The most effective and common pain reliever in pharmacies is Nurofen. Nurofen tablets - instructions for use (official), indications and contraindications, Nurofen release forms

It has a local analgesic and anti-inflammatory effect. The mechanism of action is due to the inhibition of the synthesis of PG - mediators of pain and inflammation.

Pharmacokinetics of Nurofen

When taken orally, it is well absorbed from the gastrointestinal tract. Cmax is created within 1 hour, when taken after meals - within 1.5–2.5 hours. Plasma protein binding is 90%. It slowly penetrates into the joint cavity, but lingers in the synovial tissue, creating higher concentrations in it than in plasma. The biological activity is associated with the S-enantiomer. After absorption, about 60% of the pharmacologically inactive R-form is slowly transformed into the active S-form. undergoes biotransformation. There are 3 main metabolites excreted by the kidneys. No more than 1% is excreted unchanged in the urine. It has a two-phase elimination kinetics with T1 / 2 from plasma 2-2.5 hours (for retard forms - up to 12 hours).

Use of Nurofen during pregnancy

Caution should be exercised during pregnancy and while breastfeeding.

Contraindications to the use of the drug Nurofen

hypersensitivity to ibuprofen, acetylsalicylic acid, other NSAIDs;

Bronchial asthma, urticaria, rhinitis, provoked by the intake of acetylsalicylic acid (salicylates) or other NSAIDs;

Children's age (up to 12 years).

Carefully:

Concomitant diseases of the liver or kidneys, gastrointestinal tract;

Bronchial asthma, urticaria, rhinitis, polyps of the nasal mucosa.

Side effects of Nurofen

stomach), irritation, dryness of the mucous membrane or pain in the oral cavity, ulceration of the mucous membrane of the gums, aphthous stomatitis, pancreatitis, constipation / diarrhea, flatulence, indigestion, possibly erosive and ulcerative lesions and bleeding from the gastrointestinal tract, impaired liver function.

From the nervous system and sensory organs: headache, drowsiness, anxiety, nervousness, irritability, psychomotor agitation, confusion, hallucinations, aseptic meningitis (more often in patients with autoimmune diseases), hearing loss, tinnitus, reversible toxic amblyopia, unclear vision or double vision, dryness and irritation of the eyes, swelling of the conjunctiva and eyelids (allergic genesis), scotoma.

From the side of the cardiovascular system and blood (hematopoiesis, hemostasis): heart failure, tachycardia, increased blood pressure, eosinophilia, anemia, incl. hemolytic, thrombocytopenic purpura, agranulocytosis, leukopenia.

From the respiratory system: shortness of breath, bronchospasm.

From the genitourinary system: edematous syndrome, impaired renal function, acute renal failure, polyuria, cystitis.

Allergic reactions: skin rash (erythematous, urticarial), pruritus, urticaria, allergic rhinitis, allergic nephritis, angioedema, anaphylactic reactions, incl. anaphylactic shock, erythema multiforme exudative (including Stevens-Johnson syndrome), toxic epidermal necrolysis.

Other: increased sweating, fever.

Dosage and administration of Nurofen

inside. Adults and children over 12 years old - 1 tab. (200 mg) 3-4 times a day. To achieve a rapid therapeutic effect, the dose is increased to 2 tablets. (400 mg) 3 times a day. Do not take more than 6 tablets. in 24 hours

Children 6–12 years old (weighing more than 20 kg) - 1 table. no more than 4 times a day.

The maximum daily dose is 1200 mg.

Overdose of Nurofen

Symptoms: abdominal pain, nausea, vomiting, lethargy, drowsiness, depression, headache, tinnitus, metabolic acidosis, coma, acute renal failure, hypotension, bradycardia, tachycardia, atrial fibrillation and respiratory arrest.

Treatment: gastric lavage (only during the first hour after ingestion), activated charcoal (to reduce absorption), alkaline drinking, forced diuresis and symptomatic therapy (correction of acid-base balance, blood pressure, gastrointestinal bleeding)

Interactions of the drug Nurofen with other drugs

The simultaneous use of two or more NSAIDs should be avoided due to an increased risk of side effects. With the simultaneous use of ibuprofen, it reduces the anti-inflammatory and antiaggregatory effect of acetylsalicylic acid (it is possible to increase the incidence of acute coronary insufficiency in patients receiving low doses of acetylsalicylic acid as an antiplatelet agent after starting ibuprofen). When used with thrombolytic drugs (alteplase, streptokinase, urokinase), the risk of bleeding increases at the same time. Ibuprofen enhances the effect of indirect anticoagulants, antiplatelet agents, fibrinolytics.

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.

Antacids and cholestyramine reduce the absorption of ibuprofen. Caffeine enhances the analgesic effect of ibuprofen. Cefamandol, cefoperazone, cefotetan, valproic acid increase the incidence of hypoprothrombinemia.

