Nurofen contraindications and side effects. Nurofen instructions for use

When we or our children have a fever, flu and cold symptoms appear, we look into the first-aid kit and take medicines from there to help alleviate the signs of malaise. Recently, among such drugs, Nurofen has become widespread. However, not everyone knows about the features of this drug, in which cases it should be taken, and in which it should not.

Description of the drug

The active substance of Nurofen is ibuprofen, a derivative of phenylpropionic acid. This compound belongs to the class of non-steroidal anti-inflammatory drugs (NSAIDs) and was synthesized by British pharmacists as early as 1962 of the last century. Initially, ibuprofen was considered only a remedy for rheumatoid arthritis, but gradually its scope expanded. And since the 1980s, ibuprofen has become an over-the-counter drug, thanks to which its popularity has increased significantly. Now ibuprofen can be found in various medicines, but still the original drug, Nurofen, is considered the reference among all drugs containing ibuprofen.

Ibuprofen is a white crystalline powder, practically insoluble in water. This is a well-studied substance in terms of the mechanism of drug action and side effects, which has an impeccable evidence base. Ibuprofen is included in the WHO list of essential medicines and the list of vital drugs of the Russian Ministry of Health.

Nurofen, like other NSAIDs, has three types of action at once:

  • antipyretic,
  • painkillers,
  • anti-inflammatory.

Not all NSAIDs show all three of these effects equally. For some, the main effect is analgesic, for others it is antipyretic, for others it is anti-inflammatory. Nurofen combines all three effects approximately equally. In many ways, this explains the great popularity of Nurofen as a remedy for the symptomatic treatment of many infectious diseases and inflammatory processes.

From the point of view of biochemistry, ibuprofen belongs to the category of non-selective blockers of the cyclooxygenase enzyme. Due to this effect, the drug disrupts the synthesis of prostaglandins - the main mediators of inflammation in the body. Nurofen has both local and central action, blocking the synthesis of prostaglandins in the central and peripheral nervous system. Ibuprofen also has the ability to inhibit platelet aggregation. There is evidence of moderate immunomodulatory properties of the substance, the ability to stimulate the release of endogenous interferon, and increase the nonspecific resistance of the body.

When taken orally, the therapeutic properties of Nurofen are realized at the level of the whole organism. When using Nurofen gel, analgesic and anti-inflammatory properties appear only at the level of individual tissues that have come into contact with the drug.

Nurofen is effective against any kind of pain. The only exception is pain in the stomach and intestines, liver, spleen. Ibuprofen is most effective for inflammatory pain.

Pharmacokinetics

When taken internally, Nurofen is rapidly absorbed into the gastrointestinal tract. The action of the drug begins after about half an hour and lasts up to 8 hours. The time of maximum concentration in the blood when taken on an empty stomach is 45 minutes. When taken after meals, this time can increase and reach 1.5-2.5 hours. Nurofen slowly penetrates into the joints and lingers in the synovial fluid. As a result, the concentration of the drug in the synovial fluid can be significantly higher than in the blood plasma. In a small amount penetrates into breast milk. The half-life is 2-2.5 hours, for prolonged-release tablets it can be up to 12 hours. Nurofen in the form of a suspension has a slightly higher speed. Ibuprofen is excreted by the kidneys unchanged and in the form of conjugates.

Release form

There are many dosage forms of Nurofen. But the main one is tablets. The standard dosage of Nurofen is 200 mg.

There are also tablets with a dosage of 400 mg (Nurofen Forte), prolonged-release tablets (Nurofen Period), soluble tablets, lozenges (Nurofen Active). Nurofen is also available in the form of capsules (Nurofen Ultracap and Ultracap forte). Versions of Nurofen Express and Express Neo are fast-acting tablets.

Nurofen 5% gel is intended for external use.

There is also a suspension intended for the treatment of children under 6 years of age (with strawberry or orange flavor), children's rectal suppositories. Both forms of the drug are called Nurofen Children's.

Tablets Nurofen Plus and Nurofen Plus N, in addition to ibuprofen (200 mg), contain codeine (10 mg), which enhances the analgesic effect of the drug.

Of course, it is easy to get confused in such a wide range of Nurofen varieties. The main thing to remember is the dosage of each variety.

In the following varieties of Nurofen, the dosage is 200 mg:

  • Nurofen (tablets)
  • Nurofen Active (tablets)
  • Nurofen (soluble effervescent tablets)
  • Nurofen Ultracap capsules,
  • Nurofen Plus (tablets)
  • Nurofen Express (tablets).

Long-acting tablets Nurofen Period contain 300 mg of ibuprofen. And Nurofen Forte tablets and Ultracap Forte capsules contain as much as 400 mg of ibuprofen.

This information must be kept in mind in order to avoid an overdose of Nurofen. For example, it is acceptable to take 2 regular ibuprofen 200 mg tablets at a time, because even if these tablets are taken 3 times a day, the maximum allowable dose will not be exceeded. However, if you take 2 tablets of Nurofen Forte three times a day, it is easy to get an overdose of the drug with all the unpleasant consequences.

Children's Nurofen contains 60 mg of ibuprofen per suppository and 100 mg of ibuprofen per dose of suspension (5 ml).

Excipients in tablets:

  • croscarmellose sodium,
  • sodium lauryl sulfate,
  • sodium citrate dihydrate,
  • stearic acid,
  • colloidal silicon dioxide,
  • titanium dioxide,
  • sucrose,
  • macrogol,
  • gum,
  • talc.

Nurofen's analogs

In pharmacies, you can find many structural analogues of Nurofen, that is, drugs containing the same active substance:

  • Dolgit (gel and cream),
  • Ibuprofen (ointment and gel, tablets, suspension),
  • Advil (tablets, capsules, suspension),
  • Artrocam (tablets)
  • Bonifen (tablets)
  • Burana (tablets),
  • Deblock (tablets)
  • Motrin (tablets)
  • Ibuprom (tablets, capsules)
  • Ibusan (tablets)
  • Ibutop (gel and cream)
  • Ibufen (suspension)
  • Iprene (tablets),
  • Mig 400 (tablets),
  • Pedea (solution for intravenous administration),
  • Solpaflex (tablets),
  • Faspik (tablets and granules for solution).

Indications

Nurofen is used for many inflammatory and infectious diseases, accompanied by symptoms of inflammation, high fever and severe pain. It can be:

  • SARS,
  • pharyngitis,
  • rhinitis,
  • tonsillitis,
  • flu,
  • arthritis (rheumatoid, psoriasis, arthritis with systemic lupus erythematosus),
  • arthrosis,
  • myalgia,
  • neuralgia,
  • gastralgia,
  • injury,
  • migraine,
  • algomenorrhea,
  • rheumatism,
  • muscle and ligament damage,
  • gout,
  • ankylosing spondylitis,
  • bursitis,
  • tendinitis
  • postoperative pain,
  • adnexitis,
  • endometritis.

