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# Ibuprofen ## Overview Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) used for pain, fever, and inflammation. ## Primary Indications * Pain (mild to moderate) * Fever * Inflammation (e.g., arthritis) * Patent ductus arteriosus (PDA) in premature infants ## Adult Dosing * **Pain/Fever:** 200 mg to 800 mg orally every 4 to 6 hours as needed. * **Maximum Daily Dose:** 3200 mg orally. * **Inflammation:** Doses may be higher, typically 400 mg to 800 mg orally every 6 to 8 hours. * **Maximum Daily Dose:** 3200 mg orally. ## Pediatric Dosing Dosing is typically based on weight. Always confirm specific product concentration as it can vary. * **Fever/Pain (oral):** 5 mg/kg to 10 mg/kg every 6 to 8 hours. * **Maximum Single Dose:** 400 mg. * **Maximum Daily Dose:** 40 mg/kg, not to exceed 2400 mg (for anti-inflammatory doses). * **Patent Ductus Arteriosus (Premature Infants, IV):** Dosing is complex and depends on gestational age and postnatal age. A common regimen is three doses administered at 24-hour intervals: * First dose: 10 mg/kg * Second and Third doses: 5 mg/kg each * *Requires careful monitoring and administration in a neonatal intensive care unit.* ## Dose Adjustments * **Renal Impairment:** Use with caution. Dose reduction may be necessary in severe impairment. NSAIDs can worsen renal function. * **Hepatic Impairment:** Use with caution. Dose reduction may be necessary in severe 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. * Third trimester of pregnancy. * Severe renal, hepatic, or cardiac impairment. * Active gastrointestinal bleeding or ulceration. ## Adverse Effects * **Gastrointestinal:** Nausea, vomiting, dyspepsia, abdominal pain, diarrhea, constipation, occult bleeding. Increased risk of GI ulceration and bleeding, especially with long-term use or higher doses. * **Cardiovascular:** Increased risk of myocardial infarction, stroke, and new or worsened heart failure. * **Renal:** Acute kidney injury, interstitial nephritis. * **Dermatologic:** Rash, pruritus. Stevens-Johnson syndrome and toxic epidermal necrolysis are rare but serious. * **Hematologic:** Increased bleeding time, anemia. * **Hepatic:** Elevated liver enzymes. ## Key Drug Interactions * **Anticoagulants (e.g., warfarin, heparin, DOACs):** Increased risk of bleeding. * **Aspirin:** May decrease the cardioprotective effect of low-dose aspirin and increase GI risk. * **Corticosteroids:** Increased risk of GI ulceration and bleeding. * **Diuretics and Antihypertensives (e.g., ACE inhibitors, ARBs, beta-blockers):** May reduce antihypertensive effect and increase risk of renal damage. * **Lithium:** May increase lithium levels and toxicity. * **Methotrexate:** May increase methotrexate levels and toxicity. * **Selective Serotonin Reuptake Inhibitors (SSRIs):** Increased risk of GI bleeding. ## Monitoring * **Renal function:** Especially in patients with pre-existing renal disease, dehydration, heart failure, or those on diuretics/ACE inhibitors. * **Hepatic function:** Especially with long-term use or underlying liver disease. * **Blood pressure:** Especially in patients with hypertension. * **Signs of GI bleeding:** Melena, hematemesis, abdominal pain. * **Signs of cardiovascular events:** Chest pain, shortness of breath, weakness. ## Clinical Pearls * Administer with food or milk to minimize GI upset. * Use the lowest effective dose for the shortest duration necessary to minimize risks. * NSAIDs carry a black box warning for cardiovascular thrombotic events and serious gastrointestinal adverse events. * Caution in elderly patients due to increased risk of adverse effects. *** *Disclaimer: This information is intended for healthcare professionals and does not substitute for official prescribing information or professional medical advice. Always verify current dosing, indications, contraindications, and warnings with the most up-to-date product labeling and institutional protocols.*