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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)
* Inflammation
* Fever
## Adult Dosing
* **Pain/Inflammation:** 400 mg to 800 mg every 6 to 8 hours as needed. Maximum dose: 3200 mg/day.
* **Fever:** 200 mg to 400 mg every 4 to 6 hours as needed. Maximum dose: 1200 mg/day.
## Pediatric Dosing
Dosing is typically weight-based. Consult specific product labeling or institutional guidelines as recommendations can vary.
* **Fever/Pain:** Generally 5 mg/kg to 10 mg/kg per dose orally every 6 to 8 hours.
* Maximum dose: 40 mg/kg/day (or 2400 mg/day, whichever is less).
* For infants < 6 months, use is generally not recommended due to potential risks, consult with a pediatrician.
## Dose Adjustments
No specific dose adjustments are generally required for hepatic or renal impairment, but caution is advised, especially in severe impairment. Patients with severe renal impairment may require lower doses or discontinuation.
## Contraindications
* Hypersensitivity to ibuprofen, aspirin, or other NSAIDs.
* History of asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs.
* Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery.
## Adverse Effects
Common: Nausea, vomiting, diarrhea, constipation, abdominal pain, dizziness, headache.
Serious: Gastrointestinal bleeding, ulceration, perforation, cardiovascular thrombotic events (MI, stroke), hypertension, renal toxicity, hepatotoxicity, hypersensitivity reactions.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Aspirin (low-dose):** May reduce the cardioprotective effect of aspirin. Separate administration by at least 2 hours.
* **Diuretics, ACE Inhibitors, ARBs:** May reduce antihypertensive effect and increase risk of renal toxicity.
* **Lithium, Methotrexate:** Increased serum levels and toxicity.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
## Monitoring
* Signs and symptoms of GI bleeding (melena, hematemesis).
* Blood pressure.
* Renal function (BUN, creatinine), especially in patients with pre-existing renal disease or risk factors.
* Liver function tests if indicated.
## Clinical Pearls
* Administer with food or milk to minimize GI upset.
* Use the lowest effective dose for the shortest duration necessary to reduce the risk of serious adverse events.
* Caution in elderly patients, those with heart failure, renal impairment, or history of GI ulceration.
* For pediatric fever, the 10 mg/kg dose is generally more effective for reducing fever compared to the 5 mg/kg dose.
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**Disclaimer:** This information is intended for healthcare professionals. Always consult the most current prescribing information and institutional protocols before making any clinical decisions.
