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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
* Mild to moderate pain
* Fever
* Inflammation associated with conditions like arthritis
## Adult Dosing
* **Pain/Fever:** 200-400 mg every 4-6 hours as needed. Maximum daily dose is 1200 mg for over-the-counter (OTC) use. Prescription doses can go up to 800 mg every 8 hours, with a maximum of 3200 mg per day under medical supervision.
* **Inflammation:** 400-800 mg every 6-8 hours. Maximum daily dose for prescription use is 3200 mg per day.
## Pediatric Dosing
Dosing is typically based on weight.
* **Fever/Pain:** 5-10 mg/kg per dose every 6-8 hours.
* Maximum of 4 doses in 24 hours.
* Maximum OTC daily dose should not exceed 40 mg/kg or 1200 mg, whichever is less.
* Prescription doses should not exceed 10 mg/kg per dose.
* **Kawasaki Disease (initiation):** 20 mg/kg per dose every 8 hours. Once fever has been absent for 48-72 hours, the dose may be reduced to 5-10 mg/kg per dose every 8 hours. Dosing duration and monitoring should be guided by specialist recommendations.
*Note: Specific dosing may vary based on the formulation (e.g., suspension, chewable, tablet) and local protocol.*
## Dose Adjustments
* **Renal Impairment:** Use with caution. Reduced doses may be necessary, especially in severe impairment. Monitor renal function.
* **Hepatic Impairment:** Use with caution. Reduced doses may be necessary. Monitor liver function.
* **Elderly:** Increased risk of adverse effects, particularly gastrointestinal bleeding and renal dysfunction. Consider lower doses.
## Contraindications
* Known hypersensitivity to ibuprofen, aspirin, or other NSAIDs.
* History of bronchospasm, asthma, rhinitis, or urticaria triggered by aspirin or other NSAIDs.
* Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery.
* Active gastrointestinal bleeding or history of peptic ulcer disease/bleeding.
* Severe heart failure, renal failure, or hepatic failure.
## Adverse Effects
* **Common:** Nausea, vomiting, diarrhea, constipation, dyspepsia, abdominal pain, dizziness, headache.
* **Serious:** Gastrointestinal bleeding, perforation, ulceration; myocardial infarction (MI), stroke, hypertension; renal failure, interstitial nephritis; hepatotoxicity; hypersensitivity reactions (including anaphylaxis), severe skin reactions (e.g., Stevens-Johnson syndrome, toxic epidermal necrolysis); exacerbation of asthma.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin, apixaban, rivaroxaban):** Increased risk of bleeding.
* **Antiplatelets (e.g., aspirin, clopidogrel):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of gastrointestinal bleeding and ulceration.
* **SSRIs/SNRIs:** Increased risk of bleeding.
* **ACE Inhibitors/ARBs/Diuretics:** Reduced antihypertensive efficacy and increased risk of renal impairment.
* **Lithium:** Increased lithium levels and risk of toxicity.
* **Methotrexate:** Increased methotrexate levels and risk of toxicity.
## Monitoring
* Monitor for signs and symptoms of gastrointestinal bleeding (e.g., melena, hematemesis).
* Monitor blood pressure, especially with chronic use.
* Monitor renal and liver function, particularly in patients with pre-existing impairment, elderly patients, or those on long-term therapy.
* Monitor for signs of cardiovascular events.
## Clinical Pearls
* Administer with food or milk to minimize gastrointestinal upset.
* The lowest effective dose for the shortest duration should be used to minimize risks.
* Risk of cardiovascular thrombotic events, MI, and stroke may increase with duration of use and in patients with known cardiovascular disease or risk factors.
* Avoid concurrent use with other NSAIDs.
* In pediatric patients with fever, ensure adequate hydration.
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*Disclaimer: This information is intended for healthcare professionals and is not a substitute for professional medical advice. Always consult the most current prescribing information and relevant guidelines before making any treatment decisions.*
