Instructions
Nurofen 200 is a universal antipyretic and analgesic that is prescribed for a whole range of diseases of different origins. Unlike other similar drugs, it is relatively safe and can be used in the treatment of pregnant and lactating women and children.
Nurofen 200 is a universal antipyretic and analgesic that is prescribed for a whole range of diseases of different origins.
Latin name
Nurofen (Ibuprofeni)
Release forms and composition
The main active ingredient is ibuprofen (200 mg per tablet). The shell is a complex compound based on carmellose sodium, talc, titanium dioxide, acacia gum and sucrose. The drug is sold in packages of 10 and 20 tablets.
Mechanism of action
The active ingredient of the drug, ibuprofen, belongs to the category of non-steroidal anti-inflammatory drugs (NSAIDs).
Pharmacodynamics
Ibuprofen is formed as a byproduct of reactions with propionic acid. Once in the body, the substance blocks the production of proglastandins - mediators responsible for the occurrence of pain, inflammatory processes, and increased body temperature. It has a pronounced analgesic and antipyretic effect, which can last up to 8 hours. Also helps thin the blood.
Pharmacokinetics
The active substance has a high degree of adsorption, is quickly absorbed from the gastrointestinal tract and spreads throughout the body. When taking the tablets on an empty stomach, the level of ibuprofen in the blood plasma will reach a maximum within 45 minutes. If you take the tablets with meals, the peak effect will occur only after 1-2 hours. More than 90% of the active substance forms a bond with blood proteins.
Indications for use of Nurofen 200
The drug is suitable for eliminating the symptoms of ARVI, relieving pain resulting from an injury or internal diseases. Ibuprofen has been proven effective for:
- headaches (including migraine type);
- pain with pulpitis, after removal of a tooth or nerve;
- neuralgia;
- sore throat;
- rheumatic and joint pain;
- severe PMS, painful menstruation;
- myalgia.
In addition, ibuprofen is an effective antipyretic, indispensable for influenza and colds.
Contraindications
It is strictly forbidden to prescribe the drug to patients who have a history of ulcerative lesions and bleeding in the gastrointestinal tract, severe forms of liver and kidney failure. This NSAID is not prescribed for insufficient blood clotting or excess potassium. Other contraindications include pregnancy (especially the first and second trimesters), age under 6 years, and fructose intolerance.
Directions for use and dosage of Nurofen 200
The tablets are taken orally. For maximum effect and complete absorption of ibuprofen, it is advisable to swallow them without chewing. Patients who have any problems with the digestive system are recommended to drink them directly with meals.
The optimal dosage is prescribed by the doctor. It is individual and depends both on the patient’s age and on the severity of symptoms (pain, heat or swelling associated with inflammation).
Adults and children over 12 years of age can take 200 mg of ibuprofen up to 4 times a day. If you urgently need to reduce the temperature or get rid of pain, the amount of painkiller can be doubled. The maximum daily dose is 1.2 g.
Will the drug help with kidney pain?
The drug can reduce the intensity of the discomfort, but it is important to remember that at the same time, ibuprofen increases the load on the kidneys. A doctor should prescribe pain medication, and only after making a final diagnosis.
Used in the treatment of urinary tract infections
Ibuprofen is often used in the complex treatment of cystitis. The substance helps reduce the intensity of inflammation and pain that occurs when urinating.
Use in children
For children from 6 to 12 years of age, the drug is prescribed only if their body weight is above 20 kg. Like adults, they can take 1 tablet during main meals - 3-4 times a day. The interval between doses should be at least 6 hours. The total amount of ibuprofen consumed during the day should not exceed 800 mg (4 tablets).
Does Nurofen 200 cause side effects?
Uncontrolled use of NSAIDs for a long time can provoke the occurrence of unpleasant symptoms, including:
- Gastrointestinal disorders: nausea, diarrhea, flatulence, discomfort and abdominal pain;
- allergic response of the immune system in the form of skin rashes, itching, Quincke's edema;
- dizziness, headache;
- excessive drowsiness, lethargy, or a state of increased agitation;
- impaired renal function, the appearance of edema;
- blood pressure surges, tachycardia;
- increased sweating;
- bronchospasm;
- disruption of hematopoietic processes: anemia, leukopenia, agranulocytosis, thrombocytopenia;
- convulsions.
Dizziness is one of the side effects of taking the drug.
High doses of ibuprofen increase the activity of liver enzymes, which can cause jaundice and hepatitis. Laboratory tests reveal low levels of hemoglobin and glucose, and a high concentration of creatinine.
Overdose
Symptoms of an ibuprofen overdose develop with a single use of high doses of the substance, more than 1000 mg. The main symptoms are pain in the stomach, nausea, intestinal disorders (diarrhea), headaches, melena.
In some patients, high doses of the drug can provoke gastrointestinal bleeding, manifested in the form of hematemesis. The composition and parameters of the blood may change. In medicine, this condition is called myelotoxic agranulocytosis.
In severe poisoning, damage to the nervous system occurs. The patient may experience drowsiness or, on the contrary, become hyperactive and in a state of disorientation. Often an overdose is accompanied by convulsions, nosebleeds and subcutaneous bruising.
Drug interactions
Ibuprofen has high biochemical activity and reacts not only with protein compounds, but also with other medications and substances that the human body receives from food.
With other drugs
Ibuprofen is not recommended to be used simultaneously with aspirin, other NSAIDs and antiplatelet agents. If these drugs react, the likelihood of adverse reactions and decreased effectiveness of pain medications increases. Use the drug with caution in combination with:
- thrombolytics, anticoagulants such as Warfarin;
- blood pressure lowering agents;
- ATP inhibitors and diuretics (increases toxic effects on the kidneys);
- glucocorticosteroids;
- glycosides, which are used in the treatment of heart diseases;
- lithium preparations;
- Cyclosporine;
- quinol antibiotics;
- antacids, colesters;
- uricosuric drugs.
If ibuprofen is used together with the above drugs, the load on the digestive organs, liver, and kidneys increases.
Alcohol compatibility
Drinking alcoholic beverages during treatment with NSAIDs is strictly prohibited. Ethanol activates microsomal oxidation processes, thereby increasing the production of active hydroxylated metabolites. An increase in the concentration of these substances in the body can cause severe intoxication.