Myelotoxic drugs increase the manifestations of ibuprofen hematotoxicity. Cyclosporine and gold preparations increase the effect of ibuprofen on the synthesis of PG in the kidneys, which is manifested by an increase in nephrotoxicity. Ibuprofen increases the plasma concentration of cyclosporine and the likelihood of developing its hepatotoxic effects. Drugs that block tubular secretion reduce excretion and increase the plasma concentration of ibuprofen.

Ibuprofen reduces the effect of antihypertensive drugs (including CCBs and ACE inhibitors), the natriuretic and diuretic activity of furosemide and hydrochlorothiazide, and the effectiveness of uricosuric drugs. Enhances the side effects of mineralocorticoids, glucocorticoids, estrogens, ethanol. Enhances the effect of oral hypoglycemic drugs and insulin. Increases the concentration in the blood of digoxin, lithium preparations and methotrexate. Ibuprofen may reduce the clearance of aminoglycosides (with simultaneous administration, the risk of nephrotoxicity and ototoxicity may increase).

Ibuprofen for intravenous administration should not be mixed with other drugs.

Precautions while taking Nurofen

Treatment with ibuprofen should be at the lowest effective dose, for the shortest possible duration. During long-term treatment, it is necessary to control the picture of peripheral blood and the functional state of the liver and kidneys.

Given the possibility of developing NSAID gastropathy, it is prescribed with caution to the elderly, with a history of gastric ulcers and other gastrointestinal diseases, gastrointestinal bleeding, with simultaneous therapy with glucocorticoids, other NSAIDs and for long-term therapy. When symptoms of gastropathy appear, careful monitoring is indicated (including esophagogastroduodenoscopy, a blood test to determine hemoglobin, hematocrit, fecal occult blood test). To prevent the development of NSAID gastropathy, it is recommended to combine it with PGE preparations (misoprostol).

It is prescribed with caution to patients with impaired liver and kidney function (regular monitoring of the level of bilirubin, transaminases, creatinine, concentration ability of the kidneys is required), arterial hypertension and chronic heart failure (daily monitoring of diuresis, body weight, blood pressure). If visual impairment occurs, the dose should be reduced or the drug should be discontinued.

Storage conditions for Nurofen

List B.: In a dry place, at a temperature not exceeding 25 ° C.

Nurofen expiration date

Belonging of the drug Nurofen to the ATX-classification:

M Musculoskeletal system

M01 Anti-inflammatory and antirheumatic drugs

M01A Non-steroidal anti-inflammatory drugs

M01AE Propionic acid derivatives

INSTRUCTIONS for the use of a medicinal product for medical use

Registration number: P N013012/01-090117

Trade name of the drug: Nurofen ®

International non-proprietary name (INN): ibuprofen

Chemical Name:(2RS)-2--propionic acid

Dosage form: coated tablets

Compound
One coated tablet contains the active ingredient ibuprofen 200 mg;
Excipients: croscarmellose sodium 30 mg, sodium lauryl sulfate 0.5 mg, sodium citrate dihydrate 43.5 mg, stearic acid 2 mg, colloidal silicon dioxide 1 mg.
shell composition: sodium carmellose 0.7 mg, talc 33 mg, acacia gum 0.6 mg, sucrose 116.1 mg, titanium dioxide 1.4 mg, macrogol 6000 0.2 mg, black ink [Opacode S-1-277001] (shellac 28.225%, iron dye black oxide (E172) 24.65%, propylene glycol 1.3%, isopropanol* 0.55%, butanol* 9.75%, ethanol* 32.275%, purified water* 3.25%).
*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. On the cross section of the tablet, the core is white or almost white, the shell is white or almost white.

Pharmacotherapeutic group: non-steroidal anti-inflammatory drug (NSAID).

ATC Code: M01AE01

Pharmacological properties
Pharmacodynamics
The mechanism of action of ibuprofen, a propionic acid derivative from the group of non-steroidal anti-inflammatory drugs (NSAIDs), is due to inhibition of the synthesis of prostaglandins - mediators of pain, inflammation and hyperthermic reaction. Indiscriminately blocks cyclooxygenase 1 (COX-1) and cyclooxygenase 2 (COX-2), as a result of which it inhibits the synthesis of prostaglandins. It has a fast directed action against pain (pain reliever), antipyretic and anti-inflammatory action. In addition, ibuprofen reversibly inhibits platelet aggregation. The analgesic effect of the drug lasts up to 8 hours.

Pharmacokinetics
Absorption - high, quickly and almost completely absorbed from the gastrointestinal tract (GIT). After taking the drug on an empty stomach, the maximum concentration (C max) of ibuprofen in the blood plasma is reached after 45 minutes. Taking the drug with food can increase the time to reach maximum concentration (TC max) up to 1-2 hours. Communication with blood plasma proteins - 90%. It slowly penetrates into the joint cavity, lingers in the synovial fluid, creating higher concentrations in it than in the blood plasma. In the cerebrospinal fluid, lower concentrations of ibuprofen are found compared to blood plasma. After absorption, about 60% of the pharmacologically inactive R-form is slowly transformed into the active S-form. It is metabolized in the liver. The half-life (T1 / 2) - 2 hours. It is excreted by the kidneys (in unchanged form, not more than 1%) and, to a lesser extent, with bile.
In limited studies, ibuprofen has been found in breast milk at very low concentrations.

