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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
* Mild to moderate pain (e.g., headache, dental pain, menstrual cramps, muscle aches)
* Fever
* Inflammatory conditions (e.g., arthritis)
## Adult Dosing
* **Pain and Fever:** 200 mg to 400 mg orally every 4 to 6 hours as needed.
* **Maximum Daily Dose:** 1200 mg per day for over-the-counter (OTC) use. Prescription doses can be higher under medical supervision, up to 3200 mg per day in divided doses for severe inflammatory conditions, but this requires careful risk-benefit assessment due to increased GI and cardiovascular risks.
* **Arthritis:** 400 mg to 800 mg orally 2 to 3 times daily. Maximum daily dose is typically 2400 mg to 3200 mg.
## Pediatric Dosing
* **Fever and Pain:** 5 mg/kg to 10 mg/kg orally every 6 to 8 hours.
* **Maximum Pediatric Dose:** 40 mg/kg per day.
* **Infants:** Generally not recommended for infants < 6 months of age due to potential risks, unless specifically advised by a healthcare provider.
* **Formulations:** Available as oral suspension (e.g., 100 mg/5 mL), chewable tablets, and infant drops (e.g., 50 mg/1.25 mL). Dosing must be precise based on the specific product concentration.
## Dose Adjustments
No specific dose adjustments are typically required for hepatic or renal impairment, but caution is advised, especially in severe dysfunction, due to NSAID-related risks (e.g., fluid retention, renal toxicity). Dose should be the lowest effective dose for the shortest duration necessary.
## 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.
* Active gastrointestinal bleeding or ulceration.
* Severe heart failure.
* Late third trimester of pregnancy.
## Adverse Effects
* **Common:** Nausea, vomiting, dyspepsia, abdominal pain, diarrhea, constipation, dizziness, headache.
* **Serious:** Gastrointestinal bleeding, ulceration, perforation; cardiovascular thrombotic events (myocardial infarction, stroke); renal toxicity (including acute kidney injury); fluid retention and edema; exacerbation of hypertension; hypersensitivity reactions; Stevens-Johnson syndrome/toxic epidermal necrolysis.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin, direct oral anticoagulants):** Increased risk of bleeding.
* **Aspirin (low-dose):** May diminish the cardioprotective effect of aspirin; increased risk of GI adverse effects.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **Diuretics and Antihypertensives (e.g., ACE inhibitors, ARBs, beta-blockers):** May decrease their efficacy; increased risk of nephrotoxicity and hyperkalemia.
* **Lithium:** Increased lithium levels and risk of toxicity.
* **Methotrexate:** Increased methotrexate levels and risk of toxicity.
* **Selective Serotonin Reuptake Inhibitors (SSRIs):** Increased risk of GI bleeding.
## Monitoring
* Signs and symptoms of GI bleeding (e.g., melena, hematemesis, abdominal pain).
* Renal function (BUN, creatinine), particularly in patients with pre-existing renal disease, dehydration, or those on concomitant nephrotoxic agents.
* Blood pressure, especially in patients with hypertension.
* Signs of fluid retention (e.g., edema).
* Signs and symptoms 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, particularly GI and cardiovascular events.
* Consider gastroprotective agents (e.g., PPIs) for patients at high risk of GI complications.
* In children, use the appropriate weight-based dosing and specific pediatric formulation to ensure accuracy.
* Avoid concurrent use with other NSAIDs.
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*Please verify the most current prescribing information and local protocols before initiating or modifying therapy.*
