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# Ibuprofen
## Overview
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) used for pain relief, fever reduction, and inflammation management.
## Primary Indications
* Mild to moderate pain (e.g., headache, dental pain, menstrual cramps, muscle aches)
* Fever
* Inflammation associated with conditions like arthritis
## Adult Dosing
* **Pain and Fever:** 200-400 mg every 4-6 hours as needed. Maximum daily dose: 1200 mg (over-the-counter) or 3200 mg (prescription, under medical supervision).
* **Inflammation (e.g., arthritis):** 400-800 mg every 6-8 hours. Maximum daily dose: 3200 mg (prescription, under medical supervision).
## Pediatric Dosing
Dosing is typically based on weight.
* **Pain and Fever:** 5-10 mg/kg/dose every 6-8 hours. Do not exceed 40 mg/kg/day or the adult maximum daily dose.
* Specific dosing for infants under 6 months is not well-established and should be used with caution and under medical guidance.
## Dose Adjustments
* No specific dose adjustment is required for renal or hepatic impairment, but caution is advised. Monitor patients for signs of organ toxicity.
## 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 history of peptic ulcer disease.
* Severe renal or hepatic impairment.
* Severe heart failure.
## Adverse Effects
* **Common:** Nausea, vomiting, dyspepsia, heartburn, diarrhea, constipation, abdominal pain, dizziness, headache.
* **Serious:** Gastrointestinal bleeding, ulceration, perforation; cardiovascular thrombotic events (MI, stroke); renal failure; hepatic failure; hypersensitivity reactions (including anaphylaxis); bronchospasm; Stevens-Johnson syndrome/toxic epidermal necrolysis.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **Other NSAIDs (including aspirin):** Increased risk of GI, renal, and cardiovascular adverse effects.
* **ACE inhibitors, ARBs, diuretics:** May reduce antihypertensive effect and increase risk of renal impairment.
* **Lithium:** Increased lithium levels and toxicity.
* **Methotrexate:** Increased methotrexate toxicity.
## Monitoring
* **GI symptoms:** Watch for signs of bleeding (melena, hematemesis) or ulceration.
* **Renal function:** Monitor BUN, creatinine, especially in patients with pre-existing renal disease or those on other nephrotoxic agents.
* **Hepatic function:** Monitor LFTs if used long-term or in patients with liver disease.
* **Blood pressure:** NSAIDs can increase blood pressure.
* **Cardiovascular risk:** Assess for signs of MI or stroke.
## Clinical Pearls
* Ibuprofen should be taken with food or milk to minimize gastrointestinal upset.
* The lowest effective dose should be used for the shortest duration necessary.
* Ibuprofen carries a boxed warning for cardiovascular and gastrointestinal risks.
* Use in elderly patients, those with pre-existing cardiovascular disease, or those on anticoagulants requires increased caution.
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*Disclaimer: This information is for educational purposes only and does not constitute medical advice. Always consult with a qualified healthcare professional and refer to the most current prescribing information for any medication.*