Indications for use

Contraindications

• Hypersensitivity to ibuprofen or any of the components that make up the drug.
• Complete or incomplete combination of bronchial asthma, recurrent polyposis of the nose and paranasal sinuses and intolerance to acetylsalicylic acid or other NSAIDs (including history).
• Erosive and ulcerative diseases of the gastrointestinal tract (including peptic ulcer of the stomach and duodenum, Crohn's disease, ulcerative colitis) or ulcer bleeding in the active phase or in history (two or more confirmed episodes of peptic ulcer or ulcer bleeding).
• Bleeding or perforation of an ulcer of the gastrointestinal tract in history, provoked by the use of NSAIDs.
• Severe heart failure (NYHA class IV - classification of the New York Heart Association)
• Severe liver failure or active liver disease.
• Severe renal failure (creatinine clearance< 30 мл/мин), подтвержденная гиперкалиемия.
• Decompensated heart failure; period after coronary artery bypass grafting.
• Cerebrovascular or other bleeding.
• Fructose intolerance, glucose-galactose malabsorption, sucrase-isomaltase deficiency.
• Hemophilia and other blood clotting disorders (including hypocoagulation), hemorrhagic diathesis.
• Pregnancy (III trimester).
• Children's age up to 6 years.

Carefully
If you have the conditions listed in this section, you should consult a doctor before using the drug.
Simultaneous use of other NSAIDs, a history of a single episode of gastric ulcer and duodenal ulcer or ulcerative bleeding of the gastrointestinal tract; gastritis, enteritis, colitis, Helicobacter pylori infection, ulcerative colitis; bronchial asthma or allergic diseases in the acute stage or in history - bronchospasm may develop; systemic lupus erythematosus or mixed connective tissue disease (Sharpe's syndrome) - increased risk of aseptic meningitis; chickenpox; renal failure, including dehydration (creatinine clearance less than 30-60 ml / min), nephrotic syndrome, liver failure, cirrhosis of the liver with portal hypertension, hyperbilirubinemia, arterial hypertension and / or heart failure, cerebrovascular diseases, blood diseases of unknown etiology ( leukopenia and anemia), severe physical illness, dyslipidemia/hyperlipidemia, diabetes mellitus, peripheral arterial disease, smoking, frequent alcohol use, concomitant use of drugs that may increase the risk of ulcers or bleeding, in particular oral glucocorticosteroids (including prednisolone ), anticoagulants (including warfarin), selective serotonin reuptake inhibitors (including citalopram, fluoxetia, paroxetine, sertraline) or antiplatelet agents (including acetylsalicylic acid, clopidogrel), pregnancy I-II trimester, breastfeeding period, elderly

age, under 12 years of age.
The use of the drug in the III trimester of pregnancy is contraindicated. The use of the drug in the I-II trimesters of pregnancy should be avoided; if necessary, the drug should be taken with a doctor. There is evidence that small amounts of ibuprofen can pass into breast milk without any adverse effects on the health of the infant, so there is usually no need to stop breastfeeding with short-term use. If you need long-term use of the drug, you should consult a doctor to decide whether to stop breastfeeding for the period of drug use.

Dosage and administration

Adults and children over 12 years old: inside 1 tablet (200 mg) up to 3-4 times a day. Tablets should be taken with water. To achieve a faster therapeutic effect in adults, the dose may be increased to 2 tablets (400 mg) up to 3 times a day.

Children from 6 to 12 years old: 1 tablet (200 mg) up to 3-4 times a day; the drug can be taken only if the child's body weight is more than 20 kg. The interval between taking the tablets should be at least 6 hours. The maximum daily dose for adults is 1200 mg (6 tablets). Maximum daily dose for children from 6 to 18 years: 800 mg (4 tablets). If, when taking the drug for 2-3 days, the symptoms persist or intensify, it is necessary to stop treatment and consult a doctor.

Side effect

In the elderly, there is an increased frequency of adverse reactions against the background of the use of NSAIDs, especially gastrointestinal bleeding and perforation, in some cases with a fatal outcome. Side effects are predominantly dose-dependent. The following adverse reactions were noted with short-term use of ibuprofen in doses not exceeding 1200 mg / day (6 tablets).

In the treatment of chronic conditions and with prolonged use, other adverse reactions may occur.

The incidence of adverse reactions was assessed based on the following criteria: very frequent (≥ 1/10), frequent (from ≥1/100 to< 1/10), нечастые (от ≥ 1/1000 до < 1/100), редкие (от ≥ 1/10 000 до < 1/1000), очень редкие (< 1/10 000), частота неизвестна (данных для оценки частоты недостаточно).

