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# Ibuprofen
## Overview
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that possesses analgesic, anti-inflammatory, and antipyretic properties. It inhibits cyclooxygenase (COX) enzymes, thereby reducing prostaglandin synthesis.
## Primary Indications
* Mild to moderate pain
* Fever
* Inflammatory conditions (e.g., rheumatoid arthritis, osteoarthritis)
## Adult Dosing
* **Analgesia/Antipyresis:** 200 mg to 400 mg every 4 to 6 hours as needed. Maximum daily dose: 1200 mg.
* **Inflammation:** 400 mg to 800 mg every 6 to 8 hours. Maximum daily dose: 3200 mg (under close medical supervision for specific conditions).
## Pediatric Dosing
Dosing is typically weight-based. Always refer to specific pediatric dosing guidelines or a reliable pediatric drug reference.
* **Fever/Pain:** 5 mg/kg to 10 mg/kg orally every 6 to 8 hours.
* Maximum single dose: 40 mg/kg or 400 mg (whichever is less).
* Maximum daily dose: 40 mg/kg or 2400 mg (whichever is less), not to exceed adult maximums.
* **Kawasaki Disease:** Dosing varies significantly based on the phase of illness and treatment goals; consult specific protocols.
## Dose Adjustments
No specific dose adjustments are typically required for hepatic or renal impairment, but caution is advised due to potential for renal toxicity. Monitor patients closely.
## 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.
* Advanced renal disease.
* Active peptic ulceration or gastrointestinal bleeding.
* Third trimester of pregnancy.
## Adverse Effects
Common: Nausea, dyspepsia, heartburn, abdominal pain, diarrhea, constipation, dizziness, headache.
Serious: Gastrointestinal bleeding and perforation, myocardial infarction, stroke, renal impairment/failure, fluid retention, edema, hypertension, hypersensitivity reactions, hepatic dysfunction.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin, apixaban, rivaroxaban):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of gastrointestinal bleeding.
* **Selective Serotonin Reuptake Inhibitors (SSRIs) and Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs):** Increased risk of bleeding.
* **Other NSAIDs/Aspirin:** Increased risk of adverse effects, particularly gastrointestinal and renal.
* **Diuretics and Antihypertensives:** May reduce their efficacy and increase risk of renal impairment.
* **Lithium:** Increased serum lithium levels.
* **Methotrexate:** Increased methotrexate toxicity.
## Monitoring
* Signs and symptoms of gastrointestinal bleeding (e.g., melena, hematemesis).
* Renal function (serum creatinine, BUN), especially in patients with pre-existing renal disease, dehydration, or those taking concomitant nephrotoxic agents.
* Blood pressure.
* Signs of fluid retention (e.g., edema).
* Liver function tests, particularly with prolonged use or in patients with liver disease.
## Clinical Pearls
* Administer with food or milk to minimize gastrointestinal upset.
* Use the lowest effective dose for the shortest duration necessary to reduce the risk of serious cardiovascular and gastrointestinal events.
* Ibuprofen may mask signs of infection.
* Consider COX-2 selective agents in patients at high risk for gastrointestinal complications, though cardiovascular risk remains.
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**Disclaimer:** This information is intended for educational purposes and does not substitute for professional medical advice. Always consult the most current prescribing information and relevant guidelines before making any treatment decisions.