Features of application
To eliminate the risk of negative effects on the kidneys, liver, gastrointestinal tract and other body systems, it is recommended to use the drug in short courses, the duration of which does not exceed 10 days.
If you have chronic diseases and a tendency to allergic reactions, you should discuss the possible risks with your doctor before starting treatment. Thus, the use of ibuprofen by patients with systemic lupus erythematosus increases the likelihood of developing aseptic meningitis, and in chickenpox, this substance can cause severe purulent complications. People suffering from bronchial asthma should be careful when using NSAIDs.
During pregnancy and lactation
Use of the drug during pregnancy is allowed only if there are strict medical indications. In this case, the dose of ibuprofen should be reduced as much as possible, especially in the first and second trimester. By inhibiting the synthesis of proglastandins, this substance can have a toxic effect on the fetus, in particular on the respiratory system and heart.
During lactation, the danger for mother and child is lower. Very small amounts of ibuprofen pass into breast milk. However, there is no data on the negative effects of this NSAID on infants.
Women who are just planning a pregnancy should take into account that the drug can suppress ovulation, reducing the chances of conception. After discontinuation of the drug, the hormonal levels stabilize.
In childhood
The drug is contraindicated for children under 6 years of age. Schoolchildren from 6 to 12 years old are prescribed ibuprofen in small doses for extreme heat, acute inflammatory processes, and also to relieve pain after fractures and other injuries.
In elderly patients
After 50 years, the risk of gastrointestinal perforation, gastric ulcer, liver and kidney pathologies, heart failure, and increased side effects from the use of NSAIDs increases. Taking more than 1200 mg of ibuprofen per day can be fatal.
For impaired renal function
For liver dysfunction
The possibility of using the drug depends on the degree of organ damage and the characteristics of the disease. The advisability of prescribing ibuprofen is discussed individually with the attending physician. For patients suffering from liver cirrhosis, NSAIDs are contraindicated.
Effect on concentration
The drug has no specific inhibitory effect. However, some patients, after taking painkillers, experience drowsiness, dizziness, and become sluggish. In this case, it is better to temporarily stop driving a car and operating other complex mechanisms.
Storage conditions and periods
Ibuprofen retains its medicinal properties for 3 years. In this case, the drug should be stored in a dry place, avoiding direct sunlight. The room temperature should not exceed +25°C.
Conditions for dispensing from pharmacies
The drug is widely distributed in the Russian Federation. You can buy it at any pharmacy or order it online and have it delivered to your home.
Is it sold without a prescription?
Like other ibuprofen-based pain relievers, this drug is available without a prescription.
What is the price
The price of the drug in online pharmacies ranges from 93.00 to 162.00 rubles. (20 pcs.). A more expensive option is Nurofen Express capsules. Its cost ranges from 147.00 to 250.00 rubles. One pack contains 10 soft gelatin capsules.
Recipe in Latin
When writing a prescription, the doctor indicates the Latin name of the active substance, release form, recommended dosage and frequency of administration. It might look like this:
- Rp.: Ibuprofeni 200 mg.
- D.t.d. N 20 in tab.
- S. Orally, 1 tablet 3 times a day.
In this case, the pharmacist at the pharmacy must give the patient a package of Nurofen 200 containing 20 tablets.
Manufacturer
Reckitt Benckiser Healthcare International (UK)
Analogues
The cheapest analogue of the drug is simple ibuprofen (200 mg). Other popular drugs that use an identical active ingredient:
- Arviprox;
- Arofen for children;
- Bolinet;
- Brufen Forte;
- Gofen;
- Ibuprex Soft;
- Ibuprom;
- Orafen et al.
In case of severe pain, instead of simple tablets, you can purchase Nurofen Express. It is available in the form of capsules with a gelatin shell, inside which the active substance is contained in liquid form. Due to this, the analgesic effect occurs within 15 minutes. Patients with hypersensitivity to ibuprofen are prescribed other types of NSAIDs: naproxen, paracetamol, diclofenac, ketoprofen, dexetoprofen.
Instructions
Trade name
Nurofen® Express
International Nonproprietary Name (INN)
Ibuprofen
Dosage form
Capsules 200 mg
Compound
One capsule contains
active substance- ibuprofen 200 mg
excipients: macrogol 600, potassium hydroxide, purified water
capsule shell: gelatin, sorbitol 76% solution, crimson dye [Ponceau 4R] (E 124), purified water, opacode WB NS-78-18011 (purified water, titanium dioxide (E 171), propylene glycol, isopropanol, HPMC 2910 / hypromellose 3cP).
Description
Oval capsules with a red translucent gelatin shell, with a white identifying inscription NUROFEN, containing a clear liquid from colorless to slightly pink.
Pharmacotherapeutic group
Anti-inflammatory and anti-rheumatic diseases
Non-steroidal anti-inflammatory drugs Propionic acid derivatives, Ibuprofen
ATX code M01AE01
Pharmacological properties
Pharmacokinetics
Absorption is high, quickly and almost completely absorbed from the gastrointestinal tract (GIT). After taking 2 capsules of the drug on an empty stomach, ibuprofen is detected in the blood plasma after 15 minutes, the maximum concentration (Cmax) of ibuprofen in the blood plasma is achieved after 30-40 minutes, which is two times faster than after taking an equivalent dose of Nurofen® in dosage form film-coated tablets 200 mg. Taking the drug with food may increase the time to reach maximum concentration (TCmax). Communication with blood plasma proteins is more than 90%, half-life (T1/2) is 2 hours. Slowly penetrates into the joint cavity, lingers in the synovial fluid, creating higher concentrations in it than in the blood plasma. After absorption, about 60% of the pharmacologically inactive R-form is slowly transformed into the active S-form. Metabolized in the liver. It is excreted by the kidneys (no more than 1% unchanged) and, to a lesser extent, with bile.
There were no significant differences in the pharmacokinetic profile of the drug in older adults compared to younger adults.
In limited studies, ibuprofen has been found in breast milk at very low concentrations.
Pharmacodynamics
The mechanism of action of ibuprofen, a derivative of propionic acid 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 rapid, targeted effect against pain (analgesic), antipyretic and anti-inflammatory effects. In addition, ibuprofen reversibly inhibits platelet aggregation.
Indications for use
Symptomatic treatment of mild or moderate headache, toothache, painful menstruation; febrile conditions with influenza and colds.
