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# Ibuprofen
## Overview
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that reduces inflammation, pain, and fever.
## Primary Indications
* Pain (mild to moderate)
* Fever
* Inflammatory conditions (e.g., rheumatoid arthritis, osteoarthritis)
## Adult Dosing
* **Pain/Fever:** 200 mg to 400 mg orally every 4 to 6 hours as needed. Maximum daily dose: 1200 mg. For over-the-counter (OTC) use, the maximum is typically 1200 mg/day. Prescription doses may go up to 2400 mg/day under medical supervision for inflammatory conditions.
* **Inflammatory Conditions:** 400 mg to 800 mg orally three to four times daily. Maximum daily dose: 2400 mg (may be increased to 3200 mg in severe cases under strict medical supervision).
## Pediatric Dosing
Dosing is based on weight and age. Always use an appropriate measuring device for liquid formulations.
* **Fever/Pain (6 months to 12 years):** 5 mg/kg to 10 mg/kg orally every 6 to 8 hours.
* Maximum single dose: 40 mg/kg (not to exceed 2400 mg/day).
* Commonly available infant drops (50 mg/1.25 mL) and children's suspensions (100 mg/5 mL).
* **Premature Infants:** Not typically recommended due to potential for adverse effects (e.g., patent ductus arteriosus closure). Consult specific neonatology guidelines if considered.
* **Children under 6 months:** Safety and efficacy not established.
## Dose Adjustments
* **Renal Impairment:** Use with caution. Mild to moderate impairment may not require adjustment, but monitor closely. Avoid in severe renal impairment.
* **Hepatic Impairment:** Use with caution. Mild to moderate impairment may not require adjustment, but monitor closely. Avoid in severe hepatic impairment.
* **Elderly:** Increased risk of adverse effects, especially gastrointestinal bleeding and renal events. Consider lower doses and shorter durations.
## Contraindications
* Hypersensitivity to ibuprofen, aspirin, or other NSAIDs.
* History of bronchospasm, 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 ulceration.
* Severe heart failure.
* Third trimester of pregnancy.
## Adverse Effects
Common: Nausea, dyspepsia, heartburn, abdominal pain, diarrhea, constipation, dizziness, headache.
Serious: Gastrointestinal bleeding/perforation, myocardial infarction, stroke, renal failure, exacerbation of heart failure, anaphylaxis, Stevens-Johnson syndrome.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin, DOACs):** Increased risk of bleeding.
* **Antiplatelets (e.g., aspirin, clopidogrel):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of gastrointestinal ulceration and bleeding.
* **SSRIs/SNRIs:** Increased risk of bleeding.
* **Lithium:** Ibuprofen can decrease lithium clearance, leading to increased lithium levels.
* **Methotrexate:** Ibuprofen can decrease methotrexate clearance.
* **Diuretics & Antihypertensives:** May reduce their efficacy and increase risk of renal damage.
* **ACE Inhibitors/ARBs:** Increased risk of renal impairment.
## Monitoring
* Monitor for signs and symptoms of gastrointestinal bleeding (melena, hematemesis).
* Monitor renal function (BUN, creatinine), especially in patients with risk factors.
* Monitor blood pressure.
* Assess pain and fever relief.
## Clinical Pearls
* Administer with food or milk to minimize gastrointestinal upset.
* Use the lowest effective dose for the shortest duration necessary.
* Avoid concurrent use with other NSAIDs or aspirin unless specifically indicated and monitored.
* Risk of cardiovascular thrombotic events, myocardial infarction, and stroke may increase with dose and duration of use.
* Risk of renal papillary necrosis and other renal injury exists, especially with chronic use.
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**Disclaimer:** This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant clinical guidelines before making therapeutic decisions.
