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# Ibuprofen
## Overview
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that provides analgesic, anti-inflammatory, and antipyretic effects. It works by inhibiting cyclooxygenase (COX) enzymes, thus reducing prostaglandin synthesis.
## Primary Indications
* Pain (mild to moderate)
* Fever
* Inflammation associated with conditions like arthritis and dysmenorrhea
## Adult Dosing
* **Analgesia/Antipyresis:** 200 mg to 400 mg every 4 to 6 hours as needed.
* **Rheumatoid Arthritis/Osteoarthritis:** 400 mg to 800 mg three to four times daily.
* **Maximum Daily Dose:** 3200 mg. However, for over-the-counter (OTC) use, the maximum is typically 1200 mg per day. Prescription doses exceeding 1200 mg/day should be used with caution and for the shortest duration necessary.
## Pediatric Dosing
* **Fever/Pain:** 5 mg/kg/dose every 6 to 8 hours for children 6 months to 12 years.
* **Inflammatory Conditions:** 10 mg/kg/dose every 6 to 8 hours for children 6 months to 12 years.
* **Maximum Daily Dose:** 40 mg/kg or 4000 mg per day, whichever is less.
* **Infants younger than 6 months:** Use is generally not recommended due to potential risks, but may be considered in specific clinical situations under physician guidance.
## Dose Adjustments
* **Renal Impairment:** Use with caution. Dose reduction may be necessary in severe impairment.
* **Hepatic Impairment:** Use with caution. Dose reduction may be necessary in severe impairment.
* **Elderly:** Increased risk of adverse effects; consider lower doses.
## 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.
* Third trimester of pregnancy.
## Adverse Effects
* **Common:** Nausea, dyspepsia, abdominal pain, constipation, diarrhea, rash, dizziness.
* **Serious:** Gastrointestinal bleeding, ulceration, perforation; cardiovascular thrombotic events (MI, stroke); renal failure; hepatic failure; anaphylaxis; Stevens-Johnson syndrome.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin, heparin, DOACs):** Increased risk of bleeding.
* **Aspirin (low-dose):** May diminish the cardioprotective effect of aspirin.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **Diuretics, ACE inhibitors, ARBs:** May reduce antihypertensive effect and increase risk of renal toxicity.
* **Lithium:** Increased lithium levels and risk of toxicity.
* **Methotrexate:** Increased methotrexate levels and risk of toxicity.
* **SSRIs/SNRIs:** Increased risk of GI bleeding.
## Monitoring
* **Signs and symptoms of GI bleeding/ulceration:** (e.g., melena, hematemesis, abdominal pain).
* **Renal function:** Especially in patients with pre-existing renal disease, dehydration, or those on concomitant nephrotoxic agents.
* **Liver function:** Especially with long-term use or in patients with hepatic impairment.
* **Blood pressure:** NSAIDs can cause or worsen hypertension.
## Clinical Pearls
* Administer with food or milk to minimize GI upset.
* Use the lowest effective dose for the shortest duration necessary to minimize risks.
* Patients with risk factors for GI bleeding (e.g., history of ulcers, concurrent anticoagulant use) should be carefully assessed.
* Consider gastroprotection (e.g., PPI) for patients at high risk of GI complications.
* Avoid in patients with heart failure unless benefit outweighs risk, and use with caution.
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*This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant clinical guidelines before making treatment decisions.*
