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# Ibuprofen
## Overview
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that exhibits analgesic, anti-inflammatory, and antipyretic properties. It works by inhibiting cyclooxygenase (COX) enzymes, thereby reducing prostaglandin synthesis.
## Primary Indications
* Pain relief (mild to moderate)
* Fever reduction
* Inflammation associated with conditions like arthritis, gout, and dysmenorrhea
## Adult Dosing
* **Analgesia/Antipyresis:** 200 mg to 400 mg orally every 4 to 6 hours as needed. Maximum daily dose is 1200 mg for over-the-counter (OTC) use. Prescription doses can go up to 2400 mg to 3200 mg per day in divided doses for specific inflammatory conditions, under medical supervision.
* **Rheumatoid Arthritis/Osteoarthritis:** 400 mg to 800 mg orally three to four times daily. Maximum daily dose generally 2400 mg, but may be increased to 3200 mg under specialist care.
* **Dysmenorrhea:** 200 mg to 400 mg orally every 4 to 6 hours as needed.
## Pediatric Dosing
Dosing is weight-based.
* **Analgesia/Antipyresis:** 5 mg/kg to 10 mg/kg orally every 6 to 8 hours.
* Maximum dose: 40 mg/kg/day or 400 mg per dose.
* For children < 6 months of age, consult a pediatrician.
## Dose Adjustments
No dose adjustment is typically required for renal or hepatic impairment, but caution is advised. Monitor patients closely for adverse effects.
## 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.
* Known hypersensitivity to any component of the formulation.
* Active gastrointestinal (GI) bleeding or ulceration.
## Adverse Effects
Common adverse effects include GI upset (nausea, vomiting, dyspepsia, abdominal pain), dizziness, and headache. More serious adverse effects include GI bleeding, perforation, cardiovascular thrombotic events, myocardial infarction, stroke, renal toxicity, and hypersensitivity reactions.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Aspirin:** May decrease the cardioprotective effect of low-dose aspirin.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **Diuretics, ACE inhibitors, ARBs:** May decrease antihypertensive effect and increase risk of renal toxicity.
* **Lithium:** Increased lithium levels.
* **Methotrexate:** Increased risk of methotrexate toxicity.
## Monitoring
* Monitor for signs and symptoms of GI bleeding (e.g., melena, hematemesis).
* Assess for cardiovascular and renal effects, especially with prolonged use or in patients with risk factors.
* Monitor blood pressure.
## Clinical Pearls
* Administer with food or milk to minimize GI upset.
* Use the lowest effective dose for the shortest duration necessary to minimize risks.
* Consider alternative analgesics if a patient has a history of GI ulcers or bleeding.
* Avoid in patients with severe heart failure, severe renal impairment, or severe hepatic impairment.
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*Disclaimer: This information is intended for educational purposes and does not substitute for professional medical advice. Always consult with a qualified healthcare provider for diagnosis and treatment. Verify current prescribing information and patient-specific factors before making any treatment decisions.*