Directions for use and doses
Read the instructions carefully before taking the drug.
For oral administration. For short term use only.
Adults and children over 12 years of age (over 40 kg): 1 capsule (200 mg) orally, without chewing, up to 3-4 times a day. The capsule should be taken with water. The interval between doses of the drug should be 6-8 hours.
To achieve a faster therapeutic effect in adults, the single dose can be increased to 2 capsules (400 mg) up to 3 times a day.
The maximum daily dose is 1200 mg.
The maximum daily dose for children 12-17 years old is 1000 mg.
If symptoms persist or worsen after taking the drug for 2-3 days, you should stop treatment and consult a doctor.
Side effects
The incidence of adverse reactions was assessed based on the following criteria: very often (≥ 1/10), often (from ≥ 1/100 to< 1/10), нечасто (от ≥ 1/1000 до < 1/100), редко (от ≥ 1/10 000 до < 1/1000), очень редко (> 1/10 000).
Uncommon:
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, Quincke's edema, exfoliative and bullous dermatoses, toxic epidermal necrolysis, Stevens syndrome -Johnson, erythema multiforme), allergic rhinitis, eosinophilia
Abdominal pain, nausea, dyspepsia (including heartburn, bloating)
Headache
Rarely:
Diarrhea, flatulence, constipation and vomiting
Papillonecrosis, nephritic syndrome (especially with long-term use), in combination with an increase in the concentration of urea in the blood plasma and the appearance of edema, hematuria and proteinuria
Very rarely:
Hematopoietic disorders (anemia, leukopenia, aplastic anemia, hemolytic anemia, thrombocytopenia, pancytopenia, agranulocytosis)
Severe hypersensitivity reactions, including swelling of the face, tongue and larynx, shortness of breath, tachycardia, hypotension (anaphylaxis, angioedema or severe anaphylactic shock)
Peptic ulcer, perforation or gastrointestinal bleeding, melena, hematemesis, sometimes fatal (especially in elderly patients), ulcerative stomatitis, exacerbation of colitis
Liver dysfunction (especially with long-term treatment), hepatitis and jaundice, nephrotic syndrome, acute renal failure (compensated and decompensated), interstitial nephritis, cystitis
Aseptic meningitis
Edema, including peripheral
Decreased hematocrit or hemoglobin
Increased bleeding time
Decreased plasma glucose concentration
Decreased creatinine clearance
Increased plasma creatinine concentration
Increased activity of “liver” transaminases
Frequency unknown:
Exacerbation of colitis and Crohn's disease
Heart failure, peripheral edema, with long-term use increased risk of thrombotic complications (for example, myocardial infarction), increased blood pressure
Bronchial asthma, bronchospasm, shortness of breath.
If side effects occur, you should stop taking the drug and consult a doctor.
The risk of side effects can be minimized if the drug is taken in a short course, at the minimum effective dose required to eliminate symptoms.
Side effects are predominantly dose-dependent.
The following adverse reactions were observed with short-term use of ibuprofen in doses not exceeding 1200 mg/day (3 capsules).
Contraindications
Hypersensitivity to ibuprofen or any of the components included in the drug
A history of hypersensitivity reactions (bronchial asthma, bronchospasm, rhinitis, rhinosinusitis, recurrent polyposis of the nose or paranasal sinuses, Quincke's edema, urticaria) associated with the use of acetylsalicylic acid (salicylates) or other NSAIDs
Severe dehydration (as a result of vomiting, diarrhea, or insufficient fluid intake)
Erosive and ulcerative diseases of the gastrointestinal tract (including gastric and duodenal ulcers, Crohn's disease, ulcerative colitis) or ulcerative bleeding in the active phase or in history (two or more confirmed episodes of peptic ulcer or ulcerative bleeding)
History of bleeding or perforation of a gastrointestinal ulcer caused by the use of NSAIDs
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 surgery
Hemophilia and other bleeding disorders (including hypocoagulation), hemorrhagic diathesis
Fructose intolerance
Intracranial hemorrhages
Pregnancy (III trimester)
Children's age up to 12 years
Drug interactions
The simultaneous use of ibuprofen with the following drugs should be avoided:
Acetylsalicylic acid (except for 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 simultaneous use, ibuprofen reduces the anti-inflammatory and antiplatelet effect of acetylsalicylic acid (an increase in the incidence of acute coronary insufficiency in patients receiving small doses of acetylsalicylic acid as an antiplatelet agent is possible after starting ibuprofen).
Other NSAIDs, including selective COX-2 inhibitors: The simultaneous use of two or more drugs from the NSAID group should be avoided due to a possible increased risk of side effects.
Caution should be used simultaneously with the following drugs:
Anticoagulants: NSAIDs may enhance the effect of anticoagulants, in particular warfarin and thrombolytic drugs.
Antihypertensives (ACE inhibitors and angiotensin II antagonists) and diuretics: NSAIDs may reduce the effectiveness of drugs in these groups. Diuretics and ACE inhibitors may increase the nephrotoxicity of NSAIDs.
Corticosteroids: Increased risk of gastrointestinal ulceration and gastrointestinal bleeding.
Antiplatelet agents and selective serotonin reuptake inhibitors: increased risk of gastrointestinal bleeding.
Cardiac glycosides: simultaneous administration of NSAIDs and cardiac glycosides can lead to worsening heart failure, a decrease in glomerular filtration rate and an increase in the concentration of cardiac glycosides in the blood plasma.
Lithium preparations: there is evidence of the likelihood of an increase in the concentration of lithium in the blood plasma during the use of NSAIDs.
Methotrexate: there is evidence of the likelihood of an increase in the concentration of methotrexate in the blood plasma during the use of NSAIDs.
Cyclosporine: increased risk of nephrotoxicity when NSAIDs are administered concomitantly with cyclosporine.
Mifepristone: NSAIDs should be started no earlier than 8 to 12 days after taking mifepristone, as NSAIDs may reduce the effectiveness of mifepristone.
Tacrolimus: When NSAIDs are co-administered with tacrolimus, the risk of nephrotoxicity may increase.
Zidovudine: Concomitant use of NSAIDs and zidovudine may result in increased hematotoxicity. There is evidence of an increased risk of developing hemarthrosis and hematomas in HIV-positive patients with hemophilia who received concomitant treatment with zidovudine and ibuprofen.