With rheumatoid arthritis, Nurofen has a more pronounced effect at the beginning of the inflammatory process. Ibuprofen has a less potent anti-inflammatory effect than ortofen and indomethacin, but is better tolerated.

Sometimes Nurofen is prescribed by gynecologists to reduce the contractility of the uterus with the threat of premature birth.

Nurofen Gel is indicated in the following situations:

  • muscle pain,
  • backache,
  • ligament damage,
  • injury,
  • neuralgia.
  • ARI and SARS,
  • flu,
  • reactions to vaccinations.

Contraindications

Like most other NSAIDs, Nurofen has many restrictions on its use. Conditions under which Nurofen should not be taken include:

  • severe renal and hepatic insufficiency;
  • bleeding in the gastrointestinal tract;
  • intolerance to NSAIDs;
  • severe heart failure;
  • exacerbation of erosive and ulcerative lesions of the gastrointestinal tract (gastric and duodenal ulcers, ulcerative colitis, Crohn's disease);
  • inflammatory bowel disease (enteritis and colitis);
  • pregnancy (1st and 3rd trimester);
  • severe stage of hypertension;
  • "aspirin" asthma;
  • urticaria or rhinitis caused by the use of acetylsalicylic acid;
  • diseases of the optic nerve, color vision disorders;
  • reduced blood clotting, hemophilia;
  • hemorrhagic diathesis;
  • hearing loss;
  • previously performed coronary artery bypass grafting;
  • age up to 6 years (for tablets);
  • age up to 12 years (for capsules);
  • age up to 3 months (any form of the drug);
  • hyperkalemia;
  • pathology of the vestibular apparatus;
  • bronchial asthma (in children).

With caution, Nurofen is taken in the following situations:

  • under the age of 3 years,
  • in the 2nd trimester of pregnancy,
  • with hypertension,
  • during breastfeeding,
  • with cirrhosis of the liver with portal hypertension,
  • with hyperbilirubinemia,
  • with a history of ulcerative diseases of the gastrointestinal tract,
  • with ischemic heart disease,
  • with diabetes,
  • when smoking
  • with alcoholism,
  • when infected with Helicobacter pylori,
  • with leukopenia,
  • with anemia,
  • with systemic lupus erythematosus (risk of aseptic meningitis),
  • with moderate renal failure (creatinine clearance 30-60 ml / min),
  • in old age.

For the treatment of children, Nurofen should be used after the recommendation of a doctor.

Use of Nurofen during pregnancy

In the first trimester of pregnancy, Nurofen should not be used due to possible genetic abnormalities in the development of the fetus. In the third trimester, taking Nurofen can provoke such a complication in the fetus as open ducts between the ventricles of the heart, as well as postnatal and complication of childbirth. On the other hand, Nurofen can be prescribed to those pregnant women who are at risk of preterm birth.

From 13 to 27 weeks, it is advisable to take the drug under medical supervision. In addition, the maximum dosage for pregnant women is 800 mg per day.

Side effects

Side effects when taking the drug in therapeutic doses and for a short time (2-3 days) are quite rare. Possible side effects include:

  • stomach ache;
  • heartburn;
  • diarrhea;
  • nausea and vomiting;
  • allergic reactions (skin rash, itching, urticaria, rhinitis, anaphylactic shock, angioedema, bronchospasm;
  • increase in pressure;
  • visual and hearing impairments, double vision;
  • erosive and ulcerative lesions of the gastrointestinal tract;
  • dryness of the oral mucosa;
  • headache;
  • dizziness;
  • insomnia or drowsiness;
  • excitement or depression;
  • confusion, hallucinations;
  • tinnitus;
  • tachycardia;
  • dryness, swelling and irritation of the conjunctiva;
  • gum ulceration;
  • aphthous stomatitis;
  • pancreatitis;
  • hepatitis;
  • aseptic meningitis (in people suffering from autoimmune diseases);
  • acute renal failure, nephritis;
  • polyuria;
  • anemia;
  • changes in blood composition (thrombocytopenia, thrombocytosis, agranulocytopenia, leukopenia, eosinophilia);
  • dyspnea;
  • increased sweating.

Not always the above reactions (except allergic) are observed immediately after the start of the drug. Serious side effects may appear around 4-5 days of treatment. With prolonged use (for several months), the most likely development of ulcers and bleeding in the gastrointestinal tract, visual impairment. Studies have also shown that long-term use of Nurofen increases the risk of cardiac arrest and myocardial infarction.

When applying the gel, systemic adverse reactions are not typical. Although local allergic reactions, skin itching and redness of the skin can be observed.

Interaction with other drugs

In some cases, Nurofen may enhance or, conversely, mitigate the effect of other drugs.

It is not recommended to use Nurofen simultaneously with acetylsalicylic acid, as this neutralizes the therapeutic effect of the latter. Patients taking acetylsalicylic acid preparations as an anticoagulant should be aware that the simultaneous use of Nurofen with them increases the risk of coronary heart disease.

It is not recommended to take Nurofen together with alcohol, selective serotonin reuptake inhibitors. The latter increase the risk of stomach bleeding. In addition, concomitant use with ethanol, tricyclic antidepressants and barbiturates increases the risk of liver damage.

Ibuprofen reduces the effectiveness of furosemide and hydrochlorothiazide, some antihypertensive drugs, such as ACE inhibitors. In addition, the combination of these drugs with ibuprofen increases the risk of kidney damage.

Simultaneous reception of Nurofen with cardiac glycosides contributes to the aggravation of heart failure.

The drug enhances the side effects of glucocorticosteroids, ethanol, estrogen, increases the hypoglycemic effect of antidiabetic drugs and insulin, increases the concentration and enhances the effectiveness of methotrexate.

Antacids reduce the absorption of ibuprofen.

With simultaneous use with anticoagulants and thrombolytics, the risk of bleeding increases.

Cyclosporine, when used simultaneously with the drug, enhances the synthesis of prostaglandins in the kidneys, which increases the nephrotoxic effect of ibuprofen. The plasma concentration of cyclosporine is also increased, and this can lead to liver damage.

Caffeine enhances the analgesic effect of the drug.

Instructions for use

In most situations, one 200 mg tablet should be taken 3 to 4 times daily. In some cases, with severe pain, with painful menstruation, a large dose of 400 mg may be prescribed. The drug in such situations should also be used 3 times a day. The maximum daily dose is 1200 mg.

Long-acting tablets (Nurofen Period) should be taken no more than 2 times a day. The interval between doses should be at least 12 hours.

Duration of admission depends on the disease. If Nurofen is used as an antipyretic for infectious diseases, it should be taken only when it is really required, that is, the patient has a high temperature that threatens his health. In most cases, this temperature is +38.5 °C. A lower temperature should not be brought down with antipyretics, as it is a factor that stimulates the immune system. Although, of course, nothing terrible will happen if a person takes an antipyretic at subfebrile temperature once in order to be normal at an important moment for him, for example, heading to an important meeting. However, this approach should not be applied systematically.

