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# Ibuprofen
## Overview
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) used for pain relief, fever reduction, and reducing inflammation.
## Primary Indications
* Pain (mild to moderate)
* Fever
* Inflammation (e.g., rheumatoid arthritis, osteoarthritis)
* Patent Ductus Arteriosus (PDA) in premature infants
## Adult Dosing
* **Pain/Fever:** 200-400 mg every 4-6 hours as needed.
* Maximum daily dose: 1200 mg for over-the-counter (OTC) use.
* Maximum daily dose: 2400-3200 mg (prescription, under medical supervision) depending on indication and tolerability.
* **Inflammatory Conditions:** 400-800 mg three to four times daily.
* Maximum daily dose: 3200 mg.
## Pediatric Dosing
Dosing is typically based on weight. Consult a reliable pediatric dosing reference for exact calculations.
* **Fever/Pain:** 5-10 mg/kg/dose every 6-8 hours.
* Maximum daily dose: 40 mg/kg or 2400 mg, whichever is less.
* **Patent Ductus Arteriosus (PDA):** Neonatal dosing regimens vary. Typically, a course consists of 2-3 doses given intravenously. Consult Neonatal Intensive Care Unit (NICU) protocols.
## Dose Adjustments
* **Renal Impairment:** Use with caution. Dose reduction may be necessary in severe impairment. Monitor renal function.
* **Hepatic Impairment:** Use with caution. Dose reduction may be necessary in severe impairment. Monitor liver function.
* **Elderly:** Increased risk of adverse effects. Lower doses may be preferred.
## 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.
* Severe renal or hepatic impairment.
* Active gastrointestinal bleeding or ulcer disease.
## Adverse Effects
* **Common:** Nausea, vomiting, dyspepsia, abdominal pain, diarrhea, constipation, dizziness, headache.
* **Serious:** Gastrointestinal bleeding, ulceration, perforation, myocardial infarction, stroke, hypertension, renal failure, liver failure, hypersensitivity reactions (including anaphylaxis and severe skin reactions), fluid retention, edema.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Aspirin (low-dose):** May reduce the cardioprotective effect of aspirin.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **Diuretics:** Reduced diuretic efficacy; increased risk of nephrotoxicity.
* **Lithium:** Increased lithium levels and toxicity.
* **Methotrexate:** Increased methotrexate levels and toxicity.
* **SSRIs/SNRIs:** Increased risk of GI bleeding.
* **ACE inhibitors/ARBs:** Increased risk of renal impairment.
## Monitoring
* Renal function (serum creatinine, BUN).
* Liver function (ALT, AST).
* Complete blood count (CBC), especially with long-term use.
* Signs and symptoms of GI bleeding or ulceration.
* 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 gastroprotection (e.g., PPI) in patients at high risk for GI complications.
* NSAIDs carry a black box warning regarding cardiovascular thrombotic events, myocardial infarction, and stroke.
* NSAIDs carry a black box warning regarding the risk of serious gastrointestinal adverse events.
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*Please verify current prescribing information for the most up-to-date details.*
