Ibuprofen

# Ibuprofen ## Overview - **Classification**: Nonsteroidal Anti-inflammatory Drug (NSAID) - **Mechanism**: Reversible inhibition of cyclooxygenase (COX-1 and COX-2) enzymes, reducing prostaglandin synthesis. This leads to anti-inflammatory, analgesic, and antipyretic effects. ## Primary Indications 1. **Mild-to-Moderate Pain**: Headache, dental pain, menstrual pain, musculoskeletal pain. 2. **Fever**: Reduction of elevated body temperature. 3. **Inflammation**: Management of inflammatory conditions (e.g., osteoarthritis, rheumatoid arthritis, juvenile idiopathic arthritis). ## Adult Dosing ### Standard Dosing **Mild-to-Moderate Pain & Fever** - **Dose**: **200-400 mg** - **Frequency**: Every 4-6 hours as needed - **Route**: Oral (PO) - **Maximum Dose**: **1200 mg/day** (OTC), **3200 mg/day** (Rx, under physician supervision) **Inflammatory Conditions (e.g., Arthritis)** - **Dose**: **400-800 mg** - **Frequency**: Three to four times daily (TID-QID) - **Route**: Oral (PO) - **Maximum Dose**: **3200 mg/day** ### Dose Adjustments - **Renal Impairment**: - **CrCl <30 mL/min**: **Avoid** due to risk of worsening renal function. - **CrCl 30-60 mL/min**: Use lowest effective dose, monitor renal function closely. - **Hepatic Impairment**: - **Severe**: **Avoid**. - **Mild-to-Moderate**: Use with caution, lowest effective dose, monitor liver function. - **Elderly Patients**: Increased risk of GI, renal, and CV adverse effects. Use lowest effective dose for the shortest duration. ## Pediatric Dosing ### Neonates (0-28 days) - **Dose**: Generally **not recommended** for pain/fever due to potential for renal toxicity and risk of necrotizing enterocolitis. - **Special Notes**: Specific use for Patent Ductus Arteriosus (PDA) is a specialized indication with different protocols and not for general pain/fever. ### Infants (1-12 months) - **Indication**: Pain or Fever - **Dose**: **4-10 mg/kg/dose** - **Frequency**: Every 6-8 hours as needed - **Maximum**: **40 mg/kg/day** or **400 mg/dose** (whichever is less) - **Special Notes**: Use infant drops with calibrated oral syringe for accurate dosing. ### Children (1-12 years) - **Indication**: Pain or Fever - **Dose**: **4-10 mg/kg/dose** - **Frequency**: Every 6-8 hours as needed - **Maximum**: **40 mg/kg/day** or **400 mg/dose** (whichever is less) - **Indication**: Juvenile Idiopathic Arthritis (JIA) - **Dose**: **30-50 mg/kg/day** - **Frequency**: Divided into 3-4 doses daily - **Maximum**: **2.4 g/day** ### Adolescents (13-18 years) - **Indication**: Pain or Fever - **Dose**: **200-400 mg** - **Frequency**: Every 4-6 hours as needed - **Maximum**: **1200 mg/day** (OTC limits), or up to **3200 mg/day** (Rx, short-term) ## Safety Information ### Contraindications - **Absolute**: Hypersensitivity to ibuprofen, aspirin, or other NSAIDs. - **Absolute**: History of GI bleeding or perforation related to prior NSAID use. - **Absolute**: Active peptic ulcer disease or GI bleeding. - **Absolute**: Severe heart failure (NYHA Class III-IV), severe renal or hepatic failure. - **Absolute**: Third trimester of pregnancy (premature closure of ductus arteriosus). - **Absolute**: Peri-operative pain in the setting of coronary artery bypass graft (CABG) surgery. - **Relative**: Asthma (NSAID-exacerbated respiratory disease), uncontrolled hypertension. ### Common Adverse Effects - **Very Common (>10%)**: Dyspepsia, nausea, abdominal pain. - **Common (1-10%)**: Diarrhea, constipation, flatulence, headache, dizziness, edema. - **Serious but Rare**: GI ulceration/bleeding, acute kidney injury, cardiovascular thrombotic events (MI, stroke), anaphylaxis, severe skin reactions (SJS/TEN). ### Key Drug Interactions - **Anticoagulants (e.g., Warfarin, DOACs)**: Increased risk of serious bleeding. Monitor INR/bleeding signs closely. - **Antiplatelets (e.g., Aspirin, Clopidogrel)**: Increased risk of GI bleeding. Avoid concurrent use if possible. - **SSRIs/SNRIs**: Increased risk of GI bleeding when co-administered. - **ACE Inhibitors/ARBs/Diuretics**: Reduced antihypertensive/diuretic effect, increased risk of renal impairment. Monitor BP and renal function. - **Methotrexate**: Increased methotrexate levels, leading to toxicity. Avoid concurrent use or monitor closely. - **Lithium**: Increased lithium levels, leading to toxicity. Monitor lithium levels. ## Monitoring & Follow-up - **Before Treatment**: Assess renal function (SCr, CrCl), liver function (LFTs), and GI risk factors (history of ulcers/bleeds). - **During Treatment**: - **Short-term**: No routine lab monitoring required. - **Long-term**: Monitor CBC, renal function, and LFTs periodically (e.g., every 6-12 months). - **Clinical Signs**: Monitor for signs of GI bleeding (black/tarry stools, coffee-ground emesis), edema, rash, or changes in urine output. ## Clinical Pearls - 💡 **Administration with food/milk**: Administer with food, milk, or antacids to minimize GI upset. - 💡 **Hydration**: Ensure adequate hydration, especially in children and elderly, to reduce renal risk. - 💡 **Aspirin Interaction**: If co-administering with daily low-dose aspirin for cardioprotection, take ibuprofen **8 hours before or 30 minutes after** immediate-release aspirin. > **⚠️ Important**: This information is for educational purposes only. Always consult current prescribing information, local guidelines, and clinical judgment before prescribing.