Blood and lymphatic system disorders

• Very rare: hematopoietic disorders (anemia, leukopenia, aplastic anemia, hemolytic anemia, thrombocytopenia, pancytopenia, agranulocytosis). The first symptoms of such disorders are fever, sore throat, superficial oral ulcers, flu-like symptoms, severe weakness, nosebleeds and subcutaneous hemorrhages, bleeding and bruising of unknown etiology.

Immune System Disorders

• Infrequent: hypersensitivity reactions - nonspecific allergic reactions and anaphylactic reactions, reactions from the respiratory tract (bronchial asthma, including its exacerbation, bronchospasm, shortness of breath, dyspnea), skin reactions (itching, urticaria, purpura, Quincke's edema, exfoliative and bullous dermatoses , including toxic epidermal necrolysis (Lyell's syndrome), Stevens-Johnson syndrome, erythema multiforme), allergic rhinitis, eosinophilia.
• Very rare: severe hypersensitivity reactions, including swelling of the face, tongue and throat, shortness of breath, tachycardia, hypotension (anaphylaxis, angioedema or severe anaphylactic shock).

Gastrointestinal disorders

• Uncommon: abdominal pain, nausea, dyspepsia (including heartburn, bloating).
• Rare: diarrhea, flatulence, constipation, vomiting.
• Very rare: peptic ulcer, perforation or gastrointestinal bleeding, melena, hematemesis, in some cases fatal, especially in elderly patients, ulcerative stomatitis, gastritis.
• Frequency unknown: exacerbation of colitis and Crohn's disease.

Liver and biliary tract disorders

• Very rare: abnormal liver function, increased activity of "liver" transaminases, hepatitis and jaundice.

Renal and urinary tract disorders

• Very rare: acute renal failure (compensated and decompensated), especially with prolonged use, in combination with an increase in the concentration of urea in the blood plasma and the appearance of edema, hematuria and proteinuria, nephritic syndrome, nephrotic syndrome, papillary necrosis, interstitial nephritis, cystitis.

Nervous System Disorders

• Uncommon: headache.
• Very rare: aseptic meningitis.
  Cardiovascular disorders
• Frequency unknown: heart failure, peripheral edema, prolonged use increases the risk of thrombotic complications (eg, myocardial infarction), increased blood pressure.

Respiratory and mediastinal disorders

• Frequency unknown: bronchial asthma, bronchospasm, shortness of breath.

Laboratory indicators

• hematocrit or hemoglobin (may decrease)
• bleeding time (may increase)
• plasma glucose concentration (may decrease)
• creatinine clearance (may decrease)
• plasma creatinine concentration (may increase)
• activity of "liver" transaminases (may increase)

If side effects occur, stop taking the drug and consult a doctor.

Overdose
In children, overdose symptoms may occur after taking a dose in excess of 400 mg / kg body weight. In adults, the dose-dependent effect of overdose is less pronounced. The half-life of the drug in case of overdose is 1.5-3 hours.
Symptoms: nausea, vomiting, epigastric pain or, less commonly, diarrhea, tinnitus, headache, and gastrointestinal bleeding. In more severe cases, manifestations from the central nervous system are observed: drowsiness, rarely - agitation, convulsions, disorientation, coma. In cases of severe poisoning, metabolic acidosis and an increase in prothrombin time, renal failure, liver tissue damage, decreased blood pressure, respiratory depression and cyanosis may develop. In patients with bronchial asthma, an exacerbation of this disease is possible.
Treatment: symptomatic, with the obligatory provision of airway patency, ECG monitoring and basic vital signs up to the normalization of the patient's condition. Oral activated charcoal or gastric lavage is recommended within 1 hour of a potentially toxic dose of ibuprofen. If ibuprofen has already been absorbed, an alkaline drink may be given to eliminate the acidic ibuprofen derivative by the kidneys, forced diuresis. Frequent or prolonged seizures should be treated with intravenous diazepam or lorazepam. With the worsening of bronchial asthma, the use of bronchodilators is recommended.

Interaction with other drugs

• Acetylsalicylic acid: with the exception of low doses of acetylsalicylic acid (no more than 75 mg per day) prescribed by a doctor, since combined use may increase the risk of side effects. With the simultaneous use of ibuprofen, it reduces the anti-inflammatory and antiplatelet effect of acetylsalicylic acid (it is possible to increase the incidence of acute coronary insufficiency in patients receiving low doses of acetylsalicylic acid as an antiplatelet agent after starting ibuprofen).
• Other NSAIDs, in particular selective COX-2 inhibitors: the simultaneous use of two or more drugs from the NSAID group should be avoided due to a possible increase in the risk of side effects.