The same applies to taking the drug as an anesthetic - as soon as the pain recedes, the drug should be interrupted. And even more so, taking the drug as a “prophylactic” remedy for influenza and SARS is unacceptable, since Nurofen has no effect on pathogens of infectious diseases, and its value in this capacity is zero.

However, in some cases, Nurofen has to be used on an ongoing basis. Such diseases include osteoarthritis, arthritis (ankylosing spondylitis, rheumatoid arthritis, including juvenile), soft tissue injuries. The dosage in such cases may also be different.

For osteoarthritis, ankylosing spondylitis, it is 400-600 mg three-4 times a day. The same dosage for soft tissue injuries. In rheumatoid arthritis, a single dosage is 800 mg. The drug should be used 3 times a day. In juvenile rheumatoid arthritis, the daily dosage is calculated based on body weight - 30-40 mg / kg of weight. The calculated dosage is divided into 3-4 doses.

Tablets (with the exception of soluble ones) and capsules should be swallowed with water. The optimal time to take tablets and capsules is after a meal. If you take the drug before meals, then this can lead to negative reactions from the gastrointestinal tract.

Soluble tablets are diluted in half a glass of water.

The drug in tablets can only be taken by children weighing more than 20 kg. Otherwise, a suspension should be used.

Instructions for using the gel

The gel is suitable only for the treatment of patients over 12 years of age. Squeeze out 4-10 cm of gel from the tube and rub it around the area of ​​​​inflammation until it is completely absorbed into the skin. After the gel has been applied to the skin, wash your hands with soap and water. You should also carefully avoid getting the drug on the mucous membranes of the eyes, mouth and nasopharynx. Also, you can not apply the gel on the area around the eyes and lips, on open wounds.

The maximum number of episodes of using the gel is 4 times a day, the minimum interval between episodes of use is 4 hours. Treatment with the gel can be carried out for no longer than two weeks. If after this time the patient's condition has not improved, then he should consult a doctor.

The use of suppositories

Rectal suppositories are preferable if the child cannot take the suspension for some reason (vomiting, intolerance to the components of the suspension, etc.). In addition, candles are faster than suspensions.

The dosage of the drug in the form of suppositories depends on the body weight of the child. A single dose is 5-10 mg/kg. Suppositories can be used 3-4 times a day. The maximum daily dose is 30 mg/kg.

Children aged 3-9 months are prescribed suppositories at a dosage of 60 mg (1 pc) 3 times a day after 6-8 hours. Children aged 9-24 months are prescribed 1 suppository 4 times a day.

Duration of treatment - no more than 3 days as an antipyretic, no more than 5 days as an anesthetic.

Suspension application

Shake the suspension thoroughly before use. Each vial is supplied with a double-sided measuring spoon (2.5 and 5 ml) and a dosing syringe.

With fever and pain in children, the suspension is given in such a way that the amount of ibuprofen would be 5-10 mg / kg of body weight. The maximum daily dose is 30 mg/kg.

Or you can determine the maximum daily dose from the table below:

In the event that the desired therapeutic effect is achieved with a lower dosage, then it should be used. But it is impossible to exceed the above values.

For immunization fever, the suspension is given at a dosage of 50 mg ibuprofen. The maximum daily dosage should not exceed 100 mg.

Overdose

When using the gel, an overdose is not possible. With an overdose of tablets, the main symptoms are:

  • abdominal pain,
  • nausea,
  • vomit,
  • drowsiness,
  • lethargy,
  • lowering blood pressure,
  • bradycardia or tachycardia,
  • atrial fibrillation,
  • acute renal failure.

In severe cases, respiratory arrest and coma may occur.

In case of overdose, the patient should be induced to vomit or gastric lavage should be carried out. If a lot of time has passed since taking the pills (more than an hour), then these measures will most likely not be effective. Therefore, it is recommended to use activated charcoal and other sorbents, plentiful alkaline drinking and diuretics, as well as symptomatic therapy aimed at maintaining the functions of the main organs.

Nurofen and paracetamol

Ibuprofen and paracetamol are often used together because one drug complements the benefits of the other. Ibuprofen has moderate antipyretic properties, while paracetamol, unlike ibuprofen, has weak anti-inflammatory properties. However, it should be remembered that the combined use of both drugs during pregnancy increases the risk of abnormalities in male infants (cryptorchidism). The same can be said about the simultaneous use of Nurofen and aspirin.

Many parents do not know which drug to prefer - paracetamol or Nurofen, for the symptomatic treatment of acute respiratory infections and influenza in children. Currently, paracetamol is recognized as the most effective and safe drug for use in children. This is recognized, among other things, by the manufacturers of Nurofen. However, Nurofen may be preferred over paracetamol in some cases. First, it has a more pronounced anti-inflammatory effect. In addition, Nurofen has a faster and longer duration of action compared to paracetamol and has less effect on the liver.

special instructions

One soluble tablet of Nurofen contains 1.5 g of potassium bicarbonate. This circumstance should be taken into account by patients on a hypokalemia diet. One regular tablet contains 40 mg sodium saccharinate and 376 mg sorbitol. This should be considered by patients suffering from diabetes and fructose intolerance.

Due to possible side effects associated with the activity of the central nervous system, taking the drug in any form (with the exception of the gel), it is not recommended to drive vehicles and engage in other activities that require increased attention.

During the period of treatment with Nurofen, it is best to refrain from drinking alcohol. If it is necessary to take glucocorticosteroids, it is necessary to cancel Nurofen two days before the start of glucocorticosteroid therapy.

If Nurofen therapy is carried out on an ongoing basis, then it is necessary to take general and biochemical blood tests every 1-2 weeks to determine the concentration of liver enzymes, urea and creatinine. It is also necessary to monitor the condition of the stomach. If abnormalities appear, treatment with Nurofen should be interrupted.

We always have first aid medicines at hand, which include Nurofen. When an inflammatory process occurs, the temperature rises or pain appears, we turn to rescue pills. Despite the fact that Nurofen can help relieve the symptoms of various diseases, it can also lead to side effects. Especially if you take the drug in large doses than necessary. This leads to and requires quick help.

What is Nurofen?

Nurofen is a drug, a representative of the group of non-steroidal anti-inflammatory drugs. Its action is aimed at relieving inflammation, lowering fever and pain relief. It is produced under different names and in various forms, among which there are such types:

  • tablets,
  • effervescent tablets,
  • lozenges,
  • suspensions,
  • capsules,
  • candles,
  • gels for external use.

Nurofen is for children and adults. Children's Nurofen is made in the form of suspensions or syrups, as well as suppositories. It can be taken by children from three months.