Quinolone antibiotics: In patients receiving concomitant treatment with NSAIDs and quinolone antibiotics, the risk of seizures may be increased.
Cefamandole, cefoperazone, cefotetan, valproic acid, plicamycin: increased incidence of hypoprothrombinemia.
Drugs that block tubular secretion: decreased excretion and increased plasma concentrations of ibuprofen.
Inducers of microsomal oxidation (phenytoin, ethanol, barbiturates, rifampicin, phenylbutazone, tricyclic antidepressants): increased production of hydroxylated active metabolites, increased risk of developing severe intoxications.
Microsomal oxidation inhibitors: reducing the risk of hepatotoxicity.
Oral hypoglycemic drugs and insulin, sulfonylurea derivatives: increased effect.
Antacids and cholestyramine: decreased absorption.
Caffeine: increased analgesic effect.
Special instructions
Drugs that inhibit cyclooxygenase and prostaglandin synthesis can affect ovulation, impairing female reproductive function (reversible after discontinuation of treatment).
During long-term treatment, monitoring of the peripheral blood picture and the functional state of the liver and kidneys is necessary. When symptoms of gastropathy appear, careful monitoring is indicated, including esophagogastroduodenoscopy, a complete blood count (hemoglobin determination), and a stool test for occult blood. If it is necessary to determine 17-ketosteroids, the drug should be discontinued 48 hours before the study. During the treatment period, ethanol intake is not recommended.
When treating chronic conditions and with long-term use, other adverse reactions may occur.
The first symptoms of such disorders are fever, sore throat, superficial ulcers in the mouth, flu-like syndrome, severe weakness, nosebleeds and subcutaneous hemorrhages, bleeding and bruising of unknown etiology.
With caution
If you have the conditions listed in this section, you should consult your doctor before using the drug:
- severe somatic diseases, dyslipidemia/hyperlipidemia, diabetes mellitus, peripheral arterial disease, smoking, frequent alcohol consumption, concomitant use of medications that may increase the risk of ulcers or bleeding, in particular oral corticosteroids (including prednisolone), anticoagulants (including warfarin ), selective serotonin reuptake inhibitors (including citalopram, fluoxetine, paroxetine, sertraline) or antiplatelet agents (including acetylsalicylic acid, clopidogrel), pregnancy I-II trimester, breastfeeding period, old age.
Respiratory organs: It is possible to develop bronchospasm in patients with bronchial asthma or allergic diseases in the acute stage or in history.
Systemic lupus erythematosus or mixed connective tissue disease (Sharpe's syndrome): increased risk of aseptic meningitis
Kidney failure, including dehydration (creatinine clearance less than 30-60 ml/min), nephrotic syndrome may worsen.
Hepatic dysfunction (liver failure, liver cirrhosis with portal hypertension, hyperbilirubinemia) may be worsened.
Arterial hypertension and/or heart failure, cerebrovascular diseases: fluid retention, hypertension, edema are possible.
Blood diseases of unknown etiology (leukopenia and anemia): may get worse.
Violation of reproductive function of women: There is limited evidence that agents that inhibit cyclooxygenase and prostaglandin synthesis may affect ovulation, impairing female reproductive function. This effect is reversible after discontinuation of treatment.
Gastrointestinal tract (GIT): NSAIDs should be prescribed with caution to patients with a history of gastrointestinal diseases (ulcerative colitis, Crohn's disease), as these conditions may be aggravated. Risk factors include a history of a single episode of gastric ulcer or gastrointestinal bleeding,
gastritis, enteritis, colitis, the presence of Helicobacter pylori infection, ulcerative colitis.
Gastrointestinal bleeding, ulceration or perforation of the gastrointestinal tract wall, if there is a history of complications, can develop without warning symptoms and in some cases can be fatal.
The risk of gastrointestinal bleeding, ulcers or perforation of the gastrointestinal tract wall and the poor outcome associated with the development of these conditions is higher in elderly patients, especially when taking a large dose of NSAIDs. These patients should receive short course treatment at the lowest effective dose.
Patients with a history of gastrointestinal diseases should report any new abdominal symptoms (especially gastrointestinal bleeding), which are more likely to develop during the initial stages of treatment.
This drug contains 14 mg of potassium per dose. This must be taken into account in patients who need to monitor potassium levels in the blood.
Use during pregnancy and breastfeeding
Although no teratogenic effects have been demonstrated in animal experiments, the use of ibuprofen 200 mg capsules should be avoided during the first 6 months of pregnancy.
In the third trimester, ibuprofen is contraindicated, as there is a risk of premature closure of the fetal ductus arteriosus with possible persistent pulmonary hypertension. The onset of labor may be delayed and the duration of action prolonged, and there may be an increased tendency to bleeding in both mother and child.
There is evidence that ibuprofen can pass into breast milk in small quantities without any adverse effects on the health of the nursing infant.
Features of the influence on the ability to drive vehicles and machinery.
Patients who experience dizziness, drowsiness, lethargy, or blurred vision while taking ibuprofen should avoid driving or operating machinery.
Overdose
In children, overdose symptoms may develop after taking a dose exceeding 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 increased prothrombin time, renal failure, liver tissue damage, decreased blood pressure, respiratory depression and cyanosis may develop. In patients with bronchial asthma, exacerbation of this disease is possible.
Treatment: gastric lavage within 1 hour after taking a potentially toxic dose of ibuprofen, taking activated charcoal. If necessary, symptomatic treatment, with mandatory provision of airway patency, monitoring of ECG and vital signs until the patient’s condition is normalized. If ibuprofen has already been absorbed, an alkaline drink may be prescribed in order to eliminate the acidic derivative of ibuprofen by the kidneys, forced diuresis. Frequent or prolonged seizures should be treated with intravenous diazepam or lorazepam. If bronchial asthma worsens, the use of bronchodilators is recommended.
Release form and packaging
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: carmellose sodium - 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%, dye iron oxide black (E172) 24.65%, propylene glycol 1.3%, isopropanol* 0.55%, butanol* 9.75%, ethanol* 32.275%, purified water* 3.25%).
* solvents that have evaporated after the printing process.
6 pcs. - blisters (2) - cardboard packs.
8 pcs. - blisters (1) - cardboard packs.
8 pcs. - blisters (2) - cardboard packs.
10 pcs. - blisters (1) - cardboard packs.
