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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
* Pain management (mild to moderate)
* Fever reduction
* Inflammatory conditions (e.g., rheumatoid arthritis, osteoarthritis)
* Patent ductus arteriosus (PDA) in premature infants
## Adult Dosing
* **Analgesia/Antipyresis:** 200 mg to 400 mg every 4 to 6 hours as needed. Maximum dose: 1200 mg/day for over-the-counter (OTC) use; up to 3200 mg/day under medical supervision for specific conditions.
* **Inflammatory Conditions:** 400 mg to 800 mg three to four times daily. Maximum dose: 3200 mg/day.
## Pediatric Dosing
* **Analgesia/Antipyresis:**
* **Oral:** 5 mg/kg/dose every 6 to 8 hours for fever/pain, or 10 mg/kg/dose every 6 to 8 hours for inflammation.
* **Maximum pediatric oral dose:** Generally 40 mg/kg/day.
* **Rectal:** Dosing varies by age and weight; consult specific product labeling or institutional guidelines.
* **Patent Ductus Arteriosus (Neonates):** Typically given as a course of 3 doses intravenously. Dosing is weight-based and dependent on gestational age and postnatal age. Standard initial dose is 10 mg/kg, followed by 5 mg/kg doses 24 and 48 hours later. Specific protocols may vary; consult neonatology guidelines.
## Dose Adjustments
No dose adjustment is typically required for renal or hepatic impairment unless severe. Use with caution and consider lower doses in elderly patients and those with pre-existing renal or hepatic disease.
## Contraindications
* Hypersensitivity to ibuprofen, aspirin, or other NSAIDs.
* History of bronchospasm, asthma, rhinitis, or urticaria with prior NSAID use.
* Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery.
* Active gastrointestinal bleeding or ulceration.
* Severe heart failure, renal failure, or hepatic failure.
## Adverse Effects
Common: Nausea, vomiting, diarrhea, constipation, abdominal pain, dyspepsia, dizziness, headache.
Serious: Gastrointestinal bleeding, ulceration, perforation; renal toxicity; cardiovascular thrombotic events (myocardial infarction, stroke); hypersensitivity reactions; hepatic failure; Stevens-Johnson syndrome/toxic epidermal necrolysis.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin, heparin, DOACs):** Increased risk of bleeding.
* **Aspirin:** May reduce the cardioprotective effect of low-dose aspirin; increased risk of GI adverse effects.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **Diuretics and antihypertensives:** May decrease efficacy and increase risk of nephrotoxicity.
* **Lithium:** Increased lithium levels and toxicity.
* **Methotrexate:** Increased methotrexate levels and toxicity.
* **Other NSAIDs:** Increased risk of adverse effects.
## Monitoring
* Signs and symptoms of GI bleeding or ulceration.
* Renal function (BUN, creatinine) especially in patients with risk factors.
* Hepatic function (LFTs) especially with long-term use or pre-existing liver disease.
* Blood pressure, particularly in patients taking antihypertensives.
* Signs of cardiovascular events.
## Clinical Pearls
* Administer with food or milk to minimize gastric upset.
* Use the lowest effective dose for the shortest duration necessary to minimize risk of serious adverse effects.
* Caution in patients with dehydration, heart failure, hypertension, asthma, or a history of GI disease.
* Ibuprofen's onset of action for pain relief is typically within 30 minutes to 1 hour.
* Maximum daily dose for pediatric patients should not exceed 40 mg/kg/day.
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**Disclaimer:** This information is intended for healthcare professionals and does not replace the need to consult the official prescribing information and other relevant medical literature before making any clinical decisions. Always verify current dosing and safety information.
