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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., rheumatoid arthritis, osteoarthritis)
* Dysmenorrhea
* Patent ductus arteriosus (PDA) in premature infants
## Adult Dosing
* **Pain/Fever:** 200 mg to 400 mg orally every 4 to 6 hours as needed.
* Maximum daily dose: 1200 mg orally per day for OTC use.
* Maximum daily dose: 3200 mg orally per day under medical supervision for inflammatory conditions.
* **Dysmenorrhea:** 200 mg to 400 mg orally every 4 to 6 hours as needed.
* **Inflammatory Conditions:** 300 mg to 800 mg orally 2 to 3 times daily.
* Maximum daily dose: 3200 mg orally per day.
## Pediatric Dosing
Dosing is typically based on weight. Consult product labeling or specific pediatric guidelines for precise dosing and formulation.
* **Fever/Pain:**
* **Oral suspension (100 mg/5 mL or 40 mg/mL):** 5 mg/kg to 10 mg/kg orally every 6 to 8 hours.
* Maximum single dose: 400 mg.
* Maximum daily dose: 40 mg/kg or 2400 mg, whichever is less.
* **Chewable tablets (50 mg, 100 mg):** 5 mg/kg to 10 mg/kg orally every 6 to 8 hours.
* Maximum single dose: 400 mg.
* Maximum daily dose: 40 mg/kg or 2400 mg, whichever is less.
* **Tablets (200 mg):** For children >12 years and weighing >40 kg, follow adult dosing.
* **Patent Ductus Arteriosus (PDA):**
* **IV:** Initial dose: 10 mg/kg. Followed by 5 mg/kg at 24 and 48 hours if necessary.
* **Note:** Specific protocols and monitoring are crucial for IV administration in neonates.
## Dose Adjustments
* **Renal Impairment:** Use with caution. Dose reduction may be considered in severe impairment. Monitor renal function.
* **Hepatic Impairment:** Use with caution. Dose reduction may be considered in severe impairment. Monitor hepatic function.
* **Elderly:** Increased risk of adverse effects, especially gastrointestinal bleeding and renal toxicity. Consider lower doses and shorter duration.
## Contraindications
* Hypersensitivity to ibuprofen, aspirin, or other NSAIDs.
* History of bronchospasm, asthma, rhinitis, urticaria, or other allergic-type reactions after taking aspirin or other NSAIDs.
* Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery.
* Advanced renal disease.
* Severe hepatic disease.
* Severe heart failure.
* Third trimester of pregnancy.
## Adverse Effects
Common: Gastrointestinal upset (nausea, vomiting, diarrhea, constipation, dyspepsia), dizziness, headache.
Serious: Gastrointestinal bleeding, ulceration, perforation, cardiovascular thrombotic events (myocardial infarction, stroke), renal failure, hepatotoxicity, hypersensitivity reactions, exacerbation of asthma.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin) & Antiplatelets (e.g., aspirin, clopidogrel):** Increased risk of bleeding.
* **ACE Inhibitors & ARBs:** Reduced antihypertensive effect and increased risk of renal impairment.
* **Diuretics:** Reduced diuretic effect and increased risk of renal impairment.
* **Lithium:** Increased serum lithium levels.
* **Methotrexate:** Increased risk of methotrexate toxicity.
* **Corticosteroids:** Increased risk of gastrointestinal ulceration and bleeding.
* **Other NSAIDs:** Increased risk of adverse effects.
## Monitoring
* Signs and symptoms of gastrointestinal bleeding (melena, hematemesis).
* Renal function (BUN, creatinine), especially in patients with risk factors.
* Liver function (AST, ALT), especially with long-term use or pre-existing liver disease.
* Blood pressure, particularly with concomitant antihypertensive therapy.
* For pediatric patients with PDA, monitor urine output, bleeding, and signs of renal dysfunction.
## Clinical Pearls
* Administer with food or milk to minimize gastrointestinal upset.
* Lowest effective dose for the shortest duration necessary should be used to minimize risks.
* Ibuprofen is reversible COX inhibitor, unlike aspirin.
* Use in patients with cardiovascular disease, hypertension, heart failure, or renal impairment should be with extreme caution.
* For pediatric fever, acetaminophen is often considered first-line due to a more favorable safety profile in certain populations.
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*Disclaimer: This information is intended for healthcare professionals. Always consult the official prescribing information and current clinical guidelines for the most up-to-date and comprehensive details.*