The composition of this drug usually includes ibuprofen in varying amounts. Ibuprofen itself has antipyretic and analgesic effects on the body. This tool is one of the most important medicines of the World Health Organization, as its effectiveness has been proven. The strongest analgesic effect has Nurofen, which also contains. This component is an opium alkaloid with a pronounced antitussive effect. Such varieties contribute to the most correct selection of the drug for the symptomatic treatment of certain diseases.

Nurofen is used to relieve symptoms in such diseases:

  • SARS,
  • flu,
  • toothache,
  • headache,
  • muscle and joint pain,
  • menstrual pain,
  • sore throat,
  • migraine,
  • neuralgia,
  • muscle and ligament injury,
  • sports injury.

The action of Nurofen in the body occurs by blocking the work of biologically active substances that lead to inflammation, fever and pain syndromes. It relieves these symptoms by affecting the body's production of substances such as prostaglandins, which cause pain, inflammation in the tissues and heat, either in the injured area or throughout the body.

Nurofen can be taken in three ways:

  • ingestion (when we drink medicine),
  • rectally (through the rectum)
  • locally (by applying the gel to the affected area).

The first two methods contribute to the effect of the drug in all inflamed or painful tissues and organs, to reduce the temperature throughout the body. Gels that are applied only to the affected areas of the skin relieve symptoms only in this skin and tissues under it.

When to use Nurofen for adults and children?

The action of Nurofen is aimed at symptomatic therapy. This drug does not fight the cause of the disease. Therefore, it is usually prescribed as an adjunct to other medications or procedures. This tool is shown for the following problems:

  • types of arthritis
  • gout,
  • ankylosing spondylitis,
  • neuralgic amyotrophy,
  • pain syndromes of various nature,
  • postoperative pain,
  • cancer pain,
  • pain during the menstrual cycle,
  • painful inflammation in the pelvic area,
  • labor pains,
  • the threat of premature birth (stops uterine contractions),
  • temperature during colds or infectious diseases.

Nurofen, which is used orally, has such an effect. The drug, which is applied to the skin, can be used for ligament injuries, sports injuries, arthritis, neuralgia, back and muscle pain.

Nurofen, intended for children, helps to reduce fever in young organisms with certain diseases:

  • flu,
  • reactions after vaccinations,
  • childhood infectious diseases.

It also acts as an anesthetic for children with sore throats and ears, with toothaches, headaches, migraines, neuralgia and post-traumatic phenomena in the joints, bones, tendons, muscles and ligaments.

Areas where Nurofen has no effect are pain in the liver, spleen and organs of the digestive system.

Side effects of Nurofen

Like all medicines, this medicine can cause side effects, which are many. Nurofen, used orally, can cause such complications in the gastrointestinal system:

  • heartburn,
  • nausea,
  • vomit,
  • flatulence,
  • diarrhea,
  • constipation,
  • abdominal pain,
  • anorexia,
  • erosions and ulcers on the mucous membranes of the digestive system,
  • dry mouth
  • mouth irritation,
  • ulcerative formations on the gums,
  • aphthous stomatitis,
  • pancreatitis,
  • hepatitis.

From the side of the central nervous system, the consequences are possible:

  • disturbance of consciousness
  • drowsiness,
  • insomnia,
  • dizziness,
  • headache,
  • excited state
  • depression,
  • hallucinations,
  • aseptic meningitis in those with autoimmune diseases.

In the cardiovascular system, there may be the following disorders:

  • increase in blood pressure,
  • tachycardia,
  • heart failure.

The respiratory system can respond with such problems:

  • dyspnea,
  • bronchospasm.

Changes in the circulatory system are possible:

  • low platelets,
  • thrombocytopenic purpura,
  • low white blood cell count
  • low levels of neutrophils, basophils and eosinophils,
  • anemia.

The urinary system can be affected in this way:

  • cystitis,
  • nephritis,
  • polyuria,
  • nephrotic syndrome,
  • acute renal failure.

Nurofen can damage the perception of the senses, which is expressed in the following clinical picture:

  • blurred vision,
  • doubling of objects in the eyes,
  • irritation of the mucous membrane of the eyes,
  • dryness of the mucous membrane of the eyes,
  • reversible optic neuritis,
  • swelling of the conjunctiva
  • scotoma,
  • hearing loss,
  • noise in ears.

Allergies may occur:

  • itching sensation,
  • skin rash,
  • hives,
  • runny nose,
  • angioedema,
  • anaphylactic shock,
  • fever,
  • erythema multiforme exudative,
  • lyell syndrome,
  • eosinophilia.

There may also be profuse sweating.

An overdose of Nurofen can cause these side effects. Erosion and bleeding on the mucous membranes may also occur.

The reaction to Nurofen gel can cause not only allergies and bronchospasm, but also redness, tingling and burning sensation in the place where the remedy was applied.

Particular attention should be paid to the negative manifestations of Nurofen in children.

From the digestive tract:

  • decreased appetite,
  • bloating,
  • nausea,
  • vomit,
  • pain in the stomach,
  • diarrhea,
  • ulcerative formations of the mucous membranes of the digestive organs,
  • bleeding of the digestive tract.

From the side of the central nervous system:

  • psychomotor agitation,
  • dizziness,
  • headache,
  • insomnia.

From the side of the circulatory system, there is a decrease:

  • platelets,
  • leukocytes,
  • neutrophils,
  • basophils,
  • eosinophils.

From the urinary system:

  • cystitis,
  • problems in the work of the kidneys.

Allergic reactions:

  • skin rash,
  • hives,
  • bronchospasm,
  • fever,
  • lyell syndrome,
  • multiform exudative erythema.

If the above symptoms occur, this may indicate an overdose of the drug. In any case, you need to see a doctor, especially if a child is injured.

Actions in case of Nurofen overdose

To avoid poisoning with Nurofen, you need to carefully follow the doctor's recommendations, be careful when combining it with other medicines. The appearance of side effects that are outlined above may indicate poisoning due to an overdose. Adults may experience seizures and even coma. Symptoms of childhood poisoning are similar to intoxication in adults. When such signs appear, it is necessary to provide first aid, which consists in certain actions:

  • rinsing the throat and mouth with water at room temperature,
  • inducing vomiting (if the child is more than five years old) by pressing on the root of the tongue,
  • reception
  • bed rest until the ambulance arrives.

Nurofen poisoning can lead to various diseases of the nervous and genitourinary systems, chronic bronchitis, pancreatitis and jaundice, as well as allergies. Therefore, urgently contact doctors who will help restore the body, especially when it comes to children.

When should Nurofen not be used?

Nurofen has contraindications:

  • individual intolerance to the components of the drug,
  • optic nerve diseases
  • gastric and duodenal ulcer,
  • ulcerative colitis,
  • arterial hypertension,
  • heart failure.

With all these diseases, this drug can not be used. Also, you do not need to apply the gel to areas of the skin where there is at least the slightest damage.

To avoid negative consequences from taking Nurofen, do not exceed the dose recommended by your doctor, do not use the drug with an expired expiration date or damaged packaging. Keep the medicine out of the reach of children.

