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# Ibuprofen
## Overview
Ibuprofen is a non-steroidal anti-inflammatory drug (NSAID) that reduces inflammation, pain, and fever.
## Primary Indications
* Pain relief (mild to moderate)
* Fever reduction
* Inflammation (e.g., arthritis)
* Closure of patent ductus arteriosus in premature infants
## Adult Dosing
* **Pain/Fever:** 200-400 mg orally every 4-6 hours as needed. Maximum daily dose: 1200 mg for over-the-counter (OTC) use; up to 2400-3200 mg/day under medical supervision, depending on indication and patient factors.
* **Inflammation:** 400-800 mg orally 2-3 times daily. Maximum daily dose: 2400 mg (OTC); up to 3200 mg/day under medical supervision.
* **Intravenous (IV):** 400-800 mg every 4-6 hours. Maximum IV dose: 3200 mg/day.
## Pediatric Dosing
Dosing is typically based on weight. Consult product labeling or specific pediatric guidelines for precise dosing.
* **Pain/Fever:** 5-10 mg/kg/dose orally every 6-8 hours. Maximum daily dose: 40 mg/kg.
* **Patent Ductus Arteriosus (PDA):** Neonates (postnatal age < 32 weeks): 10 mg/kg IV on day 1, followed by 5 mg/kg IV on day 2 and day 3. Alternatively, a single dose of 10 mg/kg IV can be used. Specific protocols may vary.
## Dose Adjustments
* **Renal Impairment:** Use with caution. May require dose reduction in severe impairment.
* **Hepatic Impairment:** Use with caution. May require dose reduction in severe impairment.
## Contraindications
* Hypersensitivity to ibuprofen, aspirin, or other NSAIDs.
* History of bronchospasm, asthma, rhinitis, or urticaria following aspirin or NSAID use.
* Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery.
* Active gastrointestinal bleeding or history of GI ulceration/bleeding.
* Severe heart failure.
* Third trimester of pregnancy.
## Adverse Effects
Common: Gastrointestinal upset (nausea, vomiting, diarrhea, constipation), dizziness, headache.
Serious: Increased risk of cardiovascular thrombotic events (MI, stroke), gastrointestinal bleeding/perforation/ulceration, renal toxicity, hepatotoxicity, hypersensitivity reactions, exacerbation of asthma.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **SSRIs/SNRIs:** Increased risk of bleeding.
* **Other NSAIDs/Aspirin:** Increased risk of adverse effects, particularly GI bleeding.
* **ACE inhibitors, ARBs, beta-blockers:** May decrease antihypertensive effect and increase risk of renal impairment.
* **Diuretics:** May decrease diuretic efficacy and increase risk of renal impairment.
* **Lithium:** May increase lithium levels.
* **Methotrexate:** May increase methotrexate toxicity.
## Monitoring
* Renal function (serum creatinine, BUN)
* Liver function tests (AST, ALT)
* Hemoglobin/hematocrit (for signs of GI bleeding)
* Blood pressure (especially with higher doses or prolonged use)
* Signs and symptoms of cardiovascular events
* Signs and symptoms of GI bleeding or ulceration
## Clinical Pearls
* Administer with food or milk to minimize GI upset.
* Use the lowest effective dose for the shortest duration necessary to minimize risks.
* Avoid concomitant use with other NSAIDs or aspirin unless specifically indicated and managed.
* Consider gastroprotective agents (e.g., PPIs) in patients at increased risk for GI events.
* Be aware of the increased risk of cardiovascular events, especially with higher doses and prolonged use.
* Avoid in the third trimester of pregnancy due to risks of premature closure of the ductus arteriosus and other fetal effects.
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**Disclaimer:** This information is intended for healthcare professionals. Always consult the most current prescribing information or official guidelines for complete details before making any treatment decisions.
