Ibuprofen
Brand names: Motrin, Advil
Class: 🤕 NSAIDs & Analgesics
What examiners watch for is whether you can flag the patient who should not get an NSAID. Ibuprofen inhibits COX-1 and COX-2, treating mild-to-moderate pain, fever, dysmenorrhea, osteoarthritis, and rheumatoid arthritis flares. The trade-offs are GI bleeding, renal vasoconstriction, hypertension worsening, sodium retention, and antiplatelet effect. Avoid in CKD, heart failure, peptic ulcer disease, and the third trimester of pregnancy (ductus arteriosus closure). The classic triple-whammy vignette pairs ibuprofen with an ACE/ARB and a diuretic — that combination precipitates acute kidney injury. Take with food, use the lowest effective dose for the shortest duration, and counsel patients to avoid stacking OTC ibuprofen on a prescription NSAID.
✅ Indications
Mild-moderate pain, fever, dysmenorrhea, OA, RA, inflammation.
⚙️ Mechanism of Action
Non-selective COX inhibitor.
📏 Dosing
Adults: 400–800 mg PO q6–8h (max 3200 mg/day Rx, 1200 mg OTC). Peds: 10 mg/kg q6–8h.
🚫 Contraindications
3rd trimester pregnancy, severe CKD, active GI bleed, CABG perioperative, severe HF.
⚠️ Adverse Effects
GI bleed, AKI, HTN, hyperkalemia, ↑ CV events, bronchospasm in aspirin-sensitive asthma.
🔬 Monitoring
BP, renal function with chronic use; GI symptoms.
💎 Board Pearls
- 💥 TRIPLE WHAMMY — ACE/ARB + diuretic + NSAID = AKI (esp elderly, dehydrated, CKD).
- 💊 Add PPI for chronic NSAID use if high GI bleed risk (age >65, anticoag, steroid, prior ulcer).
- 🤰 Avoid 3rd trimester (ductus closure, oligohydramnios).
Practice Questions
A 33-year-old patient at 32 weeks gestation asks about taking ibuprofen for persistent low back pain. Which of the following is the MOST appropriate response?
Related Drugs in This Class
- Naproxen — Aleve, Naprosyn
- Acetaminophen — Tylenol, APAP, Paracetamol
- Ketorolac — Toradol
Sources
Ready to practice?
1,500+ AANP-style questions with rationales — free trial.