10 pcs. - blisters (2) - cardboard packs.
10 pcs. - blisters (3) - cardboard packs.
12 pcs. - blisters (1) - cardboard packs.
12 pcs. - blisters (2) - cardboard packs.
12 pcs. - blisters (3) - cardboard packs.
12 pcs. - blisters (4) - cardboard packs.
12 pcs. - blisters (8) - cardboard packs.
Pharmacological action
NSAIDs, a derivative of phenylpropionic acid. It has anti-inflammatory, analgesic and antipyretic effects.
The mechanism of action is associated with inhibition of the activity of COX, the main enzyme in the metabolism of arachidonic acid, which is a precursor of prostaglandins, which play a major role in the pathogenesis of inflammation, pain and fever. The analgesic effect is due to both peripheral (indirectly, through suppression of prostaglandin synthesis) and central mechanisms (inhibition of prostaglandin synthesis in the central and peripheral nervous system). Suppresses platelet aggregation.
When applied externally, it has an anti-inflammatory and analgesic effect. Reduces morning stiffness and helps increase range of motion in joints.
Pharmacokinetics
When taken orally, ibuprofen is almost completely absorbed from the gastrointestinal tract. Concomitant food intake slows down the rate of absorption. Metabolized in the liver (90%). T 1/2 is 2-3 hours.
80% of the dose is excreted in the urine mainly in the form of metabolites (70%), 10% - unchanged; 20% is excreted through the intestines in the form of metabolites.
Indications
Inflammatory and degenerative diseases of the joints and spine (including rheumatic and ankylosing spondylitis, osteoarthritis), articular syndrome with exacerbation of gout, psoriatic arthritis, ankylosing spondylitis, tendonitis, bursitis, radiculitis, traumatic inflammation of soft tissues and the musculoskeletal system. Neuralgia, myalgia, pain syndrome due to infectious and inflammatory diseases of the ENT organs, adnexitis, algodismenorrhea, headache and toothache. Fever in infectious and inflammatory diseases.
Contraindications
Erosive and ulcerative lesions of the gastrointestinal tract in the acute phase, diseases of the optic nerve, “aspirin triad”, hematopoietic disorders, severe renal and/or liver dysfunction; III trimester of pregnancy; hypersensitivity to ibuprofen.
Dosage
They are set individually, depending on the nosological form of the disease and the severity of clinical manifestations. When taken orally or rectally for adults, the single dose is 200-800 mg, the frequency of administration is 3-4 times a day; for children - 20-40 mg/kg/day in several doses.
Apply externally for 2-3 weeks.
Maximum daily dose for adults when taken orally or rectally is 2.4 g.
Side effects
From the digestive system: often - nausea, anorexia, vomiting, epigastric discomfort, diarrhea; the development of erosive and ulcerative lesions of the gastrointestinal tract is possible; rarely - bleeding from the gastrointestinal tract; With long-term use, liver function disorders are possible.
From the central nervous system and peripheral nervous system: often - headache, dizziness, sleep disturbances, agitation, visual disturbances.
From the hematopoietic system: with long-term use, anemia, thrombocytopenia, and agranulocytosis are possible.
From the urinary system: With long-term use, renal dysfunction is possible.
Allergic reactions: often - skin rash, Quincke's edema; rarely - aseptic meningitis (more often in patients with autoimmune diseases), bronchospastic syndrome.
Local reactions: When used externally, skin hyperemia, burning or tingling sensations are possible.
Drug interactions
With simultaneous use, ibuprofen reduces the effect of antihypertensive drugs (ACE inhibitors), diuretics (furosemide, hydrochlorothiazide).
When used simultaneously with anticoagulants, their effect may be enhanced.
When used simultaneously with GCS, the risk of side effects from the gastrointestinal tract increases.
When used simultaneously, ibuprofen can displace indirect anticoagulants (acenocoumarol), hydantoin derivatives (phenytoin), and oral hypoglycemic drugs and sulfonylurea derivatives from compounds with blood proteins.
When used simultaneously with amlodipine, a slight decrease in the antihypertensive effect of amlodipine is possible; c - the concentration of ibuprofen in the blood plasma decreases; with baclofen - a case of increased toxic effects of baclofen is described.
When used simultaneously with warfarin, an increase in bleeding time is possible; microhematuria and hematomas were also observed; with captopril - a decrease in the antihypertensive effect is possible; with cholestyramine - a moderately pronounced decrease in the absorption of ibuprofen.
When used simultaneously with lithium carbonate, the concentration of lithium in the blood plasma increases.
When used simultaneously with magnesium hydroxide, the initial absorption of ibuprofen increases; c - the toxicity of methotrexate increases.
Special instructions
Use with caution in case of concomitant diseases of the liver and kidneys, chronic heart failure, with dyspeptic symptoms before starting treatment, immediately after surgery, with indications in the anamnesis of bleeding from the gastrointestinal tract and gastrointestinal diseases, allergic reactions associated with taking NSAIDs.
During treatment, systematic monitoring of liver and kidney functions and peripheral blood patterns is necessary.
Should not be used externally on damaged skin areas.
Pregnancy and lactation
Use in the third trimester of pregnancy is contraindicated. Use in the first and second trimesters of pregnancy is justified only in cases where the expected benefit to the mother outweighs the possible risk to the fetus.
Ibuprofen is excreted in breast milk in small quantities. Use during lactation for pain and fever is possible. If long-term use or use in high doses (more than 800 mg/day) is necessary, the issue of stopping breastfeeding should be considered.
For impaired renal function
Contraindicated in cases of severe renal impairment. Use with caution in case of concomitant kidney diseases.
For liver dysfunction
Contraindicated in cases of severe liver dysfunction. Use with caution in case of concomitant liver diseases.
The page contains instructions for use Nurofena. It is available in various dosage forms of the drug (tablets 200 mg, forte, plus, children's syrup or suspension, suppositories 60 mg, gel 5%), and also has a number of analogues. This abstract has been verified by experts. Leave your feedback on the use of Nurofen, which will help other site visitors. The drug is used for various diseases (pain, fever during influenza and ARVI). The product has a number of side effects and interactions with other substances. Doses of the drug differ for adults and children. There are restrictions on the use of the medicine during pregnancy and breastfeeding. Treatment with Nurofen can only be prescribed by a qualified doctor. The duration of therapy may vary and depends on the specific disease.
