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 The usual dose for adults is one or two 200mg tablets or capsules 3 times a day. In some cases, your doctor may prescribe a higher dose of up to 600mg to take 4 times a day if needed. This should only happen under supervision of a doctor. 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. These medicines may be affected by Nurofen Plus or may affect how well it works. You may need to take different amounts of your medicine, or you may need to take different medicines. Your doctor will advise you. If you no longer need to use this medicine or it is out of date, take it to any pharmacy for safe disposal.

Ceasing opioids. Abrupt discontinuation or rapid decreasing of the dose in a person physically dependent on an opioid may result in serious withdrawal symptoms and uncontrolled pain (see Tolerance, dependence and withdrawal). Such symptoms may lead the patient to seek other sources of licit or illicit opioids. Opioids should not be ceased abruptly in a patient who is physically dependent but withdrawn by tapering the dose slowly. Factors to take into account when deciding how to discontinue or decrease therapy include the dose and duration of the opioid the patient has been taking, the type of pain being treated and the physical and psychological attributes of the patient. A multimodal approach to pain management should be in place before initiating an opioid analgesic taper. During tapering, patients require regular review and support to manage any increase in pain, psychological distress and withdrawal symptoms. Effects on laboratory tests. Opioid analgesics interfere with a number of laboratory tests including plasma amylase, lipase, bilirubin, alkaline phosphatase, lactate dehydrogenase, alanine aminotransferase and aspartate aminotransferase. Opioids may also interfere with gastric emptying studies as they delay gastric emptying and with hepatobiliary imaging using technetium Tc 99m disofenin as opioid treatment may cause constriction of the sphincter of Oddi and increase biliary tract pressure. Heart (see Section 4.4 Special Warnings and Precautions for Use, Cardiovascular and cerebrovascular effects) or renal problems (see Section 4.4 Special Warnings and Precautions for Use, Use in renal impairment).

When seeking medical attention, take this leaflet and remaining medicine with you to show the doctor. Also tell them about any other medicines or alcohol which have been taken. 5. What should I know while using Nurofen Plus? Things you should do Adults and children 12 years and over. Initial dose two tablets taken with fluid, then one or two tablets every 4 to 6 hours when necessary. Maximum 6 tablets in a 24-hour period. Ibuprofen also brings down a fever by reducing the production of prostaglandins. Fever is associated with an increase in prostaglandins in the brain, which cause the body temperature to increase. By reducing prostaglandins in the brain, ibuprofen lowers body temperature. Inhibition of prostaglandin synthesis by ibuprofen may adversely affect pregnancy and/or the embryo/ foetal development. During the first and second trimester of pregnancy, this product should not be given unless clearly necessary, and is contraindicated in the third trimester. Methotrexate. NSAIDs inhibit tubular secretion of methotrexate in animals. As a result, reduction in the clearance of methotrexate may occur. Use of high doses of methotrexate concomitantly with NSAIDs should be avoided. At low doses of methotrexate, caution should be used if ibuprofen is administered concomitantly.

Metoclopramide, cisapride and domperidone. Codeine may antagonise the gastrointestinal effects of metoclopramide, cisapride and domperidone. Quinolone antibiotics. Animal data indicate that NSAIDs can increase the risk of convulsions associated with quinolone antibiotics. Patients taking NSAIDs and quinolone may have an increased risk of developing convulsions. Monoamine oxidase inhibitors (MAOIs). Concurrent administration or use within 14 days of ceasing monoamine oxidase inhibitors may enhance the potential respiratory depressant effects of codeine. CNS depression or excitation may occur if codeine is given to patients receiving monoamine oxidase inhibitors, or within two weeks of stopping treatment with them. Therefore, Nurofen Plus is contraindicated for use during breastfeeding. However, in circumstances where a breastfeeding mother requires codeine therapy, breastfeeding should be suspended and alternative arrangement should be made for feeding the infant for any period during codeine treatment. Breastfeeding mothers should be told how to recognize signs of high morphine levels in themselves and their babies. For example, in a mother, symptoms include extreme sleepiness and trouble caring for the baby. In the baby, symptoms include signs of increased sleepiness (more than usual), difficulty breastfeeding, breathing difficulties, or limpness. Medical advice should be sought immediately.

Store it in a cool dry place where the temperature stays below 25°C away from moisture, heat or sunlight; for example, do not store it: Using Nurofen Plus with alcohol may result in severe drowsiness, decreased awareness, breathing difficulties, coma and death. Withdrawal The white capsule-shaped tablets are marked 'N+' on one side and plain on the other. 4 Clinical Particulars

Nurofen Plus may cause dizziness light-headedness or drowsiness in some people. If this occurs, do not drive or operate machinery. When discontinuing Nurofen Plus in a person who may be physically-dependent, the drug should not be ceased abruptly but withdrawn by tapering the dose gradually (see Ceasing opioids; see Section 4.2 Dose and Method of Administration). In patients aged between 12 - 18 years in whom respiratory function might be compromised, including post tonsillectomy and/or adenoidectomy for obstructive sleep apnoea, due to an increased risk of developing serious and life-threatening adverse reactions (see Section 4.4 Special Warnings and Precautions for Use, Paediatric use). The use of an opioid to treat CNCP should only be considered after maximised nonpharmacological and non-opioid treatments have been tried and found ineffective, not tolerated or otherwise inadequate to provide sufficient management of pain. Opioids should only be prescribed as a component of comprehensive multidisciplinary and multimodal pain management.

If they take too much

Other NSAIDs: including cyclooxygenase-2-selective inhibitors. Avoid the use of two or more NSAIDs as this may increase the risk of adverse effects. Antiperistaltic antidiarrhoeals (including kaolin, pectin, loperamide). Concurrent use of these agents with codeine may increase the risk of severe constipation. Immediate-release products should not be used to treat chronic pain, but may be used for a short period in opioid-naïve patients to develop a level of tolerance before switching to a modified-release formulation. Careful and regular assessment and monitoring is required to establish the clinical need for ongoing treatment. Discontinue opioid therapy if there is no improvement of pain and/or function during the trial period or if there is any evidence of misuse or abuse. Treatment should only continue if the trial has demonstrated that the pain is opioid responsive and there has been functional improvement. The patient's condition should be reviewed regularly and the dose tapered off slowly if opioid treatment is no longer appropriate (see Ceasing opioids).

If you have pain all the time, your doctor may recommend slow-release ibuprofen tablets or capsules. You'll usually take these once a day in the evening or twice a day. Leave a gap of 10 to 12 hours between doses if you're taking ibuprofen twice a day. How to take tablets, capsules, granules and liquid Opioid analgesics can impair mental function and cause blurred vision and dizziness. Rare side effects may include convulsions, hallucinations, blurred or double vision and orthostatic hypotension. Patients should be advised not to drive or operate machinery. 4.8 Adverse Effects (Undesirable Effects) Nurofen Express 200mg Tablets contain ibuprofen as sodium dihydrate. For mild to moderate pain and fever. Mexiletine. Codeine may delay the absorption of mexiletine and thus reduce the antiarrhythmic effect of the latter.

Jo Adetunji (27 August 2011). "Nurofen Plus recalled as drug manufacturer suspects sabotage". The Guardian. London: Guardian.co.uk . Retrieved 17 November 2011. Gently massage the ibuprofen into the painful area 3 or 4 times a day. Leave at least 4 hours between applications. People who suffer from persistent headaches. Taking a painkiller for headaches or migraines too often or for too long can actually make the headaches worse.