Ibuprofen

(eye-BYOO-pro-fen)

  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; max 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 health care provider. 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.

DERM:

Rash; pruritus; erythema.

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.

OTHER:

Muscle cramps.

  Precautions:

Pregnancy: 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 health care provider if visual changes or indications of GI distress or liver or renal impairment occur.
• Monitor patient's following cardiac status: BP, pulse (eg, quality and rhythm), edema, tachycardia, palpitations.
• Assess renal function before and during therapy. Monitor serum creatinine, Ccr, and BUN 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 health care provider 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 health care provider 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 health care provider 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.

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