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# Ibuprofen
## Overview
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that inhibits cyclooxygenase (COX) enzymes, reducing prostaglandin synthesis. It possesses analgesic, anti-inflammatory, and antipyretic properties.
## Primary Indications
* Pain relief (mild to moderate)
* Fever reduction
* Inflammation associated with conditions such as arthritis
## Adult Dosing
* **Analgesia/Antipyresis:** 200-400 mg every 4-6 hours as needed. Maximum daily dose: 1200 mg for over-the-counter (OTC) use, up to 3200 mg under medical supervision for inflammatory conditions.
* **Inflammatory Conditions (e.g., rheumatoid arthritis):** 400-800 mg 2-4 times daily.
## Pediatric Dosing
Dosing is typically based on weight. The following are general guidelines; **consult specific pediatric protocols or product labeling for precise dosing.**
* **Antipyresis/Analgesia:** 5-10 mg/kg per dose every 6-8 hours.
* Maximum daily dose: 40 mg/kg or 400 mg, whichever is less.
* Available as oral suspension (e.g., 100 mg/5 mL) and chewable tablets (e.g., 50 mg, 100 mg).
## Dose Adjustments
No specific dose adjustments are typically required for renal or hepatic impairment, but caution is advised. Monitor for signs of organ toxicity.
## 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.
* Advanced renal disease.
* History of gastrointestinal bleeding or perforation related to prior NSAID use.
## Adverse Effects
* **Gastrointestinal:** Dyspepsia, nausea, abdominal pain, diarrhea, constipation, peptic ulceration, GI bleeding, perforation.
* **Cardiovascular:** Increased risk of myocardial infarction, stroke, and new-onset or worsening hypertension.
* **Renal:** Acute kidney injury, interstitial nephritis, papillary necrosis.
* **Dermatologic:** Rash, pruritus.
* **Other:** Dizziness, headache, tinnitus.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin, heparin, DOACs):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of GI bleeding.
* **Selective Serotonin Reuptake Inhibitors (SSRIs) / Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs):** Increased risk of GI bleeding.
* **Other NSAIDs (including aspirin):** Increased risk of adverse effects, particularly GI and renal.
* **Lithium:** Increased lithium levels.
* **Methotrexate:** Increased methotrexate toxicity.
* **Diuretics, ACE inhibitors, ARBs:** May reduce antihypertensive effect and increase risk of renal impairment.
## Monitoring
* Renal function (serum creatinine, BUN)
* Liver function (LFTs)
* Blood pressure
* Signs and symptoms of GI bleeding (e.g., melena, hematemesis)
* Signs of cardiovascular events
## Clinical Pearls
* Administer with food or milk to minimize GI upset.
* Lowest effective dose for the shortest duration should be used.
* Risk of cardiovascular events and GI bleeding increases with dose and duration of use.
* Use with caution in elderly patients and those with pre-existing renal, hepatic, or cardiovascular disease.
* Inquire about NSAID use, including OTC products, before initiating therapy.
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*This information is intended for healthcare professionals and does not substitute for current prescribing information or professional judgment. Always consult the official product labeling and relevant guidelines before making clinical decisions.*
