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# Ibuprofen
## Overview
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that reduces inflammation, pain, and fever.
## Primary Indications
* Pain relief (mild to moderate)
* Fever reduction
* Inflammation reduction
## Adult Dosing
* **Pain/Fever:** 200-400 mg orally every 4-6 hours as needed. Maximum dose: 1200 mg/day without medical supervision. Higher doses (up to 2400-3200 mg/day in divided doses) may be used under medical supervision for inflammatory conditions.
* **Inflammatory Conditions (e.g., Rheumatoid Arthritis):** 400-800 mg orally 2-4 times daily. Maximum dose: 3200 mg/day.
## Pediatric Dosing
Dosing is typically based on weight. Consult specific pediatric guidelines or protocols for precise dosing.
* **Fever/Pain:** 5-10 mg/kg orally every 6-8 hours. Maximum dose: 40 mg/kg/day or 400 mg/day, whichever is less.
* **Kawasaki Disease (various protocols exist):** Dosing varies widely based on phase of treatment. Consult specific guidelines.
## Dose Adjustments
* **Renal Impairment:** Use with caution. Mild to moderate impairment may not require dose adjustment, but monitor renal function. Severe impairment generally contraindicates use.
* **Hepatic Impairment:** Use with caution. Monitor liver function.
* **Elderly:** Increased risk of adverse effects; use lowest effective dose.
## Contraindications
* Hypersensitivity to ibuprofen, aspirin, or other NSAIDs
* Active gastrointestinal bleeding or ulceration
* History of GI bleeding or perforation related to prior NSAID use
* Severe heart failure, renal impairment, or hepatic impairment
* Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery
## Adverse Effects
* **Common:** Nausea, vomiting, dyspepsia, diarrhea, constipation, dizziness, headache.
* **Serious:** Gastrointestinal bleeding/perforation, cardiovascular thrombotic events (myocardial infarction, stroke), renal toxicity, hepatic toxicity, hypersensitivity reactions, bronchospasm (especially in aspirin-sensitive asthma).
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin) and Antiplatelets (e.g., aspirin, clopidogrel):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **ACE Inhibitors and ARBs:** May reduce antihypertensive effect and increase risk of renal impairment.
* **Diuretics:** May reduce diuretic and antihypertensive effects; increased risk of renal toxicity.
* **Lithium:** May increase lithium levels.
* **Methotrexate:** May increase methotrexate toxicity.
## Monitoring
* Signs and symptoms of GI bleeding (e.g., melena, hematemesis).
* Renal function (e.g., serum creatinine, BUN), especially in patients with risk factors.
* Liver function, especially with long-term use or in patients with hepatic impairment.
* Blood pressure.
## 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 increases with dose and duration of use.
* Avoid concurrent use with other NSAIDs.
* In pediatric populations, ensure accurate weight-based dosing.
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Please verify current prescribing information and consult with a qualified healthcare professional for specific patient management decisions.
