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# Ibuprofen (Nurofen, Advil, Motrin)
## Overview
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that inhibits cyclooxygenase (COX) enzymes, reducing the production of prostaglandins. It is used for its analgesic, anti-inflammatory, and antipyretic effects.
## Primary Indications
* Pain relief (mild to moderate)
* Fever reduction
* Inflammation management (e.g., arthritis, musculoskeletal injuries)
## Adult Dosing
**Analgesia/Antipyresis:**
* 200 mg to 400 mg orally every 4 to 6 hours as needed.
* Maximum daily dose: 1200 mg (over-the-counter), 2400 mg to 3200 mg (prescription, under medical supervision for specific conditions like arthritis).
**Inflammation:**
* Prescription strengths are typically used, ranging from 400 mg to 800 mg orally three times daily.
* Maximum daily dose: 3200 mg.
## Pediatric Dosing
Dosing is typically based on weight. Consult product labeling or specific pediatric guidelines for precise dosing.
**Analgesia/Antipyresis:**
* **Infants and Children 6 months to 12 years:** 5 mg/kg to 10 mg/kg orally every 6 to 8 hours as needed.
* Do not exceed 40 mg/kg per day.
* Maximum dose for children under 12 years is generally 400 mg per dose or 2400 mg per day, but lower maximums may apply based on OTC labeling.
* **Children > 12 years:** Use adult dosing.
**Note:** Ibuprofen is not recommended for infants under 6 months of age due to safety concerns.
## 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.
* **Elderly:** Increased risk of adverse events. Use lowest effective dose for the shortest duration.
## Contraindications
* Hypersensitivity to ibuprofen, aspirin, or other NSAIDs.
* History of asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs.
* Perioperative pain in the setting of coronary artery bypass graft (CABG) surgery.
* Active gastrointestinal (GI) bleeding or history of GI bleeding/perforation with prior NSAID use.
* Severe heart failure.
* Severe renal impairment.
* Severe hepatic impairment.
* Third trimester of pregnancy.
## Adverse Effects
* **Common:** Nausea, vomiting, diarrhea, constipation, dyspepsia, abdominal pain, headache, dizziness.
* **Serious:**
* **GI:** Bleeding, ulceration, perforation.
* **Cardiovascular:** Increased risk of myocardial infarction, stroke, hypertension.
* **Renal:** Acute kidney injury, interstitial nephritis.
* **Hepatic:** Liver enzyme elevations, hepatitis.
* **Dermatologic:** Serious skin reactions (e.g., Stevens-Johnson syndrome, toxic epidermal necrolysis).
* **Hematologic:** Anemia, prolonged bleeding time.
* **Hypersensitivity:** Anaphylaxis, angioedema.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin, direct oral anticoagulants):** Increased risk of bleeding.
* **Antiplatelet agents (e.g., aspirin, clopidogrel):** Increased risk of bleeding.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **Selective serotonin reuptake inhibitors (SSRIs) / Serotonin-norepinephrine reuptake inhibitors (SNRIs):** Increased risk of GI bleeding.
* **Diuretics and antihypertensives:** Reduced efficacy, increased risk of renal impairment.
* **Lithium:** Increased lithium levels and toxicity.
* **Methotrexate:** Increased methotrexate levels and toxicity.
* **Other NSAIDs (including aspirin):** Increased risk of adverse effects, particularly GI.
## Monitoring
* **GI Symptoms:** Monitor for signs of GI bleeding (e.g., melena, hematemesis).
* **Cardiovascular Risk:** Assess for signs of cardiovascular events.
* **Renal Function:** Monitor renal function, especially in patients with pre-existing renal disease or those at risk.
* **Blood Pressure:** Monitor blood pressure, especially in patients with hypertension.
* **Liver Function:** Monitor liver enzymes if prolonged therapy or in patients with hepatic impairment.
## Clinical Pearls
* Administer with food or milk to minimize GI upset.
* Use the lowest effective dose for the shortest duration necessary to minimize risks.
* Caution in patients with a history of cardiovascular disease, GI disease, or renal impairment.
* Avoid concurrent use with other NSAIDs unless specifically indicated and monitored.
* In pediatric patients, use weight-based dosing and appropriate measuring devices for accuracy.
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*Disclaimer: This information is intended for clinical use and does not substitute for professional medical judgment. Always verify current prescribing information and consult with a healthcare provider for patient-specific management.*
