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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 (mild to moderate)
* Fever
* Inflammation (e.g., arthritis)
## Adult Dosing
* **Pain/Fever:** 200 mg to 400 mg every 4 to 6 hours as needed.
* Maximum daily dose: 1200 mg for over-the-counter (OTC) use.
* Maximum daily dose: 3200 mg for prescription use under medical supervision for inflammatory conditions.
* **Inflammation (e.g., rheumatoid arthritis):** 400 mg to 800 mg three to four times daily.
* Maximum daily dose: 3200 mg.
## Pediatric Dosing
Dosing is based on weight and age. Always consult product-specific labeling or reliable pediatric dosing resources.
* **Fever/Pain (Infants > 6 months and Children):**
* **Oral Suspension (e.g., 100 mg/5 mL):** 5 mg/kg to 10 mg/kg per dose every 6 to 8 hours.
* Maximum single dose: 400 mg.
* Maximum daily dose: 40 mg/kg or 2400 mg, whichever is less.
* **Chewable Tablets (e.g., 100 mg):** Similar weight-based dosing.
* **Conventional Tablets (e.g., 200 mg):** Typically for children over 12 years or based on weight.
* **Note:** Do not use in infants under 6 months of age unless directed by a healthcare provider.
## Dose Adjustments
* **Renal Impairment:** Use with caution. May require dose reduction or avoidance in severe renal impairment.
* **Hepatic Impairment:** Use with caution. May require dose reduction or avoidance in severe hepatic impairment.
## Contraindications
* Hypersensitivity to ibuprofen, aspirin, or other NSAIDs.
* History of bronchospasm, asthma, rhinitis, or urticaria following aspirin or NSAID use.
* Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery.
* Active gastrointestinal (GI) bleeding or ulcer disease.
* Severe heart failure.
* Pregnancy (third trimester).
## Adverse Effects
* **Common:** Nausea, vomiting, dyspepsia, abdominal pain, diarrhea, constipation, dizziness, headache.
* **Serious:** GI bleeding, ulceration, perforation; cardiovascular thrombotic events (MI, stroke); renal failure; hypertension; fluid retention and edema; hypersensitivity reactions; hepatotoxicity.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Antiplatelets (e.g., aspirin, clopidogrel):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **Diuretics:** May reduce diuretic efficacy and increase risk of nephrotoxicity.
* **Lithium:** May increase lithium levels.
* **Methotrexate:** May increase methotrexate levels and toxicity.
* **ACE Inhibitors and ARBs:** May increase risk of renal impairment and reduce antihypertensive effect.
## Monitoring
* Signs and symptoms of GI bleeding or ulceration (e.g., melena, hematemesis).
* Renal function (serum creatinine, BUN), especially in patients with pre-existing renal disease or those on concomitant nephrotoxic agents.
* Liver function tests, particularly with long-term use or in patients with hepatic impairment.
* Blood pressure.
* Signs of cardiovascular events.
## Clinical Pearls
* Administer with food or milk to minimize GI upset.
* Lowest effective dose for the shortest duration necessary should be used to minimize risks.
* Use with caution in elderly patients, those with cardiovascular disease, or those with risk factors for GI events.
* For children, accurate weight measurement is crucial for appropriate dosing.
* Ibuprofen can interfere with the antiplatelet effects of low-dose aspirin; timing of administration is important if both are used concurrently.
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**Disclaimer:** This information is for educational purposes only and does not substitute for professional medical advice. Always consult the current prescribing information and a healthcare professional for accurate and complete drug information before making any treatment decisions.