Conclusion

Nurofen is an effective remedy in the fight against inflammation, fever and pain in various diseases and injuries. But any medicine should be taken with caution. Side effects from Nurofen cause serious health problems for both adults and children. Therefore, do not neglect the advice of a doctor and do not self-medicate. If you experience adverse reactions that may indicate an overdose, contact your doctor immediately. And remember that even such a popular drug has contraindications. Use your medicines wisely!

Fedor Katasonov

GMS Pediatrician I hate to repeat what other respected doctors have written so many times already, but the principle of writing posts for Pediatrics is simple: I answer the request. If the number of identical questions (gaps in the knowledge of parents) exceeds a critical mass, this gives rise to a post. Therefore - a post about fever. Pardon his banality. Please save it somewhere and remember next time before asking me one of these questions.

How to measure temperature?

I prefer a contact electronic thermometer, which is placed under the arm. After he squeaks, he must be held for another 3-4 minutes, but few people know about this, because they do not read the instructions. After that, the readings will be approximately equal to those on the standard - a mercury thermometer. Non-contact thermometers and measurements in the mouth and in the anus, I do not recommend.

Why measure temperature?

The measurement is primarily of diagnostic value. We have a slightly different approach to conditions where the temperature is above or below the conditional limit of 38 degrees Celsius. Since most fevers in our latitudes go away on their own within 3 days, in the absence of threatening symptoms, I recommend observation within 72 hours after the first rise in temperature above 38. If after this period it again rises above 38, a doctor's examination is necessary to decide whether whether it is a protracted virus (and we continue to observe) or more aggressive intervention is required. Thus, we measure the temperature to determine the tactics of treatment, but not to resolve the issue of fever.

How do you decide if you need to lower the temperature?

The answer is simple, regardless of the cause of the temperature. It doesn't matter if it's due to an infection or a post-vaccination reaction or teething or other causes. We lower the temperature when the child is unwell. There is nothing so useful in a rise in temperature that it is tolerated, and nothing so harmful that it is necessary to take medicine when feeling normal. Therefore, when solving the issue of fever reduction, we look not at the thermometer, but at the child. If he is unwell, he is breathing heavily, lethargic, his muscles or his head hurt - you even lower 37.8. But if you can't catch up with a 38.8 kid to give him medicine, then there's no need for it.

How to lower the temperature?

Since only parents of small children ask this question, I will not write about drugs for older children. Toddlers have only three home remedies to lower their temperature: the physical method, paracetamol (acetaminophen), and ibuprofen.

If the child’s arms and legs are warm, they should be undressed, hung with wet towels, wiped with water at room temperature, wrapped in a wet handkerchief, or even put in a cool shower. To give or not to give at the same time the medicine is your choice, you have the right to give and wait. (You can also give the medicine and not use the physical method.) Depends on the level of your panic and the behavior of the child. Small children cool themselves perfectly, sometimes it is enough just to free them from clothes.

If the hands and feet are cold - a vasospasm has begun - the physical method is not recommended, and only medicines remain here.

What form of the drug to use?

It's not very important. Syrups with paracetamol (Panadol, Calpol, Tylenol, etc.) or ibuprofen (Nurofen, Advil) are easier to dose. Suppositories (Panadol, Efferalgan, Cefecon with paracetamol or Nurofen with ibuprofen) are good when the child cannot drink the syrup (vomiting, allergy to supplements). It seems to me that it is enough to have paracetamol suppositories at home for low temperatures (up to 39) and Nurofen syrup for more pronounced fevers.

How to dose them?

The easiest way to dose Nurofen: syrup dose (ml) = ½ weight (kg). This is based on a single dose of 10 mg/kg. On the box of Nurofen, however, some nonsense is written about the dosage by age. This is dangerous because children of the same age weigh very differently. Properly dose drugs by weight or body surface area, but not by age. Such a single dose of Nurofen can be given no more than once every 4 hours, but preferably no more than 3 times a day. Paracetamol is dosed at 15 mg/kg, but the instructions for paracetamol preparations are more adequate than for Nurofen. It is quite possible to navigate them. If you dose the most popular syrup - Panadol - you can multiply the child's weight in kg by 0.625. This will give you the amount of ml of syrup for a single dose. The intervals and multiplicity are the same as for Nurofen.

What to do if an hour has passed and the temperature does not drop?

First, evaluate your well-being. If it has improved, the numbers are not important to us. Secondly, even if the temperature has not decreased, the spasm must have gone away, and a physical cooling method can be connected. Thirdly, if the need for antipyretics still remains, 1.5-2 hours after the first, you can give a second drug, for example, Nurofen after Panadol. However, an adequate dose of Nurofen reduces the temperature almost always.

When to call an ambulance?

You don't need to call an ambulance. No isolated rise in temperature is a reason to call an ambulance. Isolated means that there are no other threatening symptoms, such as a vague rash, severe shortness of breath, or bulging of the fontanel. Yes, an ambulance can always lower the temperature - with a lytic mixture or a hormone, but there is no need for this and it can be harmful. The drug that forms the basis of the lytic mixture - analgin (metamisole) - is prohibited in children throughout the civilized world. In addition, the ambulance will most likely start to scare you and drag you to the hospital. Fever is not an emergency. If she worries you, lower the temperature and go to the doctor. Or call the doctor at home in a planned manner.

So, should I sit back while the baby has a fever?

Make a delicious drink for your child, sit next to him and read a book.

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) in 1962 under the code BTS 13621.

The drug was registered on January 12, 1962 by the British Patent Office under the name "Brufen". It began to be used as a prescription drug for the treatment of rheumatoid arthritis.

Since 1974, ibuprofen has been used in the United States under the trade name Motrin as an analgesic and antipyretic drug.

In 1983, Nurofen (ibuprofen) received OTC status for the first time in the UK. The success of Nurofen was truly amazing - by the end of 1985, more than 100 million people were using this drug.

The brightest moment in the history of ibuprofen was in 1985, when Boots was awarded the Queen's Award in recognition of the scientific and technological advances in the development of this drug.

Today, ibuprofen is available in more than 120 countries and is effectively used in the treatment of various kinds of pain and fever by millions of people.

At the Symposium of Pediatricians on Pain (Vancouver, Canada, August 2006), the manufacturer of the original ibuprofen admitted that the effectiveness of the drug is inferior to paracetamol in therapeutic doses, which means that ibuprofen, both on the recommendation of the World Health Organization and on the recommendations of the Ministry of Health of Russia, remains the second choice drug for the treatment of fever and pain in children (paracetamol has been and remains the drug of first choice for the treatment of fever and pain in adults and children from 2 months of age).