Use with caution concomitantly with the following medicinal products
means:

• Anticoagulants and thrombolytic drugs: NSAIDs may enhance the effect of anticoagulants, in particular warfarin and thrombolytic drugs.
• Antihypertensive agents (ACE inhibitors and angiotensin II antagonists) and diuretics: NSAIDs may reduce the effectiveness of drugs in these groups. In some patients with impaired renal function (eg, patients with dehydration or elderly patients with impaired renal function), concomitant administration of ACE inhibitors or angiotensin II antagonists and agents that inhibit cyclooxygenase may lead to deterioration of renal function, including the development of acute renal failure. (usually reversible). These interactions should be considered in patients taking coxibs concomitantly with ACE inhibitors or angiotensin II antagonists. In this regard, the combined use of the above drugs should be prescribed with caution, especially in the elderly. Dehydration should be prevented in patients and consideration should be given to monitoring renal function after initiation of such combination therapy and periodically thereafter. Diuretics and ACE inhibitors may increase the nephrotoxicity of NSAIDs.
• Glucocorticosteroids: increased risk of gastrointestinal ulceration and gastrointestinal bleeding.
• Antiplatelet agents and selective serotonin reuptake inhibitors: increased risk of gastrointestinal bleeding.
• cardiac glycosides: the simultaneous appointment of NSAIDs and cardiac glycosides can lead to aggravation of heart failure, a decrease in glomerular filtration rate and an increase in the concentration of cardiac glycosides in blood plasma.
• Lithium preparations: there are data on the likelihood of an increase in the concentration of lithium in the blood plasma against the background of the use of NSAIDs.
• Methotrexate: there are data on the likelihood of an increase in the concentration of methotrexate in the blood plasma against the background of the use of NSAIDs.
• Cyclosporine: increased risk of nephrotoxicity with the simultaneous appointment of NSAIDs and cyclosporine.
• Mifepristone: NSAIDs should be started no earlier than 8-12 days after taking mifepristone, since NSAIDs can reduce the effectiveness of mifepristone.
• Tacrolimus: With the simultaneous appointment of NSAIDs and tacrolimus, an increase in the risk of nephrotoxicity is possible.
• Zidovudine: The simultaneous use of NSAIDs and zidovudine may lead to increased hematotoxicity. There is evidence of an increased risk of hemarthrosis and hematomas in HIV-positive patients with hemophilia receiving concomitant treatment with zidovudine and ibuprofen.
• Quinolone antibiotics: Patients receiving concomitant treatment with NSAIDs and quinolone antibiotics may have an increased risk of seizures.
• Myelotoxic drugs: increased hematotoxicity. Cefamandol, cefoperazone, cefotetan, valproic acid, plicamycin: an increase in the incidence of hypoprothrombinemia.
• Drugs that block tubular secretion: decrease in excretion and increase in plasma concentration of ibuprofen. Microsomal oxidation inducers (phenytoin, ethanol, barbiturates, rifampicin, phenyl butazone, tricyclic antidepressants): increased production of hydroxylated active metabolites, increased risk of severe intoxication.
• Microsomal oxidation inhibitors: reduced risk of hepatotoxicity.
• Oral hypoglycemic drugs and insulin, sulfonylurea derivatives: enhancing the effect of drugs.
• Antacids and cholestyramine: decrease in absorption.
• Uricosuric drugs: decrease in the effectiveness of drugs.
• Caffeine: enhancement of the analgesic effect.

special instructions
It is recommended to take the drug for the shortest possible course and in the minimum effective dose necessary to eliminate symptoms. If you need to take the drug for more than 10 days, you should consult a doctor.
In patients with bronchial asthma or an allergic disease in the acute stage, as well as in patients with a history of bronchial (asthma / allergic disease), the drug may provoke bronchospasm. The use of the drug in patients with systemic lupus erythematosus or mixed connective tissue disease is associated with an increased risk of developing aseptic meningitis.

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. During the treatment period, ethanol is not recommended.

Patients with renal insufficiency should consult a doctor before using the drug, as there is a risk of deterioration in the functional state of the kidneys.

Patients with hypertension, including a history of and / or chronic heart failure, should consult a doctor before using the drug, since the drug may cause fluid retention, increased blood pressure and edema.
In patients with uncontrolled hypertension, NYHA class II-III congestive heart failure, ischemic heart disease, peripheral arterial disease and/or cerebrovascular disease, ibuprofen should be prescribed only after a careful benefit-risk assessment, and high doses of ibuprofen should be avoided (> 2400 mg/day).

The use of NSAIDs in patients with chickenpox may be associated with an increased risk of developing severe purulent complications of infectious and inflammatory diseases of the skin and subcutaneous fat (for example, necrotizing fasciitis). In this regard, it is recommended to avoid the use of the drug for chicken pox.

Information for women planning pregnancy: the drug inhibits cyclooxygenase and prostaglandin synthesis, affects ovulation, disrupting female reproductive function (reversible after discontinuation of treatment).

Influence on the ability to drive vehicles, mechanisms.
Patients who experience dizziness, drowsiness, lethargy, or visual disturbances while taking ibuprofen should avoid driving or operating machinery.