Instructions for use and dosage
For adults and children over 12 years of age, the initial dose of the drug is 200 mg 3-4 times a day. To achieve a rapid clinical effect, it is possible to increase the initial dose to 400 mg 3 times a day. The maximum daily dose is 1200 mg.
Children aged 6 to 12 years - 200 mg no more than 4 times a day. It should be taken into account that the drug can only be prescribed to children weighing more than 20 kg. The interval between taking tablets should be at least 6 hours.
You should not take more than 6 tablets per day. Maximum dose - 1.2 g.
Film-coated tablets should be taken with water. Effervescent tablets should be dissolved in 200 ml of water (1 glass).
Candles for children
For fever and pain, the dose of the drug depends on the age and body weight of the child. A single dose is 5-10 mg/kg 3-4 times a day. The maximum daily dose is 30 mg/kg.
Children aged 3-9 months (body weight 5.5-8 kg) are prescribed 1 suppository (60 mg) 3 times a day with an interval of 6-8 hours, but not more than 180 mg per day.
Children aged 9 months to 2 years (body weight 8-12.5 kg) are prescribed 1 supp. (60 mg) 4 times a day with an interval of 6 hours, no more than 240 mg per day.
For post-immunization fever, children under 1 year of age are prescribed 1 supp. (60 mg); children over 1 year also - 1 supp. (60 mg), if necessary, after 6 hours you can introduce another 1 supp. (60 mg).
Duration of treatment: no more than 3 days as an antipyretic, no more than 5 days as an analgesic. If fever persists, consult a doctor.
Do not exceed the indicated doses of the drug.
Suspension or syrup for children
For fever and pain, the drug is prescribed in a dose of 5-10 mg/kg body weight of the child 3-4. The maximum daily dose should not exceed 30 mg/kg body weight.
As an antipyretic, the drug should not be taken for more than 3 days, and as an analgesic - no more than 5 days.
For fever after immunization, the drug is prescribed at a dose of 50 mg (2.5 ml); if necessary, children over 1 year of age can re-take the drug in the same dose after 6 hours. The maximum daily dose should not exceed 5 ml (100 mg).
The suspension should be shaken thoroughly before use.
For precise dosing of the suspension, the bottle is supplied with a double-sided measuring spoon (2.5 ml and 5 ml) or a measuring syringe.
Release forms
Film-coated tablets 200 mg.
Tablets for the preparation of an effervescent drink 200 mg.
Rectal suppositories 60 mg (children's form of the drug).
Tablets Nurofen forte 400 mg.
Nurofen plus tablets (contains ibuprofen + codeine).
Children's syrup or suspension with orange or strawberry flavor 100 mg.
Gel for external use 5%.
Nurofen- non-steroidal anti-inflammatory drug, a derivative of phenylpropionic acid. It has anti-inflammatory, analgesic and antipyretic effects.
The mechanism of action is associated with inhibition of the activity of COX, the main enzyme in the metabolism of arachidonic acid, which is a precursor of prostaglandins, which play a major role in the pathogenesis of inflammation, pain and fever. The analgesic effect is due to both peripheral (indirectly, through suppression of prostaglandin synthesis) and central mechanisms (due to inhibition of prostaglandin synthesis in the central and peripheral nervous system). Suppresses platelet aggregation.
When applied externally, it has an anti-inflammatory and analgesic effect. Reduces morning stiffness and helps increase range of motion in joints.
Pharmacokinetics
After oral administration, ibuprofen (the active ingredient of Nurofen) is quickly absorbed from the gastrointestinal tract. Plasma protein binding is 90%. Slowly penetrates into the joint cavity, lingers in the synovial tissue, creating higher concentrations in it than in plasma. Ibuprofen is excreted in the urine unchanged (no more than 1%) and in the form of conjugates, a small part is excreted in the bile.
Indications
- headache;
- migraine;
- toothache;
- neuralgia;
- myalgia;
- back pain;
- rheumatic pains;
- algodismenorrhea;
- fever with influenza and ARVI.
Contraindications
- erosive and ulcerative lesions of the gastrointestinal tract in the acute phase, incl. peptic ulcer of the stomach and duodenum, ulcerative colitis, peptic ulcer, Crohn's disease;
- severe heart failure;
- severe arterial hypertension;
- "aspirin" bronchial asthma, urticaria, rhinitis, provoked by taking acetylsalicylic acid (salicylates) or other NSAIDs;
- diseases of the optic nerve, impaired color vision, amblyopia, scotoma;
- deficiency of glucose-6-phosphate dehydrogenase;
- hemophilia, hypocoagulation conditions;
- leukopenia;
- hemorrhagic diathesis;
- severe dysfunction of the liver and/or kidneys;
- hearing loss, pathology of the vestibular apparatus;
- 3rd trimester of pregnancy;
- lactation period (breastfeeding);
- children under 6 years of age (for tablets);
- hypersensitivity to ibuprofen or to the components of the drug.
Special instructions
If side effects occur, you should stop taking the drug and consult a doctor.
If symptoms persist after taking the drug for 2-3 days, the drug should be discontinued and the diagnosis clarified.
When taking effervescent tablets, patients on a hypopotassium diet should take into account that 1 tablet contains 1530 mg of potassium carbonate; patients with diabetes mellitus should take into account that 1 tablet contains 40 mg of sodium saccharinate; Patients with fructose intolerance should take into account that 1 tablet contains about 376 mg of sorbitol.
Control of laboratory parameters
During long-term use of the drug, it is necessary to monitor the peripheral blood picture and the functional state of the liver and kidneys. When symptoms of gastropathy appear, careful monitoring is indicated, including esophagogastroduodenoscopy, a general blood test (hemoglobin determination), and a stool test for occult blood.
Impact on the ability to drive vehicles and operate machinery
Patients should refrain from all activities that require increased attention and speed of psychomotor reactions.
