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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 management (mild to moderate) * Inflammation (e.g., arthritis) * Fever reduction * Closure of patent ductus arteriosus (PDA) in premature infants ## Adult Dosing * **Pain/Inflammation:** 200-800 mg orally every 6-8 hours as needed. * Maximum daily dose: 3200 mg. Doses exceeding 2400 mg/day generally reserved for specific inflammatory conditions and require close monitoring. * **Rheumatoid Arthritis/Osteoarthritis:** 400-800 mg orally 3 times daily. * Maximum daily dose: 3200 mg. ## Pediatric Dosing Dosing varies significantly by indication and weight. **Always consult specific pediatric guidelines or product labeling.** * **Fever/Pain (Oral/Rectal):** * 3 months to 12 years: 5-10 mg/kg/dose every 6-8 hours. * Maximum daily dose: 40 mg/kg/day or 2400 mg/day, whichever is less. * **Note:** Generally not recommended for infants under 6 months of age without physician guidance. * **Closure of PDA (Intravenous):** * Premature infants (gestational age ≤ 30 weeks): A course of 3 doses. * Dose 1: 10 mg/kg * Doses 2 & 3 (given 24 and 48 hours after dose 1): 5 mg/kg each. * **Note:** Requires careful patient selection and monitoring. ## Dose Adjustments * **Renal Impairment:** Use with caution. Monitor renal function closely. Severe impairment may require dose reduction or avoidance. * **Hepatic Impairment:** Use with caution. May require dose reduction. * **Elderly:** Increased risk of adverse effects, particularly GI bleeding and renal dysfunction. Consider lower doses and shorter duration. ## Contraindications * Hypersensitivity to ibuprofen, aspirin, or other NSAIDs. * History of bronchospasm, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs. * Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery. * Third trimester of pregnancy. * Severe renal or hepatic impairment. * Active GI bleeding or ulceration. ## Adverse Effects * **Common:** Nausea, vomiting, dyspepsia, abdominal pain, diarrhea, constipation, dizziness, headache. * **Serious:** * Gastrointestinal: GI bleeding, ulceration, perforation. * Cardiovascular: Increased risk of myocardial infarction, stroke, and hypertension. * Renal: Renal failure, interstitial nephritis. * Hepatic: Hepatotoxicity. * Hypersensitivity reactions: Anaphylaxis, Stevens-Johnson syndrome, toxic epidermal necrolysis. * Hematologic: Anemia, prolonged bleeding time. ## Key Drug Interactions * **Anticoagulants (e.g., warfarin):** Increased risk of bleeding. * **Aspirin:** May diminish the cardioprotective antiplatelet effect of low-dose aspirin. Ibuprofen should be taken at least 8 hours before or 30 minutes after aspirin. * **Corticosteroids:** Increased risk of GI ulceration and bleeding. * **Diuretics:** May reduce diuretic efficacy and increase risk of renal toxicity. * **Lithium:** Increased lithium levels and toxicity. * **Methotrexate:** Increased risk of methotrexate toxicity. * **Other NSAIDs/Salicylates:** Increased risk of GI toxicity. ## Monitoring * **Renal function:** Especially in patients with pre-existing renal disease, dehydration, or concomitant nephrotoxic agents. * **Hepatic function:** Particularly with long-term use or in patients with liver disease. * **Blood pressure:** NSAIDs can increase blood pressure. * **Signs of GI bleeding:** Melena, hematemesis, abdominal pain. * **Bleeding time:** If co-administered with anticoagulants or in patients with bleeding disorders. ## Clinical Pearls * Use the lowest effective dose for the shortest duration necessary to minimize risks. * Administer with food or milk to reduce GI upset. * Consider PPI prophylaxis for patients at high risk of GI bleeding (e.g., elderly, history of ulcers, concomitant corticosteroids/anticoagulants). * Be aware of the black box warning regarding cardiovascular and GI risks. * In premature infants, strict criteria apply for PDA closure, and renal function must be closely monitored. --- *Disclaimer: This information is intended for healthcare professionals. Always consult the current prescribing information and relevant clinical guidelines for definitive guidance.*