It so happened that my treasure Seryozhka fell ill on his birthday

in the evening his temperature rose and mommy gave him nurofen, it was a terrible mistake, it didn’t work, the temperature didn’t drop at all, then I took a bowl of warm water and a diaper in the old fashioned way, it was not difficult to wrap Sergey in a wet diaper, I still have him small, and sat up all night, rinsing the diaper hot from the heat in water, and from time to time using the “titkavrot” method, in the morning, i.e. eight hours later, my bad head gave another dose of this poison, either nurofen still worked, or rubdown helped the fever subsided a little and we both fell asleep, and on the afternoon of December 31, leaving my son and daddy, I went shopping, well, I really wanted to meet new year as a normal family with a smart Christmas tree, tangerines and Russian olives (I managed to cook fruit drinks while Sergey Sr. was at work) I arrive loaded in three hours, I am met by panicked people.

Grandmother runs around with the phone calling an ambulance, Sarochka sobs and rushes to the bathroom then to the room, Sergey Sr. keeps Sergey Jr. in the bath and washes his nose with cold water - the child has a fever, blood from the nose and vomited with blood before the nose bleed .

Mom first reassured her daughter that her brother would not die and nothing would happen to him, then an ambulance was called for her grandmother, everything would be all right, then my husband came!

Two hours later, an ambulance arrived, the doctor, a calm young girl, liked the younger so much during the examination =) rolled his vehicles to her, sat side by side, dangling his legs and inspiredly told her about his adventures =)

The doctor reassured me that the bleeding was caused by the action of Nurofen, recommended changing the prescribed treatment, and in general it would be great to have a nebulizer, which was done by grandfather - on the next working day, grandfather went to the pharmacy and now we have this miracle of technology.

I looked online and this is what I found:

95% of sick children with acute respiratory infections and acute respiratory viral infections need the use of antipyretics. Antipyretic drugs are widely used, which are classified as non-opioid analgesics (analgesics-antipyretics). They are divided into non-steroidal anti-inflammatory drugs (NSAIDs) and "simple analgesics" (paracetamol or acetaminafen). Paracetamol has almost no anti-inflammatory effect, unlike NSAIDs (ibuprofen).

Nurofen Or paracetamol?

Today, only paracetamol and ibuprofen meet the criteria for strict safety and high efficacy. Therefore, they are officially recommended by the National programs of the Russian Federation in pediatric practice and WHO as antipyretics. The antipyretic effect of paracetamol and ibuprofen is comparable.

Paracetamol acts mainly in the central nervous system, affects the centers of thermoregulation and pain, inhibiting the synthesis of prostaglandins. This explains the pronounced analgesic, antipyretic effect and low anti-inflammatory.

Ibuprofen inhibits the biosynthesis of prostaglandins not so much in the central nervous system as in peripheral inflamed tissues, which leads to the addition of an anti-inflammatory effect to the antipyretic and analgesic effect. When peripheral inflammation is expressed, the effectiveness of paracetamol is insufficient. Here it is more expedient to use NSAIDs based on ibuprofen.

Ibuprofen effectively reduces fever. Its antipyretic effect begins quickly (15-25 minutes), simultaneously with paracetamol, and lasts longer (6-8 hours). Repeated use of ibuprofen to control hyperthermia is much less common than with paracetamol. Ibuprofen is better than paracetamol at reducing critically high temperatures. The antipyretic effect of ibuprofen at a dose of 10 mg/kg is more pronounced than that of the same dose of paracetamol.

When choosing an antipyretic, you need to pay attention to the ease of administration and the availability of dosage forms for children of all ages. Taste properties, appearance and method of administration of the drug is very important for the child. In pediatrics, dosage forms of suppositories, syrups and suspensions are most often used. Ibuprofen and paracetamol are available in all of these forms.

Thus, ibuprofen and paracetamol have their own advantages in different clinical situations with different causes of fever. In the event of a sudden critical temperature, the emergency use of any of these agents (taking into account contraindications) will be justified, and subsequent treatment should be agreed with the pediatrician, who will help make the right choice.

Why is Nurofen dangerous?

Ibuprofen is well tolerated, but has side effects, which are usually associated with excess recommended doses and prolonged unreasonable therapy. May appear:

dyspepsia (nausea, vomiting or diarrhea) and intestinal erosion; headache, dizziness, sleep disturbances; increased blood pressure, tachycardia; changes in the blood formula (cytopenic conditions); skin allergies, angioedema, bronchospasm, anaphylaxis; dysfunction of the kidneys, liver, etc.

When taking the recommended dosages of the drug, complications practically do not develop. At the slightest side effects, ibuprofen is canceled. If accidental poisoning occurs (for example, a child drank syrup), you need to call an ambulance, and before it arrives, induce vomiting by drinking plenty of water.

When is Nurofen contraindicated?

with hypersensitivity to the components of the drug or any NSAIDs; with allergic bronchospasm and rhinitis, an allergic history after the use of aspirin or other NSAIDs; with bleeding and coagulopathy with clotting disorders; with ulcers of any part of the intestine (including those cured); with an allergy to fructose. Suspension is contraindicated up to 3 months. Suppositories are contraindicated in children ≤ 6 kg.

What else do you need to know about Nurofen?

When taken simultaneously with aspirin or anticoagulants, the risk of side effects increases. They potentiate each other's action.

Simultaneous administration with drugs that reduce blood pressure and diuretics reduces their effectiveness.

Increases the concentration of methotrexate and lithium preparations in blood plasma.

Compound

One coated tablet contains the active substance:

200 mg ibuprofen;

excipients: croscarmellose sodium 30 mg, sodium lauryl sulfate 0.5 mg, sodium citrate dihydrate 43.5 mg, stearic acid 2.0 mg, colloidal silicon dioxide

Shell composition: sodium carmellose 0.7 mg, talc 33.0 mg, acacia gum 0.6 mg, sucrose 116.1 mg, titanium dioxide 1.4 mg, macrogol 6000 0.2 mg, black ink [Opacode S-1 - 277001JND*.

*(The inscription Nurofen is applied in black ink [Opacode S-1-277001JND - (shellac, iron dye black oxide (E172), propylene glycol, isopropanol **, butanol **, ethanol **, purified water **.

** Solvents evaporated after the printing process)

Description

White or off-white, round, biconvex film-coated tablets with Nurofen black overprint on one side of the tablet.

pharmachologic effect

The drug belongs to non-steroidal anti-inflammatory drugs (NSAIDs). Nurofen® has analgesic, antipyretic and anti-inflammatory effects. Indiscriminately blocks COX1 and COX2. The mechanism of action of ibuprofen is due to inhibition of the synthesis of prostaglandins - mediators of pain, inflammation and hyperthermic reaction.

The decrease in temperature during fever begins 30 minutes after ingestion, its maximum effect is manifested after 3 hours.

The leading analgesic mechanism is a decrease in the production of prostaglandins of classes E, F and I, biogenic amines, which leads to the prevention of the development of hyperalgesia at the level of changes in the sensitivity of nociceptors. The analgesic effect is most pronounced in inflammatory pain. Pain relief is felt within 15 minutes after taking ibuprofen.

