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# Ibuprofen (Nurofen, Advil, Motrin)
## Overview
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) used for pain relief, fever reduction, and inflammation management.
## Primary Indications
* Mild to moderate pain (e.g., headache, dental pain, menstrual cramps, muscle aches)
* Fever
* Inflammatory conditions (e.g., rheumatoid arthritis, osteoarthritis)
## Adult Dosing
* **Pain and Fever:** 200 mg to 400 mg every 4 to 6 hours as needed. Maximum daily dose is 1200 mg for over-the-counter use. Prescription doses can go up to 2400 mg to 3200 mg per day, divided into 3-4 doses, for inflammatory conditions, but this requires close medical supervision.
* **Inflammatory Conditions:** 400 mg to 800 mg two to three times daily.
## Pediatric Dosing
* **Pain and Fever:** Dosing is weight-based.
* **6 months to 11 years:** 5 mg/kg to 10 mg/kg per dose, given every 6 to 8 hours. Do not exceed 40 mg/kg per day.
* **For infants under 6 months:** Consult a pediatrician. Ibuprofen is generally not recommended for infants under 6 months due to potential risks.
* **Maximum Dose:** For pediatric patients, the maximum daily dose should not exceed 40 mg/kg or the adult maximum daily dose, whichever is lower.
## Dose Adjustments
No dose adjustment is typically required for hepatic or renal impairment, but caution is advised. Use the lowest effective dose for the shortest duration necessary, especially in patients with pre-existing renal disease.
## Contraindications
* Hypersensitivity to ibuprofen 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 ulcer disease.
* Severe heart failure.
* Severe renal or hepatic impairment.
* Pregnancy (third trimester).
## Adverse Effects
* **Gastrointestinal:** Dyspepsia, nausea, abdominal pain, ulceration, bleeding, perforation.
* **Cardiovascular:** Increased risk of thrombotic events (myocardial infarction, stroke), hypertension, edema, heart failure.
* **Renal:** Renal insufficiency, acute kidney injury, interstitial nephritis.
* **Hepatic:** Elevated liver enzymes, hepatitis.
* **Other:** Dizziness, headache, rash, bronchospasm (especially in asthmatics).
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Aspirin:** May decrease cardioprotective effects of low-dose aspirin; increased risk of GI adverse effects.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **Diuretics and antihypertensives:** May reduce their efficacy and increase risk of renal toxicity.
* **Lithium:** Increased lithium levels and toxicity.
* **Methotrexate:** Increased risk of methotrexate toxicity.
* **Other NSAIDs (including COX-2 inhibitors):** Increased risk of adverse effects.
## Monitoring
* **Renal function:** Especially in elderly patients or those with pre-existing renal disease.
* **Hepatic function:** If signs or symptoms of liver disease develop.
* **Blood pressure:** Monitor for potential increases.
* **Signs of GI bleeding:** Black stools, hematemesis.
* **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 gastrointestinal events.
* Ibuprofen is generally more effective for inflammatory pain than acetaminophen.
* For pediatric fever, use the 10 mg/kg dose for higher fevers if needed.
* Avoid in the third trimester of pregnancy due to risks to the fetus (e.g., premature closure of the ductus arteriosus).
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*Disclaimer: This information is intended for healthcare professionals. Always consult the current prescribing information and relevant guidelines for complete details before making any clinical decisions.*
