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# Ibuprofen
## Overview
Ibuprofen is a non-steroidal anti-inflammatory drug (NSAID) used for its analgesic, anti-inflammatory, and antipyretic properties.
## Primary Indications
* Pain relief (mild to moderate)
* Fever reduction
* Inflammation associated with conditions like arthritis, dysmenorrhea, and musculoskeletal injuries.
## Adult Dosing
* **Pain/Fever:** 200 mg to 400 mg orally every 4 to 6 hours as needed.
* **Inflammation:** 400 mg to 800 mg orally three times daily.
* **Maximum Daily Dose:** 3200 mg for adults. However, doses exceeding 1200 mg daily are typically reserved for specific inflammatory conditions under close medical supervision.
## Pediatric Dosing
Dosing is based on weight.
* **Fever/Pain:** 5 mg/kg to 10 mg/kg orally every 6 to 8 hours.
* **Maximum Single Dose:** 40 mg/kg or 400 mg, whichever is less.
* **Maximum Daily Dose:** 40 mg/kg, not to exceed 2400 mg (for children over 12 years, adult maximum applies).
* **Infants < 6 months:** Use with caution and only under medical guidance. Specific dosing is often protocol-dependent.
## Dose Adjustments
No specific dose adjustments are typically required for renal or hepatic impairment, but caution is advised, and the lowest effective dose should be used.
## Contraindications
* Known hypersensitivity to ibuprofen or other NSAIDs.
* History of bronchospasm, asthma, rhinitis, or urticaria following aspirin or other NSAID use.
* Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery.
* Third trimester of pregnancy.
* Active gastrointestinal bleeding or ulceration.
## Adverse Effects
* **Common:** Nausea, dyspepsia, heartburn, abdominal pain, diarrhea, constipation, dizziness, headache.
* **Serious:** Gastrointestinal bleeding/perforation, myocardial infarction, stroke, renal failure, hepatic dysfunction, hypersensitivity reactions (including anaphylaxis and severe skin reactions), fluid retention, edema.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of gastrointestinal ulceration and bleeding.
* **SSRIs/SNRIs:** Increased risk of bleeding.
* **ACE inhibitors, ARBs, Beta-blockers, Diuretics:** Can reduce antihypertensive effect and increase risk of renal impairment.
* **Lithium, Methotrexate:** Increased serum levels and toxicity.
## 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.
* Liver function tests, particularly with prolonged use or in patients with hepatic impairment.
* Blood pressure, especially in patients with hypertension.
## Clinical Pearls
* Administer with food or milk to minimize gastrointestinal upset.
* Use the lowest effective dose for the shortest duration necessary to minimize risks.
* Caution in patients with cardiovascular disease, hypertension, history of GI disease, renal or hepatic impairment, or those taking anticoagulants.
* May mask signs of infection.
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*Please consult the most current prescribing information for detailed guidance. This information is not a substitute for professional medical advice.*