The anti-inflammatory effect is due to inhibition of cyclooxygenase (COX) activity. As a result, the synthesis of prostaglandins in inflammatory foci. This leads to a decrease in the secretion of inflammatory mediators and a decrease in the activity of the exudative and proliferative phases of the inflammatory process.

Pharmacokinetics

Absorption is high, the connection with plasma proteins (mainly with albumins) is more than 90%. The high degree of protein binding results in a relatively low volume of distribution (0.1 l/kg). Although ibuprofen actively binds to albumin, this does not affect drug interactions.

The time to reach the maximum concentration in plasma Tmax - 1-2 hours. The half-life is 2 hours. In the elderly (over 65 years), the half-life of the drug increases, the total clearance decreases. According to some reports, infants aged 6-18 months have a higher Tmax (3 hours). It is believed that in children the half-life of ibuprofen does not differ significantly from the value established for adults.

Eating slows down the absorption of ibuprofen, but does not reduce its bioavailability. When taken with food, Tmax increases by 30-60 minutes compared to fasting and is 1.5-3 hours.

Ibuprofen slowly penetrates into the joint cavity, lingers in the synovial tissue, creating higher concentrations in it than in plasma; the maximum concentration is observed 5-6 hours after ingestion. In the cerebrospinal fluid, lower concentrations of ibuprofen are found compared to plasma. After absorption, about 60% of the pharmacologically inactive R-form is slowly converted to the active S-form in the gastrointestinal tract and liver. Exposed to metabolism in the liver with the formation of 4 metabolites. It is excreted by the kidneys (70-90% of the administered dose in the form of ibuprofen and its metabolites; unchanged, no more than 1%) and, to a lesser extent, with bile (less than 2%). Excretion of metabolites in the urine is usually completed 24 hours after the last dose. The total excretion of ibuprofen and its metabolites in the urine is linearly dependent on dosage. At the age of over 2 months, the kidneys are well developed to cope with the excretion of ibuprofen by glomerular filtration. The study, which included 49 children aged 3 months to 12 years, did not show any age-related differences in the rate of absorption and excretion of ibuprofen.

Indications for use

Nurofen is used for headache and toothache, migraine, painful menstruation, neuralgia, back pain, muscle and rheumatic pain; as well as in a feverish state with influenza and colds.

Contraindications

Erosive and ulcerative lesions of the gastrointestinal tract in the acute phase, including peptic ulcer of the stomach and 12 duodenal ulcer in the acute stage and / or recurrent form, ulcerative colitis, peptic ulcer, Crohn's disease;

Gastrointestinal bleeding or perforation associated with NSAIDs;

severe heart failure;

Severe course of arterial hypertension;

Hypersensitivity to ibuprofen or to the components of the drug;

Complete or incomplete syndrome of acetylsalicylic acid intolerance (rhinosinusitis, urticaria, polyps of the nasal mucosa, bronchial asthma); - diseases of the optic nerve; color vision disorder, amblyopia, scotoma;

Deficiency of glucose-6-phosphate dehydrogenase, hemophilia and other blood clotting disorders, hemorrhagic diathesis, hypocoagulable states;

Pregnancy III trimester, breastfeeding period;

Severe liver dysfunction;

Severe renal failure (creatinine clearance less than 30 ml / min);

Hearing loss, pathology of the vestibular apparatus;

Gastrointestinal bleeding in acute and recurrent form;

Intracranial hemorrhages;

Hemophilia and other blood clotting disorders, hemorrhagic diathesis;

Children under the age of 6;

With caution: old age, coronary heart disease, cerebrovascular disease, dyslipidemia, diabetes mellitus, peripheral arterial disease, smoking, frequent alcohol use, long-term use of NSAIDs, severe somatic diseases, concomitant use of oral corticosteroids (including prednisolone), anticoagulants (including warfarin, clopidogrel, acetylsalicylic acid), taking selective serotonin reuptake inhibitors, diseases when taking the drug in patients with a history of gastric ulcer and 12 duodenal ulcer, with gastritis, enteritis, colitis, with anamnestic information about bleeding from the gastrointestinal tract; in the presence of concomitant diseases of the liver and / or kidneys; with cirrhosis of the liver with portal hypertension, nephrotic syndrome, chronic heart failure; arterial hypertension; with blood diseases of unclear etiology (leukopenia and anemia); with bronchial asthma, with hyperbilirubinemia; pregnancy (I, II trimesters); age under 12 years old.

Pregnancy and lactation

The use of the drug during pregnancy is possible only under the supervision of a physician. The use of the drug during the I and II trimesters is undesirable, but possible with caution. If Nurofen is used by a woman planning a pregnancy, or by a woman in the first and second trimesters of pregnancy, then the lowest effective dose and the shortest duration of treatment should be chosen.

Application during the III trimester is contraindicated.

The use of the drug during lactation is not recommended. In a number of studies, ibuprofen has been found in very low concentrations in breast milk, and its effect on infants is unlikely.

Dosage and administration

The drug is intended for short-term use.

NUROFEN® is prescribed to adults and children over 12 years old by mouth, after meals in tablets of 200 mg 3-4 times a day. The tablets should be taken with water.

To achieve a rapid therapeutic effect in adults, the dose may be increased to 400 mg (2 tablets) 3 times a day.

The lowest effective dose should be used for the shortest time necessary to relieve symptoms.

Do not exceed 6 tablets in 24 hours. The maximum daily dose is 1200 mg. If symptoms persist after taking the drug for 2-3 days, stop treatment and consult a doctor.

It is recommended that special care be taken when prescribing the drug to patients with reduced renal function. In case of a significant decrease in this function, periodic monitoring of creatinine clearance or serum creatinine concentration is recommended.

The use of the drug in patients with chronic liver disease, in the elderly should be carried out under medical supervision.

In case of missing the next dose of the drug, it is recommended to take the dose in accordance with the prescribed dosing regimen, without doubling the amount of the drug.

In exceptional cases (in the absence of children's forms of ibuprofen), by prescription and under the supervision of a doctor, the drug can be prescribed to children aged 6 to 12 years: 1 tablet no more than 3-4 times a day; the drug can be used only if the child's body weight is more than 20 kg. The interval between taking the tablets is at least 6 hours.

For children aged 6-9 years (average child weight 20-29 kg), the maximum dose is not more than 600 mg of ibuprofen per day (3 tablets per day).

For children aged 10-12 years (average child weight 30-40 kg), the maximum dose is not more than 800 mg of ibuprofen per day (4 tablets per day).

Side effect

When using the drug NUROFEN® for 2-3 days, side effects are practically not observed. In case of prolonged use, the following side effects may occur:

From the gastrointestinal tract: nausea, vomiting, heartburn, anorexia, pain and discomfort in the epigastrium, diarrhea, flatulence, erosive and ulcerative lesions of the gastrointestinal tract may occur (in some cases complicated by perforation and bleeding), abdominal pain, irritation , dryness of the oral mucosa or pain in the mouth, ulceration of the mucous membrane of the gums, aphthous stomatitis, pancreatitis, constipation, hepatitis.

