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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 relief (mild to moderate)
* Fever reduction
* Inflammation reduction (e.g., arthritis)
* Patent ductus arteriosus (PDA) closure in neonates
## Adult Dosing
**Pain and Fever:**
* **Oral:** 200 mg to 400 mg every 4 to 6 hours as needed. Maximum daily dose is 1200 mg. For prescription strengths, up to 800 mg every 8 hours can be used, with a maximum daily dose of 3200 mg under medical supervision for specific inflammatory conditions.
* **Intravenous (IV):** 400 mg to 800 mg every 6 to 8 hours as needed. Maximum daily dose is 3200 mg.
**Inflammatory Conditions (e.g., Rheumatoid Arthritis):**
* **Oral:** 400 mg to 800 mg every 6 to 8 hours. Maximum daily dose is 3200 mg.
## Pediatric Dosing
**Fever and Pain (Oral):**
* Dosing is typically weight-based: 5 mg/kg to 10 mg/kg per dose every 6 to 8 hours.
* Do not exceed 40 mg/kg per day or 400 mg per dose.
* Infants < 6 months: Use with caution and under medical supervision due to potential risks.
**Patent Ductus Arteriosus (PDA) Closure (Intravenous):**
* **Premature Neonates:** A typical course consists of three doses.
* First dose: 10 mg/kg.
* Second and third doses: 5 mg/kg each, administered at 24-hour intervals after the first dose.
* Dosing may vary based on gestational age and postnatal age; consult specific neonatology protocols.
## Dose Adjustments
No dose adjustments are typically needed for renal or hepatic impairment in standard doses for pain and fever, but caution is advised, and lower doses may be considered in severe impairment. Higher doses for inflammatory conditions may require closer monitoring in these populations.
## Contraindications
* Hypersensitivity to ibuprofen, aspirin, or other NSAIDs.
* Active gastrointestinal bleeding or history of GI ulceration/perforation.
* Severe renal or hepatic impairment.
* Severe heart failure.
* Third trimester of pregnancy.
* Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery.
## Adverse Effects
* **Common:** Nausea, vomiting, diarrhea, abdominal pain, dyspepsia, dizziness, headache.
* **Serious:** Gastrointestinal bleeding/ulceration, renal toxicity, hepatic toxicity, cardiovascular events (MI, stroke), hypersensitivity reactions (including anaphylaxis and Stevens-Johnson syndrome), exacerbation of asthma.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin, heparin, DOACs):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **SSRIs/SNRIs:** Increased risk of GI bleeding.
* **Other NSAIDs/Aspirin:** Increased risk of adverse effects, especially GI.
* **ACE inhibitors/ARBs/Diuretics:** Reduced antihypertensive effect, increased risk of renal impairment.
* **Lithium/Methotrexate:** Increased serum levels and toxicity.
## Monitoring
* Signs and symptoms of GI bleeding (melena, hematemesis).
* Renal function (BUN, creatinine), especially in those with risk factors or on prolonged therapy.
* Liver function tests (LFTs), particularly with high-dose or prolonged use.
* Blood pressure.
* Signs of cardiovascular events.
## 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 adverse events.
* Caution in elderly patients and those with pre-existing cardiovascular, renal, or hepatic disease.
* IV formulations may be more rapidly absorbed and can lead to quicker symptom relief.
* For PDA closure, IV ibuprofen is generally preferred over indomethacin due to a potentially better safety profile in certain contexts, though efficacy can vary.
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*Disclaimer: This information is intended for clinical use and does not substitute for professional medical advice. Always verify current prescribing information and institutional protocols before administering medications.*
