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# Ibuprofen
## Overview
Ibuprofen is a non-steroidal anti-inflammatory drug (NSAID) with analgesic, anti-inflammatory, and antipyretic properties.
## Primary Indications
* Mild to moderate pain (e.g., headache, dental pain, menstrual cramps, muscle aches).
* Fever reduction.
* Inflammation associated with conditions like rheumatoid arthritis and osteoarthritis.
## Adult Dosing
* **Analgesia/Antipyresis:** 200 mg to 400 mg orally every 4 to 6 hours as needed. Maximum daily dose: 1200 mg.
* **Inflammation (Rheumatoid Arthritis, Osteoarthritis):** 400 mg to 800 mg orally twice to three times daily. Maximum daily dose: 3200 mg (typically under specialist supervision for higher doses).
## Pediatric Dosing
Dosing is weight-based. Always calculate based on current weight.
* **Analgesia/Antipyresis:** 5 mg/kg to 10 mg/kg orally every 6 to 8 hours as needed.
* Maximum dose for children under 12 years: 40 mg/kg/day or 2400 mg/day, whichever is less.
* For children 12 years and older: follow adult dosing and maximums.
## Dose Adjustments
No dose adjustment is typically required for renal or hepatic impairment, but caution is advised, and the lowest effective dose should be used. Monitor for signs of toxicity.
## Contraindications
* Known hypersensitivity to ibuprofen, aspirin, or other NSAIDs.
* History of bronchospasm, asthma, rhinitis, or urticaria following NSAID or aspirin use.
* Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery.
* Active gastrointestinal bleeding or a history of GI bleeding/perforation related to prior NSAID use.
* Severe heart failure.
* Third trimester of pregnancy.
## Adverse Effects
Common adverse effects include nausea, vomiting, dyspepsia, abdominal pain, diarrhea, constipation, headache, dizziness, and rash. Serious adverse effects include gastrointestinal bleeding and perforation, myocardial infarction, stroke, renal toxicity, and hypersensitivity reactions.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin) and Antiplatelets (e.g., aspirin, clopidogrel):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of gastrointestinal ulceration and bleeding.
* **Diuretics and Antihypertensives (e.g., ACE inhibitors, ARBs, beta-blockers):** May reduce antihypertensive effect and increase risk of renal impairment.
* **Lithium:** May increase lithium levels and toxicity.
* **Methotrexate:** May increase methotrexate levels and toxicity.
* **Selective Serotonin Reuptake Inhibitors (SSRIs):** Increased risk of gastrointestinal bleeding.
## Monitoring
* Monitor for signs and symptoms of gastrointestinal bleeding (e.g., melena, hematemesis).
* Monitor renal function (BUN, creatinine) especially in patients with pre-existing renal disease or those at risk.
* Monitor blood pressure, particularly when used concurrently with antihypertensives.
* Assess for signs of cardiovascular events.
## Clinical Pearls
* Administer with food or milk to minimize gastrointestinal upset.
* Use the lowest effective dose for the shortest duration necessary to minimize risks.
* Consider gastroprotective agents (e.g., PPIs) for patients at high risk of GI complications.
* Avoid in patients with significant cardiovascular disease or risk factors unless benefits outweigh risks.
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*Disclaimer: This information is intended for healthcare professionals and does not replace current prescribing information. Always verify the most up-to-date drug information with official product labeling or reliable clinical resources before making prescribing decisions.*