From the nervous system: headache, dizziness, insomnia, agitation, drowsiness, depression, confusion, hallucinations, rarely - aseptic meningitis (more often in patients with autoimmune diseases).

From the side of the cardiovascular system: heart failure, increased blood pressure (BP), tachycardia.

From the urinary system: nephrotic syndrome (edema), acute renal failure, allergic nephritis, polyuria, cystitis.

On the part of the hematopoietic organs: anemia (including hemolytic, aplastic), thrombocytopenia and thrombocytopenic purpura, agranulocytosis, leukopenia.

From the sensory organs: hearing loss, ringing or tinnitus, reversible toxic optic neuritis, blurred vision or diplopia, dryness and irritation of the eyes, swelling of the conjunctiva and eyelids (allergic origin), scotoma.

Allergic reactions: skin rash, itching, urticaria, angioedema, anaphylactoid reactions, anaphylactic shock, fever, exudative erythema multiforme (including Stevens-Johnson syndrome), toxic epidermal necrolysis (Lyell's syndrome), eosinophilia, allergic rhinitis.

From the respiratory system: bronchospasm, shortness of breath.

Other: increased sweating.

With prolonged use in high doses - ulceration of the mucous membrane of the gastrointestinal tract, bleeding (gastrointestinal, gingival, uterine, hemorrhoidal), visual impairment (color vision impairment, scotoma, amblyopia). If side effects occur, you should stop taking the doctor.

Overdose

Symptoms: abdominal pain, nausea, vomiting, lethargy, headache, tinnitus, metabolic acidosis, coma, acute renal and hepatic failure, gastrointestinal bleeding, decreased blood pressure (BP), bradycardia, tachycardia, atrial fibrillation, arrest respiration, an increase in prothrombin time, convulsions are rarely possible.

Treatment: during the first hour after taking the drug, gastric lavage and activated charcoal

In case of frequent or prolonged seizures, anticonvulsants (diazepam or intravenous lorazepam) should be used.

Interaction with other drugs

Co-administration of NUROFEN tablets with acetylsalicylic acid (aspirin) is not recommended unless low-dose aspirin (not exceeding 75 mg per day) is recommended by a doctor, as it increases the risk of adverse side effects. When taken concomitantly, ibuprofen may inhibit the effect of low doses of aspirin on platelet aggregation.

You should also avoid the simultaneous use of two or more NSAIDs, including selective cyclooxygenase-2 inhibitors, as this may increase the risk of side effects.

When administered with anticoagulant and thrombolytic drugs (alteplase, streptokinase, urokinase), the risk of bleeding increases at the same time. Cefamandol, cefoperazone, cefotetan, valproic acid, plicamycin, increase the incidence of hypoprothrombinemia.

Cyclosporine and gold preparations increase the effect of ibuprofen on the synthesis of prostaglandins in the kidneys, which is manifested by an increased risk of nephrotoxicity. Ibuprofen increases the plasma concentration of cyclosporine and the likelihood of developing its hepatotoxic effects.

NSAIDs should not be used within 8-12 days after taking mifepristone, as NSAIDs may reduce the effect of mifepristone.

Concomitant use of NSAIDs and tacrolimus may increase the risk of nephrotoxicity.

With the simultaneous administration of NSAIDs and zidovudine, the risk of hematological toxicity increases.

Patients taking NSAIDs and quinolones have an increased risk of seizures. Drugs that block tubular secretion reduce excretion and increase the plasma concentration of ibuprofen.

Microsomal oxidation inducers (phenytoin, ethanol, barbiturates, rifampicin, phenylbutazone, tricyclic antidepressants) increase the production of hydroxylated active metabolites, increasing the risk of severe hepatotoxic reactions. Microsomal oxidation inhibitors - reduce the risk of hepatotoxicity.

Reduces the hypotensive activity of vasodilators, natriuretic in furosemide and hydrochlorothiazide.

Reduces the effectiveness of uricosuric drugs, enhances the effect of indirect anticoagulants, antiplatelet agents, fibrinolytics.

Enhances the side effects of mineralocorticosteroids, glucocorticosteroids, estrogens, ethanol.

Enhances the effect of oral hypoglycemic drugs, sulfonylurea derivatives and insulin. Antacids and cholestyramine reduce absorption.

Increases the concentration in the blood of digoxin, lithium preparations, methotrexate. Caffeine enhances the analgesic effect.

Precautionary measures

Nurofen is prescribed with caution to patients with heart failure, arterial hypertension, with blood clotting disorders, with impaired renal and / or liver function. Care should be taken when using the drug in patients with bronchial asthma and other obstructive pulmonary diseases due to the risk of bronchospasm. Patients with diseases of the gastrointestinal tract (ulcerative colitis, Crohn's disease) should be prescribed NSAIDs with caution due to the possible exacerbation of these diseases.

With caution, the drug is prescribed to elderly patients, since they often show adverse reactions to NSAIDs, mainly gastrointestinal bleeding and perforation, which can lead to a sharp deterioration in the condition. Patients with a history of gastrointestinal toxicity, especially elderly patients, should report any unusual abdominal symptom (especially gastrointestinal bleeding), especially if the symptom occurs at the initial stage of taking the drug.

If patients develop gastrointestinal bleeding while taking the drug, the drug should be stopped immediately.

The simultaneous use of Nurofen and other NSAIDs, including selective cyclooxygenase-2 inhibitors, should be avoided.

Systemic lupus erythematosus, as well as mixed connective tissue diseases, contribute to an increased risk of aseptic meningitis.

There is some evidence that drugs that inhibit cyclogenase/prostaglandin synthesis can cause fertility problems in women by affecting ovulation. This phenomenon is reversible upon discontinuation of the drug.

The drug should not be administered to patients with fructose intolerance, with glucose-galactose malabsorption syndrome or sucrase-isomaltase deficiency.

Two Nurofen tablets contain 25.3 mg of sodium, which should be considered by patients on a controlled sodium diet.

During long-term treatment, it is necessary to control the picture of peripheral blood and the functional state of the liver and kidneys.

When symptoms of gastropathy appear, careful monitoring is indicated, including esophagogastroduodenoscopy, complete blood count (hemoglobin determination), fecal occult blood analysis. If it is necessary to determine 17-ketosteroids, the drug should be discontinued 48 hours before the study.

Patients should refrain from all activities related to driving vehicles and working with moving mechanisms, as well as from other potentially hazardous activities associated with concentration of attention and increased speed of psychomotor reactions.

During the treatment period, you should refrain from drinking alcohol.

When used in children aged 6 to 12 years, it should be borne in mind that the tablets are not subject to division, and therefore can only be used in those children who have a single dose of at least 1 tablet.