Release form
Film-coated tablets 200 mg.
6, 8, 10 or 12 tablets per blister (PVC / PVDC / aluminum). One blister (6, 8, 10 or 12 tablets each) or two blisters (6, 8, 10 or 12 tablets each) or 3 blisters (10 or 12 tablets each) or 4 blisters (12 tablets each) or 8 blisters (each 12 tablets) together with instructions for use are placed in a cardboard box.

Storage conditions
Store at a temperature not exceeding 25 °C. Keep out of the reach of children.

Shelf life
3 years.
Do not use an expired drug.

Holiday conditions
Over the counter.

The legal entity in whose name the registration certificate is issued and the manufacturer

Representative in Russia/Consumer Claims Receiver
Reckitt Benckiser Healthcare LLC
Russia, 115114, Moscow, Shluzovaya nab., 4

Nurofen can be called one of the most popular medicines prescribed for fever and to reduce pain. For the smallest patients, Nurofen is made in the most convenient forms for use in babies. These are rectal suppositories used in infants older than 3 months to two years of age, as well as a sweet suspension that is prescribed for children from 3 months to 12 years of age.

However, the dosage in such forms of Nurofen is designed for children of the first years of life, therefore, as they grow older, one candle is not enough for the child, and a single dose of syrup becomes very large. In such situations, a tablet preparation helps out. At what age is it given to children, when are such tablets in demand in pediatrics, and at what dose are they advised to use if a child is sick?

Release form and composition

Nurofen tablets can be found in two packaging options - in silver-colored boxes and in orange boxes, on which there is an inscription "from 6 years old". Both of these drugs are small white tablets with a round shape. Their sweet shell has a black Nurofen inscription on one side.

The composition of the tablets is the same - The main component is ibuprofen at a dose of 200 mg. Sodium citrate and sodium lauryl sulfate, as well as stearic acid, croscarmellose sodium and silicon dioxide are added to it to form the core of the drug. For the manufacture of the shell, sucrose, macrogol 6000, acacia gum, talc, titanium dioxide and carmellose sodium are used.

Tablets are placed in blisters of 6, 8, 10 or 12 pieces, and in one pack there can be from one to eight blisters, so there are silver packages on sale containing from 6 to 96 tablets. As for Nurofen in orange boxes, inside such a pack there is only 1 blister with 8 tablets.

Operating principle

Taken orally, tablets begin to act in about 45-60 minutes, when their active ingredient enters the bloodstream and accumulates in the maximum amount.

After binding to protein molecules, it is transferred to the site of inflammation and other organs, where it exerts its effect. The metabolism of the drug takes place in the liver, therefore, a violation of the function of this organ may affect the treatment with Nurofen. Excretion of the drug depends on the normal functioning of the kidneys, since most of the ibuprofen leaves the child's body with urine.

Indications

This drug is prescribed:

• With a fever caused by SARS, influenza or other infection.
• With pain caused by trauma, sprain, bruise, inflammatory disease.
• For headaches and migraines.
• With myalgia, neuralgia, as well as with toothache.

At what age are they prescribed?

As noted on the packaging of orange Nurofen tablets, this medicine is allowed for children over 6 years of age. The instruction also clarifies that this medication in the shell is used only with a weight of more than 20 kilograms. If a six-year-old child weighs less, it is better to give him a suspension, calculating its dosage according to body weight.

Tablets in silver boxes also have an age limit of up to 6 years.

Both versions of the drug are not used in babies of the first years of life, since they contain a dosage that will only be effective for patients over six years old, and for small children a smaller dose is required. In addition, a child of 7 years and older already knows how to swallow a pill and does not protest against such a dosage form.

Contraindications

Nurofen tablets are not prescribed not only to patients under the age of six, but also in such cases:

• If a high level of potassium is found in the baby’s blood test or a coagulogram showed adverse changes in blood clotting.
• If there are erosive or ulcerative changes in the organs of the digestive system of a small patient.
• If bleeding has begun from the wall of the stomach, cerebral vessels or other localization.
• If the patient does not tolerate ibuprofen or another component of the tablets.
• If the baby was diagnosed with a serious disease of such important organs as the kidneys, liver or heart.
• If the child had an allergic reaction to acetylsalicylic acid or other anti-inflammatory drugs of the nonsteroidal group.
• If the child does not tolerate fructose, his body lacks enzymes (sucrase, isomaltase) or he has glucose-galactose malabsorption.

In addition, with many pathologies, Nurofen treatment requires medical supervision. Such diseases include bronchial asthma, diabetes mellitus, anemia, systemic lupus erythematosus and other diseases.

Side effects

The drug can cause the following side effects:

• Rash, runny nose, skin inflammation, redness and other manifestations of allergies.
• The digestive tract of some children reacts to taking Nurofen with the appearance of nausea, discomfort or pain in the abdomen, and other symptoms of gastrointestinal irritation.
• In children with bronchial asthma, taking Nurofen often provokes an exacerbation of this disease.
• Sometimes treatment with pills causes insomnia or headaches.
• In very rare cases, the drug impairs hematopoiesis, inhibits kidney function, causes swelling and other negative reactions.

