Ibuprofen (nurofen, Advil, Motrin)

# Ibuprofen (Nurofen, Advil, Motrin) ## Overview Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that acts by inhibiting cyclooxygenase (COX-1 and COX-2) enzymes, leading to decreased prostaglandin synthesis. It possesses analgesic, antipyretic, and anti-inflammatory properties. ## Primary Indications * Mild to moderate pain. * Fever reduction. * Inflammatory conditions (e.g., rheumatoid arthritis, osteoarthritis). * Dysmenorrhea. ## Adult Dosing * **Analgesia/Antipyretic:** 200–400 mg every 4–6 hours as needed. Maximum 1200 mg/day (OTC) or up to 3200 mg/day under medical supervision. * **Anti-inflammatory:** 400–800 mg 3–4 times daily. Maximum 3200 mg/day. ## Pediatric Dosing * **Fever/Pain:** 5–10 mg/kg/dose every 6–8 hours. * **Maximum Daily Dose:** 40 mg/kg/day or 400 mg per single dose. * **Minimum Age:** Generally not recommended for infants under 6 months without provider guidance. ## Dose Adjustments * **Renal Impairment:** Use with caution. Avoid in severe renal impairment (CrCl < 30 mL/min) due to risk of further decline in renal function. * **Hepatic Impairment:** Monitor closely; consider dose reduction in severe hepatic disease. * **Elderly:** Use the lowest effective dose for the shortest duration due to increased risk of gastrointestinal (GI) and renal toxicity. ## Contraindications * Known hypersensitivity to ibuprofen, aspirin, or other NSAIDs (e.g., history of asthma, urticaria, or allergic-type reactions). * Peri-operative pain in the setting of coronary artery bypass graft (CABG) surgery. * Active peptic ulcer disease or GI bleeding. * Severe heart failure. ## Adverse Effects * **GI:** Dyspepsia, nausea, occult GI bleeding, gastric ulceration. * **Renal:** Acute kidney injury, fluid retention, edema, hypertension. * **CV:** Increased risk of thrombotic events (myocardial infarction, stroke). * **Hematologic:** Increased risk of bleeding due to platelet inhibition. ## Key Drug Interactions * **Anticoagulants/Antiplatelets (e.g., Warfarin, SSRIs):** Increased risk of major bleeding. * **ACE Inhibitors/ARBs/Diuretics:** Reduced antihypertensive effect and increased risk of acute kidney injury ("triple whammy"). * **Lithium:** May increase serum lithium levels, potentially leading to toxicity. * **Methotrexate:** May increase methotrexate toxicity by reducing renal clearance. ## Monitoring * **Renal Function:** Serum creatinine and electrolytes (especially if on long-term therapy or with pre-existing renal disease). * **GI:** Monitor for signs of bleeding (melena, hematemesis, unexplained anemia). * **BP:** Regular monitoring for new-onset or worsening hypertension. ## Clinical Pearls * **Administration:** Take with food or milk to minimize GI irritation. * **Cardiovascular Warning:** Avoid in patients with established ischemic heart disease or peripheral arterial disease if possible; if necessary, use the lowest dose for the shortest duration. * **Pregnancy:** Avoid in the third trimester (after 30 weeks) due to risk of premature closure of the ductus arteriosus and oligohydramnios. * **Dosing Variation:** Always confirm exact dosing protocols with local institutional guidelines or current product labels, as pediatric formulations vary by concentration. *** *Disclaimer: This information is for educational purposes only and does not replace professional clinical judgment. Always verify current prescribing information, contraindications, and drug interactions via a reliable clinical database (e.g., Lexicomp, UpToDate) or the package insert before prescribing or administering medication.*