Ibuprofen

OVERVIEW

Ibuprofen is one of the most common NSAIDs due to its effectiveness in treating pain, fever, and inflammation. However, it is essential for users to follow the recommended dosage and consult healthcare providers about potential interactions and contraindications to ensure safe use.

DOSAGE

Adult Dosage

For Analgesia (pain relief): 200-400 mg every 4-6 hours as needed.

For Anti-inflammatory effects:

• 300 mg every 6-8 hours or
• 400-800 mg three to four times daily.

Maximum Dose:

• Over the counter (OTC): 1200 mg/day
• Prescription: Up to 3200 mg/day, divided into doses.

Pediatric Dosage

Pediatric Dosage

• For Fever (antipyretic):5-10 mg/kg every 6 hours, with a maximum of 40 mg/kg per day.
• For Anti-inflammatory effects:20-40 mg/kg/day, divided into 3-4 doses.

Specific Dosages by Age and Weight
Age/Weight	Liquid (100 mg/5 mL)	Chewable Tablets (50 mg)	Adult Tablets (200 mg)
3 to 5 months (weighing >5 kg)	2.5 mL (50 mg)	Not recommended	Not recommended
1 to 3 years	5 mL (100 mg)	2 tablets	Not recommended
4 to 6 years	7.5 mL (150 mg)	3 tablets	Not recommended
7 to 9 years	10 mL (200 mg)	4 tablets	Not recommended
10 to 11 years	15 mL (300 mg)	Not applicable	Not recommended
Ages 12 to 17	200-400 mg	Up to 6 tablets	Up to 2 tablets

MECHANISM OF ACTION

Inhibition of COX Enzymes:

• COX-1 is involved in the production of prostaglandins that protect the stomach lining and support platelet Role.
• COX-2 is induced during inflammation and is responsible for producing prostaglandins that mediate pain and inflammation.

Reduction of Prostaglandin Synthesis:

• By blocking COX enzymes ibuprofen decreases the condition of arachidonic acid (released from membrane phospholipids) into prostaglandins and thromboxane.
• This reduction leads to decreased inflammation pain and fever as prostaglandins are important mediators in these Methodes.

Effect on Pain and Inflammation:

• The analgesic (pain-relieving) effect is attributed to both peripheral actions at the site of inflammation and central effects in the brain where it modulates pain perception.
• The antipyretic (fever-reducing) effect is Although to result from action on the hypothalamus leading to increased peripheral blood flow and heat dissipation.

Additional Actions:

Ibuprofen may also influence other pathways involved in inflammation including potential effects on endogenous cannabinoid systems and NMDA receptors Even if these mechanisms are less well understood.

ADVERSE DRUG REACTIONS

Common Adverse Effects

Gastrointestinal Issues:

• Nausea
• Indigestion
• Heartburn
• Diarrhea or constipation
• Abdominal pain
• Gastrointestinal bleeding, ulcers, or perforation

Central Nervous System:

• Dizziness
• Headaches
• Tinnitus (ringing in the ears)

Dermatological Reactions:

• Skin rashes or irritation
• Increased sensitivity to sunlight

Serious Adverse Effects

Gastrointestinal Complications:

Serious gastrointestinal bleeding may occur, especially in people who have a history of ulcers or have used it for a long time. Symptoms may include black stools or blood in the vomit.

Renal Issues:

Decreased kidney function, which can cause symptoms such as swollen ankles or changes in urine output. This risk is especially high in individuals who already have kidney problems.

Cardiovascular Risks:

The risk of myocardial infarction (heart attack) and stroke is increased, especially with long-term use or high doses.

Respiratory Reactions:

Cases of bronchospasm and exacerbation of asthma symptoms, which may be serious and potentially fatal, have been reported.

Allergic Reactions:

Anaphylaxis is a rare but serious reaction that may manifest as difficulty breathing, swelling of the face or throat, and hives. If these reactions occur, immediate medical attention is required.

Other Reactions:

• Hepatotoxicity: Rare cases of liver damage have been documented.
• DRESS syndrome: Drug reaction (DRESS) syndrome with eosinophilia and systemic symptoms may occur, including fever, rash, and multiple organ involvement.

CONTRAINDICATION AND WARNING

Hypersensitivity: Known allergy to ibuprofen, other NSAIDs or aspirin. Patients with a history of severe allergic reactions should avoid ibuprofen.

Cardiovascular Conditions: Its use is contraindicated in patients undergoing coronary artery bypass graft (CABG) surgery due to the increased risk of cardiovascular events. Ibuprofen may increase the risk of serious cardiovascular events, including myocardial infarction and stroke, particularly with long-term use or in patients with pre-existing heart disease.

Gastrointestinal Issues: Patients with a history of active gastrointestinal bleeding, ulcers, or recurrent gastrointestinal problems should not use ibuprofen.

Renal and Hepatic Impairment: People who have severe kidney damage or liver disease should avoid ibuprofen as it can increase the risk of kidney damage and liver complications.

Asthma: Patients with a history of asthma attacks caused by NSAIDs or aspirin should not take ibuprofen, as it may make respiratory problems worse.

Preterm Infants: This intravenous formula is contraindicated for premature infants with certain congenital heart diseases because it requires an open patent ductus arteriosus (PDA).

Pregnancy Considerations: Its use during pregnancy after 20 weeks is generally not recommended, as it may cause potential harm to the fetus, including kidney complications and low levels of amniotic fluid.

Alcohol Consumption: Taking alcohol along with ibuprofen may increase the risk of gastrointestinal bleeding; hence, it is advised to avoid alcohol consumption while taking this medicine.

DRUG-DRUG INTERACTIONS

Warfarin: The risk of gastrointestinal bleeding may be increased when ibuprofen is taken with warfarin. It is important to monitor for signs of bleeding when these drugs are used together.

Aspirin and naproxen: Using them together may increase the risk of gastrointestinal side effects such as ulcers and bleeding. Using multiple NSAIDs together should generally be avoided.

ACE inhibitors and diuretics: Ibuprofen may decrease the effectiveness of these medications, potentially causing increased blood pressure or acute kidney injury. Close monitoring is recommended.

Lithium: Ibuprofen may increase plasma lithium levels by reducing renal clearance, increasing the risk of lithium toxicity. Close monitoring is necessary when these drugs are given.

Methotrexate: Taking high doses of methotrexate with ibuprofen may increase toxicity, which can particularly affect kidney function.

Antidepressants: SSRIs may increase the risk of gastrointestinal bleeding when taken with ibuprofen.

Corticosteroids: Taking ibuprofen with corticosteroids increases the risk of gastrointestinal complications.

Diabetes Medications: The effect of oral hypoglycemics may alter when taken with ibuprofen; hence it is advisable to monitor blood sugar levels.

Beta-Blockers: Ibuprofen may reduce the antihypertensive effect of beta-blockers, which may increase blood pressure.

Alcohol: Consuming it with alcohol increases the risk of gastrointestinal bleeding and liver damage.

USE

Pain Relief: Effective for mild to moderate pain, including headache, toothache, menstrual cramps, and musculoskeletal pain.

Fever Reduction: It is commonly used to reduce fever in adults and children.

Anti-inflammatory: It is used in the treatment of inflammatory conditions like arthritis (osteoarthritis and rheumatoid arthritis) and other musculoskeletal disorders.

Specific Conditions: May be prescribed for conditions such as acute pericarditis and gouty arthritis.