Instructions for use

Reception scheme:

• The drug is given to the child to swallow and drink with plain water. To reduce the risk of negative effects of Nurofen on the digestive system, taking the tablet is recommended during or immediately after a meal.
• A single dosage for patients over 6 years old is one tablet, and children over 12 years old can be given 2 tablets at once, but the maximum dosage for patients 6-18 years old is 4 tablets per day.
• The medicine is usually prescribed three times with a break between doses of 8 hours, but if necessary, Nurofen can be given 4 times a day, that is, every 6 hours. Breaks of less than six hours between two tablets are not recommended.
• With regard to the duration of administration, it is important to know that Nurofen tablets are prescribed only as a short-term treatment for symptoms such as pain and fever. Usually such a medication is used for only 1-3 days to eliminate symptoms. If there is no improvement after 2-3 days of taking it, you should consult your doctor.

Overdose

Nurofen taken at too high a dose can affect the digestive tract (causing symptoms of dyspepsia, pain or even bleeding), the nervous system, kidneys, liver and other organs. In the most severe cases of overdose in a small patient, cyanosis, weakened breathing, convulsions and other dangerous symptoms. In the treatment, symptomatic agents are used, as well as forced diuresis (drinking a lot so that the ibuprofen leaves the child's body faster).

Interaction with other drugs

Annotation to the tablets notes a rather large list of drugs with which Nurofen should not be combined or treatment should be done with caution. These drugs include nimesulide, cyclosporine, caffeine, antacids, ketorol, some antibiotics, diuretics, and many other drugs. Some of them interfere with the action of ibuprofen, others increase the side effects.

Therefore, if a child is taking any medication, this must be taken into account before giving the patient a Nurofen tablet.

Terms of sale

Like children's Nurofen in suppositories and suspensions, a tablet preparation can be purchased without any difficulty at any pharmacy, since it is an over-the-counter medicine. The average price of 8 tablets for children is 100-110 rubles, and 10 tablets in a silver box - 80-90 rubles.

Storage features

It is necessary to keep Nurofen tablets at home in a place inaccessible to children. It is also important that the drug is not affected by elevated temperature (it should not be higher than +25 degrees) or humidity. A medicine with an expired shelf life of 3 years from the date of issue should not be used in the treatment of children.

Reviews

There are many positive reviews about the treatment of children with Nurofen tablets, which confirm the high effectiveness of this medication. According to parents, the drug quickly helps with headaches, reduces fever, eliminates pain in the joints, muscles, back, and so on.

Adverse reactions to the drug are rare and are often represented by negative symptoms from the gastrointestinal tract or allergies. The size of the tablets is small, and their shell is sweet in taste, so most patients have no problems with swallowing this Nurofen.

One of the main disadvantages of the drug, parents call its cost, which is why cheaper analogues are often preferred.

Other types of Nurofen tablets

Let's analyze them in more detail.

"Nurofen Forte"

In such coated tablets, ibuprofen is contained in a dosage of 400 mg each, so the drug is allowed in pediatrics only from 12 years old. Like regular Nurofen, Forte is presented in round white tablets, but the inscription on one side of such a medicine is red and next to the word Nurofen there is the number 400. One package contains from 6 to 24 tablets.

Indications for taking "Nurofen Forte" are the same as for the use of Nurofen tablets. Possible negative effects on the children's body, the list of contraindications, overdose symptoms and storage characteristics of such drugs also coincide.

The only difference is the dosing regimen, since Nurofen Forte can be given to children over 12 years old, one tablet no more than twice a day.

"Nurofen Express Neo"

Such a drug in a coated tablet contains ibuprofen in the same dose as Nurofen tablets - 200 mg per tablet. One package of this type of Nurofen includes from 6 to 24 round-shaped tablets with the inscription N>> on one of the sides. It is also available in capsules and gel, as well as in tablets with twice the amount of the main ingredient (forte).

The main feature of Express Neo tablets, as their name implies, is a faster action. It is due to the form of ibuprofen in which this substance is contained in the preparation. This is sodium dihydrate, which is absorbed faster, so the analgesic and antipyretic effect develops already 30-35 minutes after taking the pill.

The medicine is allowed to be used in children from 12 years of age.

The instruction indicates that the composition of this medicine includes active ingredients ibuprofen and (the form codeine phosphate hemihydrate ), as well as additional components: sodium starch glycolate, MCC, corn starch, hypromellose, talc, M-1-7111B hazardous spray.

Release form

Nurofen Plus is available in tablets. The tablets are capsule-shaped, biconvex, film-coated. On one side of the tablet there is an embossed inscription " N+". Packed in blisters of 2, 4, 6 or 12 tablets, 1 or 2 blisters are put into a cardboard box.

pharmachologic effect

The drug Nurofen Plus is a combination drug, the effect of which is determined by the action of those components that make up its composition. The tool acts as an antipyretic, anti-inflammatory, analgesic and antitussive.

