Ibuprofen

 Action Decreases inflammation, pain, and fever, probably through inhibition of cyclooxygenase activity and prostaglandin synthesis.

 Indications Relief of symptoms of rheumatoid arthritis, osteoarthritis, mild-to-moderate pain, primary dysmenorrhea, reduction of fever. Unlabeled use(s): Symptomatic treatment of juvenile rheumatoid arthritis, sunburn, resistant acne vulgaris.

 Contraindications Hypersensitivity to aspirin, iodides, or any other NSAID.

 Route/Dosage

Rheumatoid Arthritis and Osteoarthritis

Adults: PO 300 to 800 mg tid to qid, not to exceed 3.2 g/day.

Mild-to-Moderate Pain

ADULTS: PO 400 mg q 4 to 6 hr prn.

Primary Dysmenorrhea

ADULTS: PO 400 mg q 4 hr prn.

Juvenile Arthritis

CHILDREN: PO 30 to 40 mg/kg/day in 3 to 4 divided doses.

Fever Reduction

CHILDREN 1 to 12 yr: £ 39.2° C (102.5° F) recommended dose PO 5 mg/kg; > 39.2° C (102.5° F) recommended dose PO 10 mg/kg; maximum daily dose 40 mg/kg.

OTC Use (Minor Aches/Pains, Dysmenorrhea, Fever Reduction)

PO 200 mg q 4 to 6 hr. Do not exceed 1.2 g in 24 hr or take for pain for > 10 days or for fever for > 3 days, unless directed by physician. Use smallest effective dose.

 Interactions

Beta-blockers: Antihypertensive effect may be decreased. Digoxin: Ibuprofen may increase digoxin serum levels. Lithium: May increase lithium levels. Loop diuretics: Diuretic effects may be decreased. Methotrexate: May increase methotrexate levels. Warfarin: May increase risk of gastric erosion and bleeding.

 Lab Test Interferences None well documented.

 Adverse Reactions

CV: Peripheral edema; water retention; worsening or precipitation of CHF. CNS: Dizziness; lightheadedness; drowsiness; vertigo; headaches; aseptic meningitis. EENT: Visual disturbances; photophobia; tinnitus. GI: Gastric distress; occult blood loss; diarrhea; vomiting; nausea; heartburn; dyspepsia; anorexia; constipation; abdominal distress/cramps/pain; flatulence; indigestion; GI tract fullness. GU: Menometrorrhagia; hematuria; cystitis; acute renal insufficiency; interstitial nephritis; hyperkalemia; hyponatremia; renal papillary necrosis. DERM: Rash; pruritus; erythema. OTHER: Muscle cramps.

 Precautions

Pregnancy: Pregnancy category undetermined. Lactation: Undetermined. Children: Safety and efficacy not established. Elderly: Increased risk of adverse reactions. GI effects: Serious GI toxicity (eg, bleeding, ulceration, perforation) can occur at any time, with or without warning symptoms. Renal effects: Increased risk of dysfunction in patients with preexisting renal disease.

 Administration/Storage

• Give medication soon after meals or with food, milk, or antacids to minimize GI irritation.

 Assessment/Interventions

• Obtain complete patient history, including drug history and any known allergies.
• Notify physician if visual changes or indications of GI distress or liver or renal impairment occur.
• Monitor patient's cardiac status: BP, pulse (quality and rhythm), edema, tachycardia, palpitations.
• Assess renal function before and during therapy. Serum creatinine, creatinine clearance, and BUN should be monitored in patients with renal impairment.
• Document any changes in liver function (AST, ALT), eye examinations and Hgb and Hct in patients on long-term therapy.
• Notify physician if indigestion, epigastric pain, unusual bleeding or bruising, or dark tarry stools occur.

 Patient/Family Education

• Tell patient to take medication soon after meals or with food, milk, or antacids.
• Tell patient to avoid alcohol and medications containing aspirin, such as cold remedies.
• Advise patient to discontinue drug and notify physician if any of the following occur: Persistent GI upset or headache, skin rash, itching, visual disturbances, black stools, weight gain or edema, changes in urine pattern, joint pain, fever, blood in urine.
• Instruct patient not to take otc preparation for > 3 days for fever and > 10 days for pain and to notify physician if condition does not improve.
• Advise patient that drug may cause drowsiness and to use caution while driving or performing other tasks requiring mental alertness.