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# Ibuprofen
## Overview
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that provides analgesia, antipyresis, and anti-inflammatory effects by inhibiting cyclooxygenase (COX) enzymes, which reduces prostaglandin synthesis.
## Primary Indications
* Pain (mild to moderate)
* Fever
* Inflammation
## Adult Dosing
* **Pain/Fever:** 200-400 mg every 4-6 hours as needed. Maximum daily dose: 1200 mg for over-the-counter (OTC) use; up to 2400-3200 mg daily may be used under medical supervision for specific inflammatory conditions.
* **Inflammation:** 400-800 mg three times daily. Maximum daily dose: 3200 mg.
Dosing should be initiated at the lowest effective dose and titrated as needed.
## Pediatric Dosing
* **Pain/Fever:** Dosing is typically weight-based.
* **Oral suspension (100 mg/5 mL or 50 mg/1.25 mL):** 5-10 mg/kg per dose every 6-8 hours. Maximum dose: 40 mg/kg per day or 400 mg per day, whichever is less.
* **Chewable tablets (50 mg or 100 mg):** Dosing varies by age and weight, consult product labeling.
* **Infants < 6 months:** Generally not recommended due to potential risks. Consult a pediatrician.
## Dose Adjustments
No specific dose adjustments are typically required for renal or hepatic impairment, but caution is advised. Patients with severe renal or hepatic impairment should be closely monitored.
## Contraindications
* Hypersensitivity to ibuprofen, aspirin, or other NSAIDs.
* History of bronchospasm, 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.
* Third trimester of pregnancy.
## Adverse Effects
* **Gastrointestinal:** Dyspepsia, nausea, abdominal pain, diarrhea, constipation, GI bleeding, ulceration, perforation.
* **Cardiovascular:** Increased risk of thrombotic events (MI, stroke), edema, hypertension.
* **Renal:** Acute kidney injury, interstitial nephritis.
* **Hepatic:** Elevated liver enzymes, hepatitis.
* **Dermatologic:** Rash, pruritus.
* **Hematologic:** Increased bleeding time.
* **Other:** Dizziness, headache, tinnitus.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin, DOACs):** Increased risk of bleeding.
* **Aspirin (low-dose):** May reduce the cardioprotective effect of aspirin.
* **Corticosteroids:** Increased risk of GI adverse effects.
* **Diuretics:** Reduced antihypertensive effect, increased risk of nephrotoxicity.
* **Lithium:** Increased serum lithium levels.
* **Methotrexate:** Increased risk of methotrexate toxicity.
* **SSRIs/SNRIs:** Increased risk of GI bleeding.
## Monitoring
* Signs and symptoms of GI bleeding or ulceration.
* Renal function (BUN, creatinine), especially in patients with pre-existing renal disease or those on concomitant nephrotoxic agents.
* Liver function tests if therapy is prolonged or in patients with hepatic impairment.
* Blood pressure.
* Signs of fluid retention or edema.
## Clinical Pearls
* Ibuprofen should be taken with food or milk to minimize GI upset.
* The lowest effective dose should be used for the shortest duration necessary to minimize risks.
* Consider the increased risk of cardiovascular and gastrointestinal events, particularly with chronic use or higher doses.
* Patients with asthma may be at increased risk of NSAID-exacerbated respiratory disease.
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*Disclaimer: This information is intended for healthcare professionals and is not a substitute for professional medical advice. Always consult the most current prescribing information and your institution's guidelines before making any treatment decisions.*
