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# Ibuprofen
## Overview
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) used for the relief of pain, fever, and inflammation.
## Primary Indications
* Pain (mild to moderate)
* Fever
* Inflammation (e.g., rheumatoid arthritis, osteoarthritis)
* Dysmenorrhea
* Closure of patent ductus arteriosus (PDA) in premature infants
## Adult Dosing
* **Pain/Fever:** 200 mg to 400 mg every 4 to 6 hours as needed. Maximum daily dose: 1200 mg. Higher doses (up to 2400 mg/day in divided doses) may be used under medical supervision for inflammatory conditions.
* **Inflammatory Conditions:** 400 mg to 800 mg three to four times daily. Maximum daily dose: 2400 mg to 3200 mg (depending on indication and supervision).
## Pediatric Dosing
* **Pain/Fever:** 5 mg/kg to 10 mg/kg orally every 6 to 8 hours as needed. Maximum daily dose: 40 mg/kg or 400 mg, whichever is less.
* Infants younger than 6 months: Use is generally not recommended due to potential risks.
* **Patent Ductus Arteriosus (Neonates):** IV administration is typically used. Refer to specific neonatal guidelines or product information. A common regimen is 10 mg/kg for the first dose, followed by 5 mg/kg every 48 hours for two additional doses.
## Dose Adjustments
No specific dose adjustments are generally required for hepatic or renal impairment, but caution and monitoring are advised due to potential for worsening renal function or hepatic toxicity. Use the lowest effective dose for the shortest duration necessary.
## 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.
* Active gastrointestinal (GI) bleeding or history of GI ulceration/bleeding.
* Severe heart failure.
* Third trimester of pregnancy.
## Adverse Effects
* **Common:** GI upset (nausea, vomiting, diarrhea, constipation, dyspepsia), dizziness, headache.
* **Serious:** GI bleeding/perforation, myocardial infarction, stroke, renal impairment/failure, hypertension, hypersensitivity reactions (including anaphylaxis), hepatic dysfunction, fluid retention/edema, exacerbation of heart failure.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin) and Antiplatelets (e.g., aspirin, clopidogrel):** Increased risk of bleeding.
* **ACE Inhibitors, Angiotensin Receptor Blockers (ARBs), Diuretics:** May decrease antihypertensive efficacy and increase risk of renal impairment.
* **Lithium, Methotrexate:** Increased serum levels and toxicity.
* **Other NSAIDs and Salicylates:** Increased risk of GI toxicity and other adverse effects.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
## Monitoring
* Signs and symptoms of GI bleeding or ulceration.
* Renal function (BUN, creatinine) and electrolytes, especially in patients with pre-existing renal disease or those at risk.
* Liver function tests (LFTs) may be considered with prolonged use or in patients with hepatic impairment.
* Blood pressure, particularly in patients with hypertension.
* Signs of cardiovascular events (chest pain, shortness of breath).
## Clinical Pearls
* Administer with food or milk to minimize GI upset.
* Use the lowest effective dose for the shortest duration necessary to reduce the risk of serious cardiovascular and GI events.
* Avoid concurrent use with other NSAIDs.
* Consider gastroprotective agents (e.g., PPIs) in patients with increased risk of GI bleeding.
* For pediatric use, precise weight-based dosing is crucial.
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*Disclaimer: This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant clinical guidelines before making treatment decisions.*
