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# Ibuprofen
## Overview
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that inhibits cyclooxygenase (COX) enzymes, reducing prostaglandin synthesis. It possesses analgesic, anti-inflammatory, and antipyretic properties.
## Primary Indications
* Pain (mild to moderate)
* Fever
* Inflammatory conditions (e.g., arthritis)
## Adult Dosing
* **Pain/Fever:** 200 mg to 400 mg every 4 to 6 hours as needed.
* **Inflammatory Conditions:** 400 mg to 800 mg three to four times daily.
* **Maximum Daily Dose:** 3200 mg. However, for over-the-counter use, the maximum daily dose is typically 1200 mg. Higher doses require prescription.
## Pediatric Dosing
Dosing is typically based on weight. **Always use an appropriate measuring device for liquid formulations.**
* **Fever/Pain:** 5 mg/kg to 10 mg/kg per dose orally every 6 to 8 hours.
* **Maximum dose:** 40 mg/kg/day or 400 mg per dose, whichever is less.
* For infants under 6 months, consult a pediatrician due to potential safety concerns.
## Dose Adjustments
* **Renal Impairment:** Use with caution. Consider a lower dose and monitor renal function.
* **Hepatic Impairment:** Use with caution. Consider a lower dose and monitor liver function.
## Contraindications
* Known 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.
* Advanced renal disease.
* Severe heart failure.
* Active gastrointestinal bleeding or ulceration.
## Adverse Effects
* **Common:** Nausea, vomiting, dyspepsia, abdominal pain, diarrhea, constipation, dizziness, headache.
* **Serious:** Gastrointestinal bleeding/perforation, myocardial infarction, stroke, renal failure, hepatic failure, hypersensitivity reactions (including anaphylaxis), bronchospasm, Stevens-Johnson syndrome.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin) and Antiplatelets (e.g., aspirin, clopidogrel):** Increased risk of bleeding.
* **ACE Inhibitors and ARBs:** Reduced antihypertensive effect and increased risk of renal impairment.
* **Diuretics:** Reduced diuretic and antihypertensive effects; increased risk of renal impairment.
* **Lithium:** Increased serum lithium levels.
* **Methotrexate:** Increased risk of methotrexate toxicity.
* **Other NSAIDs and Salicylates:** Increased risk of gastrointestinal adverse effects.
* **Corticosteroids:** Increased risk of gastrointestinal ulceration and bleeding.
## Monitoring
* Signs and symptoms of gastrointestinal bleeding (e.g., melena, hematemesis).
* Renal function (serum creatinine, BUN), especially in patients with pre-existing renal disease or those taking concomitant nephrotoxic agents.
* Liver function tests (LFTs), especially with prolonged use or in patients with liver disease.
* Blood pressure, particularly in patients treated for hypertension.
* Signs of cardiovascular events.
## Clinical Pearls
* Administer with food or milk to minimize gastrointestinal upset.
* Use the lowest effective dose for the shortest duration necessary to minimize risks.
* Patients with asthma may be at increased risk for bronchospasm.
* Risk of serious cardiovascular thrombotic events, myocardial infarction, and stroke may increase with dose and duration of use.
* Consider withholding ibuprofen in patients undergoing surgery, particularly CABG, until further clinical guidance is available.
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**Disclaimer:** This information is intended for healthcare professionals and is not a substitute for professional medical advice. Always consult the current prescribing information and relevant clinical guidelines before making treatment decisions.
