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# Ibuprofen
## Overview
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that provides analgesia, anti-inflammatory effects, and antipyresis. It is available in various oral and intravenous formulations.
## Primary Indications
* Pain (mild to moderate)
* Fever
* Inflammatory conditions (e.g., rheumatoid arthritis, osteoarthritis)
* Patent ductus arteriosus (PDA) in premature neonates (IV formulation)
## Adult Dosing
* **Pain/Fever:** 200 mg to 400 mg orally every 4 to 6 hours as needed. Maximum daily dose: 1200 mg orally.
* **Pain/Fever (IV):** 400 mg to 800 mg IV every 6 to 8 hours as needed. Maximum daily dose: 3200 mg IV (typically reserved for specific situations).
* **Inflammatory Conditions:** 400 mg to 800 mg orally 2 to 4 times daily. Maximum daily dose: 3200 mg orally.
## Pediatric Dosing
Dosing is typically weight-based.
* **Pain/Fever (Oral Suspension/Chewable):** 5 mg/kg to 10 mg/kg orally every 6 to 8 hours.
* Maximum single dose: 400 mg.
* Maximum daily dose: Not to exceed 40 mg/kg or 1200 mg, whichever is less.
* **Pain/Fever (IV):** 10 mg/kg IV every 6 to 8 hours. Maximum daily dose: 40 mg/kg or 3200 mg (adult maximum), whichever is less.
* **PDA (IV, Neonates):** Refer to specific neonatal protocols. Typically a 3-dose regimen is administered over 24-48 hours, with doses around 10 mg/kg, 5 mg/kg, and 5 mg/kg (or variations based on gestational age and weight).
## Dose Adjustments
* **Renal Impairment:** Use with caution. Mild to moderate impairment may not require dose adjustment, but close monitoring for renal effects is essential. Avoid in severe renal impairment.
* **Hepatic Impairment:** Use with caution. May require dose reduction; monitor liver function. Avoid in severe hepatic impairment.
## 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.
* Active gastrointestinal bleeding or ulceration.
## Adverse Effects
* **Common:** Nausea, vomiting, dyspepsia, abdominal pain, diarrhea, constipation, dizziness, headache.
* **Serious:** Gastrointestinal bleeding, perforation, ulceration; cardiovascular thrombotic events (MI, stroke); renal toxicity (acute kidney injury, interstitial nephritis); hepatic toxicity; hypersensitivity reactions (including anaphylaxis); exacerbation of asthma; hypertension.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin) and Antiplatelets (e.g., aspirin, clopidogrel):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of gastrointestinal ulceration and bleeding.
* **ACE Inhibitors, ARBs, Diuretics:** Reduced antihypertensive effect; increased risk of renal toxicity.
* **Lithium:** Increased serum lithium levels.
* **Methotrexate:** Increased methotrexate toxicity.
* **Other NSAIDs (including aspirin):** Additive adverse effects, increased risk of toxicity.
## Monitoring
* Signs and symptoms of GI bleeding (melena, hematemesis, abdominal pain).
* Renal function (BUN, creatinine).
* Liver function (AST, ALT).
* Blood pressure.
* For patients with cardiovascular risk factors, monitor for signs of cardiovascular events.
## Clinical Pearls
* Administer with food or milk to minimize gastrointestinal upset.
* Lowest effective dose for the shortest duration should be used to minimize risk of serious adverse events.
* IV formulation should be administered as a slow infusion.
* Hydration is important, especially in elderly patients and those with renal compromise.
* Consider risks vs. benefits in patients with pre-existing cardiovascular disease, hypertension, renal impairment, hepatic impairment, or a history of GI issues.
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*This information is intended for healthcare professionals. Always consult the official prescribing information and current guidelines for complete details. Dosing may vary based on specific patient factors and local protocols.*
