for renal or hepatic impairment, but caution is advised. Monitor closely for adverse effects.
## Contraindications
* Hypersensitivity to ibuprofen, aspirin, or other NSAIDs.
* History of bronchospasm, asthma, rhinitis, or urticaria after taking aspirin or other NSAIDs.
* Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery.
* Active gastrointestinal bleeding or perforation.
* Severe heart failure.
* Third trimester of pregnancy.
## Adverse Effects
* **Common:** Nausea, vomiting, diarrhea, constipation, dyspepsia, abdominal pain, headache, dizziness, rash.
* **Serious:** Gastrointestinal bleeding/ulceration, cardiovascular thrombotic events (MI, stroke), renal impairment/failure, hepatic impairment, hypersensitivity reactions, Stevens-Johnson syndrome/toxic epidermal necrolysis.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin) and Antiplatelets (e.g., aspirin, clopidogrel):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of gastrointestinal bleeding.
* **Diuretics and Antihypertensives (e.g., ACE inhibitors, ARBs):** May decrease their efficacy and increase risk of renal impairment.
* **Lithium:** Increased serum lithium levels.
* **Methotrexate:** Increased risk of methotrexate toxicity.
* **Other NSAIDs:** Additive adverse effects, particularly gastrointestinal and renal.
## Monitoring
* Signs and symptoms of gastrointestinal bleeding (e.g., melena, hematemesis).
* Renal function (BUN, creatinine), especially in patients with pre-existing renal disease or those at risk.
* Hepatic function (ALT, AST), particularly with long-term use or in patients with liver disease.
* Blood pressure.
* 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 to minimize risks.
* Avoid concomitant use with other NSAIDs, including aspirin (unless for cardiovascular prophylaxis and separated by several hours).
* Risk of cardiovascular events and gastrointestinal bleeding increases with duration of use and higher doses.
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**Disclaimer:** This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant clinical guidelines before making therapeutic decisions.