Component ibuprofen - This is an NSAID, the substance is a derivative of phenylpropionic acid. Ibuprofen in the body inhibits the synthesis of prostaglandins by blocking cyclooxygenases.

Codeine Phosphate is an opium alkaloid of the phenanthrene series. This substance is an opioid receptor agonist. The substance reduces the level of excitability of the cough center. Also, its analgesic effect is activated when taken with ibuprofen.

Pharmacokinetics and pharmacodynamics

There is a high degree of absorption, the connection with plasma proteins is 90%. It slowly penetrates into the joints, is determined in the synovial tissue, and the concentrations in it are higher than in plasma. The half-life of ibuprofen is 2 hours, codeine - 3 hours. Subject to . It leaves the body through the kidneys, a smaller amount - with.

Indications for use

Nurofen Plus is used for the following diseases and conditions:

• with dental and;
• at ;
• with painful menstruation;
• at ;
• in case of back pain, rheumatic and muscle pain;
• at during flu and colds.

Contraindications

You should not take Nurofen Plus in such conditions and diseases:

• high sensitivity of the patient to ibuprofen or to other components of this tool;
• respiratory failure, heart failure;
• erosion and ulcers of the digestive system in a state of exacerbation;
• arterial hypertension (in severe course);
• high ICP;
• condition after TBI;
• , or that were triggered by treatment with salicylates or other NSAIDs;
• leukopenia , hemophilia , state of hypocoagulation;
• diseases of the optic nerve, impaired color vision, scotoma, amblyopia ;
• violations of the functions of the liver, kidneys;
• pathology of the vestibular apparatus, hearing impairment;
• in a chronic form;
• period ;
• age up to 12 years.

Carefully prescribe tablets to people in the elderly, as well as patients with , peptic ulcer and bleeding from the gastrointestinal tract in history, diseases of the kidneys, liver, chronic heart failure, blood diseases, and.

Side effects

If the remedy is used for 2-3 days, then the development of negative effects is unlikely. With longer therapy, Nurofen Plus may cause the following side effects:

• Digestive system: nausea and vomit , anorexia , , a feeling of discomfort in the epigastrium, exacerbation of stomach ulcers, disturbances in the liver;
• Nervous system: , hearing loss , manifestations, excitement, ;
• Heart and blood vessels: performance increase , heart failure , ;
• hematopoiesis: thrombocytopenia , leukopenia , anemia , agranulocytosis ;
• urinary system: , violation of the kidneys;
• Allergy: rash, ;
• Other manifestations: severe sweating, suppression of the cough reflex, respiratory depression, bronchospasm .

With a long period of treatment and the use of Nurofen Plus tablets in large doses, the patient may develop ulceration of the gastrointestinal mucosa, various types of bleeding, visual impairment.

Instructions for use (Method and dosage)

You need to take the drug inside, after taking it, drink it with liquid.

Adults and adolescents over 12 years of age take 1-2 tablets three to four times a day. If necessary, take a large dose of the drug - 400 mg three times a day, but you can not drink more than 6 pcs. during the day.

If the symptoms of the disease persist for two to three days, then the therapy should be suspended and consult a specialist.

Overdose

When taking too large doses of Nurofen Plus, the patient may develop the following symptoms: vomiting, nausea, feelings of lethargy, depression , drowsiness , headache , tinnitus . In severe cases, it may develop , atrial fibrillation, respiratory arrest. It is important to promptly carry out gastric lavage, since these actions are effective only in the first hour after taking large doses of drugs. The following shows the intake of alkaline drink, tablets, forced , symptomatic treatment.

If the patient has respiratory depression after an overdose, the reception is indicated naloxone a specific opioid antagonist.

Interaction

The interaction of the drug Nurofen Plus with such drugs is noted:

• with Acetylsalicylic acid , as well as with other NSAIDs , since ibuprofen lowers the antiaggregatory and anti-inflammatory effect of acetylsalicylic acid; there is also a risk of acute coronary insufficiency;
• with thrombolytic drugs and anticoagulants (increased chance of bleeding)
• with Cefotetan , cefamandole , Plikamycin , Valproic acid , Cefoperazone (the frequency of manifestation of hypoprothrombinemia increases);
• with Drugs that block tubular secretion (decreases excretion and increases the concentration of ibuprofen in plasma);
• with Cyclosporine and gold preparations (the effect of ibuprofen on the synthesis of PG in the kidneys is activated, as a result of which nephrotoxicity increases, and the risk of hepatotoxic manifestations also increases);
• with inducers of microsomal oxidation (the risk of hepatotoxic manifestations increases);
• with vasodilators (hypotensive activity decreases);
• with inhibitors of microsomal oxidation (reduces the likelihood of hepatotoxic effects);
• with Hydrochlorothiazide and