Side effect
When using Nurofen for 2-3 days, practically no side effects are observed. In case of long-term use, the following side effects may occur:
- nausea, vomiting;
- heartburn;
- anorexia;
- feeling of discomfort in the epigastrium;
- diarrhea;
- flatulence;
- erosive and ulcerative lesions of the gastrointestinal tract (in some cases complicated by perforation and bleeding);
- abdominal pain, irritation;
- dryness and pain in the oral mucosa;
- constipation;
- headache;
- dizziness;
- insomnia, agitation, drowsiness, depression;
- confusion, hallucinations;
- blurred vision;
- dryness and irritation of the eyes;
- hearing loss, ringing or noise in the ears;
- increased blood pressure;
- tachycardia;
- nephrotic syndrome;
- acute renal failure;
- anemia (including hemolytic, aplastic);
- thrombocytopenia;
- thrombocytopenic purpura;
- agranulocytosis;
- leukopenia;
- skin rash, itching, urticaria, angioedema, anaphylactoid reactions, anaphylactic shock;
- allergic rhinitis;
- bronchospasm, shortness of breath;
- increased sweating.
With long-term use in high doses: ulceration of the gastrointestinal mucosa, bleeding (including from the gastrointestinal tract, gums, uterine, hemorrhoidal), visual impairment (impaired color vision, scotoma, amblyopia).
Drug interactions
When administered simultaneously, ibuprofen reduces the anti-inflammatory and antiplatelet effect of acetylsalicylic acid (an increase in the incidence of acute coronary insufficiency may occur after starting ibuprofen in patients receiving small doses of acetylsalicylic acid as an antiplatelet agent).
When used simultaneously with anticoagulants and thrombolytic drugs (including alteplase, streptokinase, urokinase), the risk of bleeding increases.
When used together with Nurofen, cefamandole, cefoperazone, cefotetan, valproic acid, and plicamycin increase the incidence of hypoprothrombinemia.
When used together, cyclosporine and gold preparations enhance the effect of ibuprofen on the synthesis of prostaglandins in the kidneys, which leads to an increased nephrotoxic effect.
Ibuprofen increases the plasma concentration of cyclosporine and the likelihood of developing its hepatotoxic effects.
Drugs that block tubular secretion, when used simultaneously, reduce the excretion and increase the plasma concentration of ibuprofen.
When used together, inducers of microsomal oxidation (including phenytoin, ethanol, barbiturates, rifampicin, phenylbutazone, tricyclic antidepressants) increase the production of hydroxylated active metabolites, increasing the risk of severe hepatotoxic reactions.
Inhibitors of microsomal oxidation reduce the risk of developing hepatotoxic effects of ibuprofen.
When used together, Nurofen reduces the hypotensive activity of vasodilators, the natriuretic effect of furosemide and hydrochlorothiazide.
Ibuprofen reduces the effectiveness of uricosuric drugs and enhances the effect of indirect anticoagulants, antiplatelet agents and fibrinolytics.
Increases the side effects of mineralocorticoids, glucocorticosteroids (GCS), estrogens, ethanol (alcohol).
When used together, it increases the hypoglycemic effect of oral antidiabetic agents (sulfonylurea derivatives) and insulin.
When taken simultaneously, antacids and cholestyramine reduce the absorption of Nurofen.
When used together, ibuprofen increases the blood concentration of digoxin, lithium, and methotrexate.
Caffeine enhances the analgesic effect of ibuprofen.
Analogues of the drug Nurofen
Structural analogues of the active substance:
- Advil;
- ArthroCam;
- Bonifen;
- Brufen;
- Burana;
- Deblock;
- Children's Motrin;
- Dolgit;
- Ibuprom;
- Ibuprofen;
- Ibusan;
- Ibutop gel;
- Ibufen;
- Yprene;
- MIG 200;
- MIG 400;
- Nurofen for children;
- Nurofen Period;
- Nurofen UltraCap;
- Nurofen forte;
- Nurofen Express;
- Pedea;
- Solpaflex;
- Faspik.
Use during pregnancy and breastfeeding
Nurofen is contraindicated for use in the 3rd trimester of pregnancy.
The use of the drug in the 1st and 2nd trimesters of pregnancy is possible only if the expected benefit to the mother outweighs the potential risk to the fetus or infant.
If it is necessary to prescribe the drug during lactation, the issue of stopping breastfeeding should be decided.
Release form
Pills
Compound
Ibuprofen 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: carmellose sodium - 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
Pharmacological effect
Anti-inflammatory, antipyretic, analgesic.
Pharmacokinetics
Absorption is high, quickly and almost completely absorbed from the gastrointestinal tract. After taking the drug on an empty stomach, the Cmax of ibuprofen in the blood plasma is achieved after 45 minutes. Taking the drug with food can increase Tmax by up to 1–2 hours. Communication with blood plasma proteins is 90%. Slowly penetrates into the joint cavity, lingers in the synovial fluid, creating higher concentrations in it than in the blood plasma. Lower concentrations of ibuprofen are found in cerebrospinal fluid compared to blood plasma. After absorption, about 60% of the pharmacologically inactive R-form is slowly transformed into the active S-form. Metabolized in the liver. T1/2 - 2 hours. Excreted in urine (unchanged, no more than 1%) and, to a lesser extent, in bile. In limited studies, ibuprofen has been found in breast milk at very low concentrations.
Indications
Headache; migraine; toothache; painful menstruation; neuralgia; back pain; muscle pain; rheumatic pain; joint pain; fevers with flu and colds.
Contraindications
Hypersensitivity to ibuprofen or any of the components included in 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 a history); erosive and ulcerative diseases of the gastrointestinal tract (including peptic ulcer of the stomach and duodenum, Crohn's disease, ulcerative colitis) or ulcerative bleeding in the active phase or in history (two or more confirmed episodes of peptic ulcer or ulcerative bleeding); bleeding or perforation of a gastrointestinal ulcer in history, provoked use of NSAIDs; severe liver failure or active liver disease; severe renal failure (Cl creatinine
Precautions
With caution: simultaneous use of other NSAIDs, a history of a single episode of gastric and duodenal ulcers or gastrointestinal ulcer bleeding; gastritis, enteritis, colitis, the presence of 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; renal failure, incl. when dehydrated (Cl creatinine
Use during pregnancy and breastfeeding
The use of the drug is contraindicated in the third trimester of pregnancy. The use of the drug in the first and second trimesters of pregnancy should be avoided; if it is necessary to take the drug, you should consult your doctor. There is evidence that ibuprofen in small quantities can pass into breast milk without any negative consequences for the health of the infant, therefore, usually with short-term There is no need to stop breastfeeding. If long-term use of the drug is necessary, you should consult a doctor to decide whether to stop breastfeeding for the period of use of the drug.
