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# Ibuprofen
## Overview
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) used for pain relief, fever reduction, and inflammation management.
## Primary Indications
* Pain (mild to moderate)
* Fever
* Inflammation (e.g., arthritis)
* Ductus arteriosus closure in premature infants
## Adult Dosing
* **Pain/Fever:** 200-400 mg every 4-6 hours as needed. Maximum daily dose: 1200 mg (OTC); 3200 mg (prescription, under medical supervision).
* **Inflammation:** 400-800 mg every 6-8 hours. Maximum daily dose: 3200 mg (prescription, under medical supervision).
* **Ductus Arteriosus Closure (Premature Infants):** Dosing varies significantly based on gestational age and postnatal age. A typical course involves three doses administered intravenously:
* Initial dose: 10 mg/kg
* Subsequent doses (24 and 48 hours later): 5 mg/kg each
## Pediatric Dosing
* **Pain/Fever:** 5-10 mg/kg/dose every 6-8 hours. Maximum daily dose: 40 mg/kg, not to exceed the adult maximum.
* Infants 6 months and older: 5-10 mg/kg/dose every 6-8 hours.
* Dosing in neonates and infants <6 months should be carefully considered and often reserved for specific indications due to potential renal and GI risks.
## Dose Adjustments
* **Renal Impairment:** Use with caution. May require dose reduction and increased monitoring, especially in severe impairment.
* **Hepatic Impairment:** Use with caution. May require dose reduction and increased monitoring.
## Contraindications
* Hypersensitivity to ibuprofen, aspirin, or other NSAIDs.
* History of bronchospasm, asthma, rhinitis, or urticaria precipitated by aspirin or other NSAIDs.
* Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery.
* Severe renal, hepatic, or cardiac impairment.
* Active gastrointestinal bleeding or ulcer disease.
* Third trimester of pregnancy.
## Adverse Effects
* **Common:** Nausea, vomiting, dyspepsia, heartburn, abdominal pain, dizziness, headache.
* **Serious:** Gastrointestinal bleeding/ulceration, cardiovascular thrombotic events (MI, stroke), renal toxicity, hepatotoxicity, hypersensitivity reactions (including anaphylaxis), Stevens-Johnson syndrome/toxic epidermal necrolysis.
## 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:** Reduced antihypertensive effect; increased risk of renal impairment.
* **Diuretics:** Reduced diuretic effect; increased risk of renal impairment.
* **Lithium & Methotrexate:** Increased serum levels and toxicity.
* **Other NSAIDs/Salicylates:** Increased risk of adverse effects, particularly GI.
## Monitoring
* **Renal function:** Monitor serum creatinine and BUN, especially in patients with pre-existing renal disease, dehydration, or those on concomitant nephrotoxic agents.
* **Hepatic function:** Monitor LFTs, especially in patients with liver disease.
* **Signs of GI bleeding:** Monitor for melena, hematemesis, abdominal pain.
* **Blood pressure:** NSAIDs can cause or exacerbate hypertension.
* **For Ductus Arteriosus Closure:** Monitor urine output, fluid status, and renal function.
## Clinical Pearls
* Administer with food or milk to minimize GI upset.
* The lowest effective dose should be used for the shortest duration necessary to minimize risks.
* NSAIDs can mask signs of infection.
* Caution is advised in elderly patients due to increased risk of adverse effects.
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*Please verify the most current prescribing information and institutional protocols for definitive guidance.*
