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# Ibuprofen
## Overview
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) used for its analgesic, antipyretic, and anti-inflammatory properties. It works by inhibiting cyclooxygenase (COX) enzymes, thereby reducing prostaglandin synthesis.
## Primary Indications
* Pain relief (mild to moderate)
* Fever reduction
* Inflammation reduction (e.g., in rheumatoid arthritis, osteoarthritis)
* Closure of patent ductus arteriosus (PDA) in premature infants
## Adult Dosing
**Analgesia/Antipyresis:**
* **Oral:** 200 mg to 400 mg every 4 to 6 hours as needed. Maximum daily dose: 1200 mg (OTC), 2400-3200 mg (prescription, under medical supervision).
* **IV:** 400 mg to 800 mg every 6 hours as needed. Maximum daily dose: 3200 mg.
**Inflammation:**
* **Oral:** 400 mg to 800 mg three to four times daily. Usual maximum daily dose: 2400 mg. In some cases, up to 3200 mg may be used under close medical supervision.
## Pediatric Dosing
**Analgesia/Antipyresis:**
* **Oral (suspension):** 5 mg/kg/dose every 6-8 hours for fever/pain. Maximum 200 mg per dose.
* **Oral (suspension):** 10 mg/kg/dose every 6-8 hours for inflammation. Maximum 400 mg per dose.
* **IV:** 10 mg/kg/dose every 6-8 hours for neonates and infants. **For premature infants:** IV for PDA closure, typically 10 mg/kg for the first dose, followed by 5 mg/kg at 24 and 48 hours if needed. Dosing varies significantly based on gestational age and postnatal age; consult specialized resources.
*Note: Pediatric dosing is weight-based and precise measurement is crucial. Total daily dose should not exceed 40 mg/kg for anti-inflammatory effects.*
## Dose Adjustments
No dose adjustment is typically required for hepatic or renal impairment, but caution is advised, especially with moderate to severe impairment, due to potential for nephrotoxicity and hepatic effects. Monitor renal and hepatic function closely.
## 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 bleeding or ulceration.
* Severe heart failure.
* Third trimester of pregnancy.
## Adverse Effects
* **Common:** Nausea, vomiting, diarrhea, constipation, abdominal pain, dyspepsia, rash, dizziness, headache.
* **Serious:** Gastrointestinal bleeding, ulceration, perforation; renal toxicity (including interstitial nephritis, papillary necrosis); hepatotoxicity; cardiovascular thrombotic events (MI, stroke); hypersensitivity reactions; exacerbation of asthma; fluid retention and edema.
## Key Drug Interactions
* **Anticoagulants (e.g., warfarin):** Increased risk of bleeding.
* **Aspirin:** May diminish the cardioprotective effect of low-dose aspirin; increased GI risk.
* **Corticosteroids:** Increased risk of GI ulceration and bleeding.
* **Diuretics and Antihypertensives (e.g., ACE inhibitors, ARBs, beta-blockers):** Reduced antihypertensive effect; increased risk of renal impairment.
* **Lithium:** Increased lithium levels and toxicity.
* **Methotrexate:** Increased methotrexate toxicity.
* **SSRIs/SNRIs:** Increased risk of bleeding, particularly GI bleeding.
## Monitoring
* **Renal function:** Creatinine, BUN, urine output, especially in patients with risk factors for renal toxicity.
* **Hepatic function:** AST, ALT, bilirubin, especially with long-term use or in patients with hepatic disease.
* **Gastrointestinal symptoms:** Monitor for signs of bleeding (melena, hematemesis) or ulceration.
* **Cardiovascular risk factors:** Blood pressure, signs of heart failure.
* **Bleeding:** Prothrombin time/INR if co-administered with anticoagulants.
## Clinical Pearls
* Administer with food or milk to minimize gastrointestinal upset.
* Use the lowest effective dose for the shortest duration necessary to reduce the risk of adverse effects.
* Consider gastroprotective agents (e.g., PPIs) in patients at high risk for GI complications.
* Avoid in patients with severe renal or hepatic impairment unless benefits clearly outweigh risks.
* IV formulation should be administered as a slow infusion.
* For PDA closure in neonates, efficacy and safety are well-established, but careful monitoring for complications like renal dysfunction and bleeding is essential.
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**Disclaimer:** This information is intended for clinical use and does not replace professional medical judgment. Always verify current prescribing information with an official drug compendium or the manufacturer's product information before making any clinical decisions.
