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# Ibuprofen
## Overview
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that possesses analgesic, anti-inflammatory, and antipyretic properties. It is a racemic mixture of R- and S-enantiomers.
## Primary Indications
* Pain (mild to moderate)
* Fever
* Inflammation (e.g., rheumatoid arthritis, osteoarthritis)
* Dysmenorrhea
## Adult Dosing
* **Analgesia/Antipyresis:** 200 mg to 400 mg every 4 to 6 hours as needed.
* **Rheumatoid Arthritis/Osteoarthritis:** 300 mg to 800 mg three to four times daily.
* **Dysmenorrhea:** 200 mg to 400 mg every 4 to 6 hours as needed, or a single dose of 400 mg.
* **Maximum Daily Dose:** 3200 mg (though generally not recommended for chronic use due to increased risk of adverse events; often limited to 2400 mg for chronic inflammatory conditions).
## Pediatric Dosing
Dosing is typically based on weight. Always use the oral suspension for accurate dosing in young children.
* **Analgesia/Antipyresis:** 5 mg/kg to 10 mg/kg orally every 6 to 8 hours.
* **Maximum Pediatric Dose:** 40 mg/kg/day or 4000 mg/day, whichever is less.
* **Infants under 6 months:** Use is generally not recommended due to potential risks, unless specifically advised by a pediatrician.
## Dose Adjustments
No dose adjustment is typically required for renal or hepatic impairment, but caution is advised and lower doses may be considered, especially in patients with severe impairment. Ibuprofen can exacerbate existing renal dysfunction.
## Contraindications
* Hypersensitivity to ibuprofen, aspirin, or other NSAIDs.
* History of bronchospasm, asthma, rhinitis, urticaria, or other 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 ulcer disease.
* Severe heart failure, renal impairment (CrCl <30 mL/min), or hepatic impairment.
## Adverse Effects
* **Gastrointestinal:** Dyspepsia, nausea, abdominal pain, heartburn, diarrhea, constipation, peptic ulceration, GI bleeding, perforation.
* **Cardiovascular:** Increased risk of myocardial infarction, stroke, hypertension, edema.
* **Renal:** Renal insufficiency, acute kidney injury, interstitial nephritis.
* **Hematologic:** Anemia, bruising, prolonged bleeding time.
* **Dermatologic:** Rash, pruritus.
* **Other:** Headache, dizziness, tinnitus, hypersensitivity reactions.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin, rivaroxaban):** Increased risk of bleeding.
* **Aspirin (low-dose):** May reduce the cardioprotective effect of aspirin. Administer ibuprofen at least 30 minutes after aspirin or 8 hours before aspirin.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **Diuretics, ACE inhibitors, ARBs:** May reduce antihypertensive and diuretic effects; increased risk of renal impairment.
* **Lithium:** Increased serum lithium levels and risk of toxicity.
* **Methotrexate:** Increased risk of methotrexate toxicity.
## Monitoring
* **GI Symptoms:** Monitor for signs and symptoms of GI bleeding or ulceration.
* **Renal Function:** Monitor BUN, creatinine, and urine output, especially in patients with pre-existing renal disease or those receiving long-term therapy.
* **Cardiovascular Risk Factors:** Assess and manage blood pressure, especially in patients with a history of hypertension.
* **Liver Function:** Monitor LFTs if indicated, especially in patients with hepatic impairment or those on long-term therapy.
## Clinical Pearls
* Administer with food or milk to minimize GI upset.
* Use the lowest effective dose for the shortest duration necessary to minimize risks.
* The risk of serious cardiovascular thrombotic events, myocardial infarction, and stroke may increase with duration of use and in patients with existing cardiovascular risk factors.
* NSAIDs can cause serious skin adverse reactions such as exfoliative dermatitis, Stevens-Johnson syndrome, and toxic epidermal necrolysis. Discontinue ibuprofen at the first sign of rash or any other sign of hypersensitivity.
* Ibuprofen can inhibit platelet aggregation and prolong bleeding time.
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*Disclaimer: This information is intended for clinical use and does not replace professional medical advice. Always refer to the most current prescribing information and consult with a healthcare professional for patient-specific management.*
