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# Ibuprofen (Nurofen, Advil, Motrin)
## Overview
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) used for its analgesic, anti-inflammatory, and antipyretic properties.
## Primary Indications
* Pain relief (mild to moderate)
* Fever reduction
* Inflammation reduction (e.g., arthritis)
## Adult Dosing
* **Pain/Fever:** 200 mg to 400 mg orally every 4 to 6 hours as needed.
* **Inflammation:** 400 mg to 800 mg orally every 6 to 8 hours as needed.
* **Maximum Daily Dose:** 3200 mg orally. For over-the-counter (OTC) use, the maximum daily dose is typically 1200 mg.
## Pediatric Dosing
Dosing is weight-based and typically provided every 6 to 8 hours. Consult specific product labeling or local protocols for precise dosing. General guidelines:
* **Fever/Pain:** 5 mg/kg to 10 mg/kg per dose orally.
* **Maximum Daily Dose:** 40 mg/kg/day or 4000 mg/day, whichever is less.
* **Infants < 6 months:** Use is generally not recommended unless specifically advised by a healthcare provider.
## Dose Adjustments
* **Renal Impairment:** Use with caution. Severe renal impairment may require dose reduction or avoidance.
* **Hepatic Impairment:** Use with caution. Moderate to severe hepatic impairment may require dose reduction or avoidance.
## 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.
* Third trimester of pregnancy.
## Adverse Effects
* **Common:** Nausea, vomiting, diarrhea, constipation, abdominal pain, dizziness, headache.
* **Serious:** Gastrointestinal bleeding, ulceration, perforation; cardiovascular thrombotic events (MI, stroke); renal toxicity; hepatic toxicity; hypersensitivity reactions (including Stevens-Johnson syndrome/toxic epidermal necrolysis); exacerbation of asthma.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin) and Antiplatelets (e.g., aspirin, clopidogrel):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **Diuretics and Antihypertensives (e.g., ACE inhibitors, ARBs, beta-blockers):** May decrease efficacy and increase risk of renal toxicity.
* **Lithium:** Increased lithium levels.
* **Methotrexate:** Increased methotrexate levels and toxicity.
* **Selective Serotonin Reuptake Inhibitors (SSRIs):** Increased risk of GI bleeding.
## Monitoring
* **GI Symptoms:** Monitor for signs of bleeding (melena, hematemesis).
* **Renal Function:** Especially in patients with pre-existing renal disease, dehydration, or those taking concurrent nephrotoxic agents.
* **Hepatic Function:** Periodically, especially with long-term use or in patients with hepatic impairment.
* **Blood Pressure:** NSAIDs can increase blood pressure.
## Clinical Pearls
* Administer with food or milk to minimize GI upset.
* Use the lowest effective dose for the shortest duration necessary to minimize risks.
* Avoid concurrent use with other NSAIDs, including aspirin (unless low-dose aspirin for cardioprotection, taken at least 8 hours before or 30 minutes after ibuprofen).
* Consider gastroprotection (e.g., PPI) in patients at high risk for GI complications.
* Cardiovascular risk may be increased with higher doses and longer durations of use.
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*Disclaimer: This information is intended for healthcare professionals. It is essential to consult the most current prescribing information and institutional protocols before initiating therapy, as drug information can change.*