Directions for use and doses
Inside, with water. Patients with hypersensitivity of the stomach are recommended to take the drug with meals. For short term use only. Before taking the drug, you should carefully read the instructions. Adults and children over 12 years of age: 1 tablet orally. (200 mg) up to 3-4 times a day. To achieve a faster therapeutic effect in adults, the dose can 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 weighs more than 20 kg. The interval between taking tablets should be at least 6 hours. The maximum daily dose for adults is 1200 mg (6 tablets). The maximum daily dose for children from 6 to 18 years is 800 mg (4 tablets). If symptoms persist or intensify when taking the drug for 2-3 days, you should stop treatment and consult a doctor.
Side effects
The risk of side effects can be minimized if the drug is taken in a short course, at the minimum effective dose required to eliminate symptoms. Elderly people have an increased incidence of adverse reactions with the use of NSAIDs, especially gastrointestinal bleeding and perforation, in some cases with fatal outcome. Side effects are predominantly dose-dependent. The following adverse reactions were observed with short-term use of ibuprofen in doses not exceeding 1200 mg/day (Table 6). When treating chronic conditions and long-term use, other adverse reactions may occur. The frequency of adverse reactions is assessed based on the following criteria: very often (≥1/10); often (from ≥1/100 to
Overdose
In children, overdose symptoms may occur after taking a dose exceeding 400 mg/kg body weight. In adults, the dose-dependent effect of overdose is less pronounced. T1/2 of the drug in case of overdose is 1.5–3 hours. Symptoms: nausea, vomiting, pain in the epigastric region 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 mandatory maintenance of airway patency, monitoring of ECG and vital signs until the patient’s condition is normalized. It is recommended to administer activated charcoal orally or gastric lavage within 1 hour after taking a potentially toxic dose of ibuprofen. If ibuprofen has already been absorbed, an alkaline drink may be prescribed in order to eliminate the acidic derivative of ibuprofen by the kidneys, forced diuresis. Frequent or prolonged seizures should be treated with IV diazepam or lorazepam. If bronchial asthma worsens, the use of bronchodilators is recommended.
Interaction with other drugs
The simultaneous use of ibuprofen with the following LSAs: acetylsalicylic acid should be avoided: with the exception of low doses of acetylsalicylic acid (no more than 75 mg/day) prescribed by a doctor, since combined use may increase the risk of side effects. With simultaneous use, ibuprofen reduces the anti-inflammatory and antiplatelet effect of acetylsalicylic acid (there may be an increase in the incidence of acute coronary insufficiency in patients receiving small 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 increased risk of side effects. Use with caution simultaneously with the following drugs Anticoagulants and thrombolytic drugs: NSAIDs may enhance the effect of anticoagulants, in particular warfarin and thrombolytic drugs. Antihypertensive drugs (inhibitors ACEs and ARBs II) and diuretics: NSAIDs may reduce the effectiveness of drugs in these groups. In some patients with impaired renal function (for example, in patients with dehydration or in elderly patients with impaired renal function), the concomitant administration of ACE inhibitors or ARB II and drugs that inhibit COX may lead to a 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 ARB II. In this regard, the combined use of the above drugs should be prescribed with caution, especially in the elderly. It is necessary to prevent dehydration in patients, and also consider monitoring renal function after starting this combination treatment and periodically thereafter. Diuretics and ACE inhibitors may increase the nephrotoxicity of NSAIDs. GCS: increased risk of gastrointestinal ulcers and gastrointestinal bleeding. Antiplatelet agents and SSRIs: increased risk of gastrointestinal bleeding. Cardiac glycosides: simultaneous administration of NSAIDs and cardiac glycosides can lead to worsening heart failure, a decrease in glomerular filtration rate and an increase in the concentration of cardiac glycosides in the blood plasma. Lithium preparations: there is evidence of the likelihood of an increase in the concentration of lithium in the blood plasma against the background of the use of NSAIDs. Methotrexate: There is evidence that there is a potential for increased plasma concentrations of methotrexate with the use of NSAIDs. Cyclosporine: Increased risk of nephrotoxicity when NSAIDs and cyclosporine are co-administered. Mifepristone: NSAIDs should be started no earlier than 8-12 days after taking mifepristone, since NSAIDs may reduce the effectiveness of mifepristone. Tacrolimus: with simultaneous administration of NSAIDs and tacrolimus, an increased risk of nephrotoxicity may occur. Zidovudine: 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 who received joint treatment with zidovudine and ibuprofen. Quinolone antibiotics: in patients receiving joint treatment with NSAIDs and quinolone antibiotics, there may be an increased risk of seizures. Myelotoxic drugs: increased Hematotoxicity. Champamonol, cefoperisone, cefotetan, valproic acid, plycucin: an increase in the frequency of development of hypoprotrombinemia.LS, blocking the canal secretion: reduction of the excretion and increase in plasma concentration of ibuprofen. Indurators of microsomal oxidation (phenytoin, ethanol, barbiturates, rifampicin, phenylba Tazone, tricyclic antidepressants): increased production of hydroxylated active metabolites, increased risk of severe intoxication. Inhibitors of microsomal oxidation: reduced risk of hepatotoxicity. Oral hypoglycemic drugs and insulin, sulfonylurea derivatives: increased effect of drugs. Antacids and colestyramics: decreased absorption. Uricosuric drugs: decreased effectiveness of drugs. Caffeine: increased 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, monitoring of the peripheral blood picture and the functional state of the liver and kidneys is necessary. When symptoms of gastropathy appear, careful monitoring is indicated, including esophagogastroduodenoscopy, a complete blood count (hemoglobin determination), and a stool test for occult blood. If it is necessary to determine 17-ketosteroids, the drug should be discontinued 48 hours before the study. During the treatment period, it is not recommended to take ethanol. Patients with renal failure should consult a doctor before using the drug, since there is a risk of deterioration in the functional state of the kidneys. Patients with hypertension, incl. history and/or CHF, you should consult a doctor before using the drug, since the drug can cause fluid retention, increased blood pressure and edema. Information for women planning pregnancy: the drug suppresses COX and PG synthesis, affects ovulation, disrupting female reproductive function ( reversible after discontinuation of treatment).Effect on the ability to drive vehicles and machinery. Patients who experience dizziness, drowsiness, lethargy, or blurred vision while taking ibuprofen should avoid driving or operating machinery.