Ibuprofen
Clinical Notes
Ibuprofen (Advil, Motrin) is a nonselective NSAID for pain, fever, and inflammation.
| Indication | Mild-moderate pain (headache, dental, menstrual, musculoskeletal); fever reduction; inflammatory conditions (osteoarthritis, rheumatoid arthritis); patent ductus arteriosus closure (IV in neonates); primary dysmenorrhea |
| Mechanism of Action | Nonselective COX-1 and COX-2 inhibitor; reduces prostaglandin synthesis peripherally (anti-inflammatory, analgesic) and centrally (antipyretic); reversible platelet inhibition; peripheral and central pain pathways affected |
| Pharmacokinetics | Oral bioavailability >80%; onset 30-60 min; peak 1-2 hours; duration 4-6 hours; half-life 2-4 hours; hepatic CYP2C9 metabolism; renal excretion; highly protein bound (99%); food delays but doesn’t reduce absorption |
| Dosing | Pain/fever OTC: 200-400mg q4-6h (max 1200mg/day); Rx: 400-800mg q6-8h (max 3200mg/day); Arthritis: 400-800mg TID-QID; Pediatric: 5-10mg/kg q6-8h; use lowest effective dose for shortest duration |
| Contraindications | NSAID/aspirin-sensitive asthma; perioperative CABG; active GI bleeding/ulcer; severe renal impairment; third trimester pregnancy; hypersensitivity |
| Adverse Effects | GI upset, dyspepsia, nausea, dizziness, headache; serious: GI bleeding/ulceration, cardiovascular events (MI, stroke), acute kidney injury, hypertension, serious skin reactions (SJS/TEN), hepatotoxicity |
| Drug Interactions | Anticoagulants – bleeding risk; aspirin – reduced cardioprotection if ibuprofen taken before; ACE/ARBs – reduced efficacy, AKI risk; lithium – toxicity; methotrexate – toxicity; SSRIs – bleeding; diuretics – reduced efficacy |
| Monitoring | GI symptoms; blood pressure; renal function (especially with ACE/ARB); CBC if prolonged use; LFTs if high-dose or prolonged; signs of bleeding |
| Other Considerations | Take with food to reduce GI upset; lowest CV risk among NSAIDs (but still elevated vs no NSAID); if taking aspirin for cardioprotection, take aspirin 30 min BEFORE ibuprofen; avoid in 3rd trimester (premature DA closure) |
| Reference | Ibuprofen prescribing information; FDA NSAID boxed warnings |
💊 Quick Tip: If taking aspirin for heart protection, take aspirin 30 minutes BEFORE ibuprofen to preserve cardioprotection! Lowest CV risk among NSAIDs.
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