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# Ibuprofen
## Overview
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that works by inhibiting cyclooxygenase (COX) enzymes, reducing prostaglandin synthesis. It possesses analgesic, anti-inflammatory, and antipyretic properties.
## Primary Indications
* Pain (mild to moderate)
* Fever
* Inflammation associated with conditions like arthritis
## Adult Dosing
* **Pain/Fever:** 200-400 mg every 4-6 hours as needed. Maximum daily dose: 1200 mg.
* **Inflammation (e.g., Rheumatoid Arthritis):** 400-800 mg every 6-8 hours as needed. Maximum daily dose: 3200 mg (under strict medical supervision, typically in hospital settings).
## Pediatric Dosing
Dosing is weight-based. Consult specific pediatric guidelines or product labeling for precise dosing.
* **Fever/Pain:** 5-10 mg/kg/dose orally every 6-8 hours. Do not exceed 4 doses in 24 hours.
* For infants 6-11 months: 5 mg/kg/dose.
* For children 1-12 years: 10 mg/kg/dose.
* **Maximum pediatric daily dose:** 40 mg/kg/day.
## Dose Adjustments
No specific dose adjustments are typically required for renal or hepatic impairment, but caution is advised, and the lowest effective dose should be used. Monitor patients closely for adverse effects.
## Contraindications
* Hypersensitivity to ibuprofen 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.
* Advanced renal disease.
* Active gastrointestinal bleeding or ulceration.
* Pregnancy (third trimester).
## Adverse Effects
Common: Gastrointestinal upset (nausea, dyspepsia, diarrhea), dizziness, headache.
Serious:
* Cardiovascular thrombotic events (myocardial infarction, stroke).
* Gastrointestinal bleeding, ulceration, perforation.
* Renal toxicity (including interstitial nephritis, papillary necrosis).
* Hepatotoxicity.
* Hypersensitivity reactions, including severe skin reactions (e.g., Stevens-Johnson syndrome).
* Fluid retention and edema.
## 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.
* **Diuretics:** Reduced diuretic efficacy; increased risk of renal toxicity.
* **Lithium:** Increased serum lithium levels.
* **Methotrexate:** Increased risk of methotrexate toxicity.
* **ACE inhibitors and ARBs:** Increased risk of renal impairment.
## Monitoring
* **Renal function:** Especially in patients with pre-existing renal disease, dehydration, or those on concomitant nephrotoxic agents.
* **Hepatic function:** If signs or symptoms of liver dysfunction develop.
* **Blood pressure:** NSAIDs can increase blood pressure.
* **Signs of bleeding:** Especially in patients with risk factors or those on anticoagulants.
## Clinical Pearls
* Administer with food or milk to minimize gastrointestinal upset.
* Use the lowest effective dose for the shortest duration necessary to minimize risks.
* Avoid in patients with a history of NSAID-induced bronchospasm.
* Caution with patients who have cardiovascular disease, hypertension, or risk factors for cardiovascular events.
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**Disclaimer:** This information is intended for healthcare professionals and does not replace comprehensive drug information resources. Always consult current prescribing information and relevant guidelines before making clinical decisions.
