Ibuprofen is a propionic acid derivative NSAID that has demonstrated its efficacy by inhibition of prostaglandin synthesis. In humans, ibuprofen reduces inflammatory pain, swellings and fever. Furthermore, ibuprofen reversibly inhibits platelet aggregation. If you're taking the tablet that melts in your mouth, put it on your tongue, let it dissolve and then swallow. You do not need to drink any water. Anticoagulants: NSAIDs may enhance the effects of anti-coagulants, such as warfarin (See section 4.4). Pain-relieving medication: Pain relievers that reduce the effects of prostaglandins are very effective for period pain. These pain relievers are called non-steroidal anti-inflammatory drugs (or NSAIDs for short) and include ibuprofen, the active ingredient in Nurofen

The white capsule-shaped tablets are marked 'N+' on one side and plain on the other. 4 Clinical Particulars

How to give ibuprofen to your child

Women who are pregnant. Ibuprofen may increase the risk of miscarriage and malformations and should not be used during the first and second trimesters of pregnancy unless considered essential by your doctor. Ibuprofen must not be taken in the third trimester because it may delay labour, increase the length of labour and cause complications in the newborn baby. Nurofen Plus may cause dizziness light-headedness or drowsiness in some people. If this occurs, do not drive or operate machinery. If you drink alcohol, dizziness, light-headedness and/or drowsiness may be worse. Drinking alcohol Use in renal impairment. Renal impairment as renal function may deteriorate, especially in dehydrated paediatric patients (see Section 4.3 Contraindications; Section 4.8 Adverse Effects (Undesirable Effects)). You can become addicted to Nurofen Plus even if you take it exactly as prescribed. Nurofen Plus may become habit forming causing mental and physical dependence. If abused it may become less able to reduce pain. Dependence

In serious poisoning metabolic acidosis may occur and the prothrombin time/INR may be prolonged, probably due to interference with the actions of circulating clotting factors. Acute renal failure and liver damage may occur. There is some evidence that drugs which inhibit cyclo-oxygenase/ prostaglandin synthesis may cause impairment of female fertility by an effect on ovulation. This is reversible on withdrawal of treatment. Severe hepatic impairment (see Section 4.4 Special Warnings and Precautions for Use, Use in hepatic impairment). In patients younger than 12 years (see Section 4.4 Special Warnings and Precautions for Use, Paediatric use). If you no longer need to use this medicine or it is out of date, take it to any pharmacy for safe disposal.CYP2D6 metabolism. Nurofen Plus is contraindicated for use in patients who are CYP2D6 ultra-rapid metabolisers. All medicines can have side effects. If you do experience any side effects, most of them are minor and temporary. However, some side effects may need medical attention. Use in the elderly. Adverse effects may have more serious consequences in the elderly, and they may be more susceptible to the CNS depressant effects of opioids.

GI bleeding, ulceration or perforation, which can be fatal has been reported with all NSAIDs at any time during treatment, with or without warning symptoms or a previous history of GI events. Systemic lupus erythematosus as well as mixed connective tissue disease – increased risk of aseptic meningitis (see section 4.8). Symptoms – Most patients who have ingested clinically important amounts of NSAIDs will develop no more than nausea, vomiting, epigastric pain, or more rarely diarrhoea. Tinnitus, headache and gastrointestinal bleeding are also possible. In more serious poisoning, toxicity is seen in the central nervous system, manifesting as drowsiness, occasionally excitation and disorientation or coma. Occasionally patients develop convulsions. In serious poisoning metabolic acidosis may occur and the prothrombin time/ INR may be prolonged, probably due to interference with the actions of circulating clotting factors. Acute renal failure and liver damage may occur. Exacerbation of asthma is possible in asthmatics. Call your doctor straight away, or go straight to the Emergency Department at your nearest hospital if you notice any of these serious side effects. Always follow your doctor or pharmacist's advice, and the instructions that come with your medicine. Dosage and strength for tablets, capsules, granules and liquid

5.1 Pharmacodynamic Properties

Zidovudine: Increased risk of haematological toxicity when NSAIDs are given with zidovudine. There is evidence of an increased risk haemarthroses and haematoma in HIV (+) haemophiliacs receiving concurrent treatment with zidovudine and ibuprofen. Physical dependence, which can occur after several days to weeks of continued opioid usage, results in withdrawal symptoms if the opioid is ceased abruptly or the dose is significantly reduced. Withdrawal symptoms can also occur following the administration of an opioid antagonist (e.g. naloxone) or partial agonist (e.g. buprenorphine). Careful consideration should also be exercised before initiating long-term treatment of patients with risk factors for cardiovascular events (e.g. hypertension, hyperlipidaemia, diabetes mellitus, smoking), particularly if high doses of ibuprofen (2400 mg/day) are required.