Other precautions. As with other drugs of this class, ibuprofen may mask the usual signs of infection.

Probenecid and phenytoin. Interactions may also occur with probenecid, antidiabetic medications and phenytoin. Use of opioids in chronic (long-term) non-cancer pain (CNCP). Opioid analgesics have an established role in the treatment of acute pain, cancer pain and palliative and end-of-life care. Current evidence does not generally support opioid analgesics in improving pain and function for most patients with chronic non-cancer pain. The development of tolerance and physical dependence and risks of adverse effects, including hazardous and harmful use, increase with the length of time a patient takes an opioid. The use of opioids for long-term treatment of CNCP is not recommended. Nurofen liquid capsules, Nurofen express liquid capsules and Nurofen express period pain capsules should be swallowed with a drink. These capsules contain ibuprofen in liquid form. These start to work faster than all the other Nurofen dose forms mentioned here.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). Nurofen Rapid Relief Maximum Strength 400mg Liquid Capsules contain ibuprofen. For mild to moderate pain and fever.

Aspirin. Experimental data suggest that ibuprofen may inhibit the effect of low dose aspirin on platelet aggregation when they are dosed concomitantly. However, no clinically relevant effect is considered to be likely for occasional ibuprofen use. When discontinuing Nurofen Plus in a person who may be physically-dependent, the drug should not be ceased abruptly but withdrawn by tapering the dose gradually (see Ceasing opioids; see Section 4.2 Dose and Method of Administration). Nurofen Plus should be administered with caution in patients with hypertension or fluid retention (see Section 4.3 Contraindications, Heart). COX is involved in making substances in the body known as prostaglandins, in response to injury and in certain diseases and conditions. The prostaglandins cause pain, swelling and inflammation. Ibuprofen reduces inflammation and pain by reducing the production of these prostaglandins. 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.

6.7 Physicochemical Properties

Nurofen Plus contains the active ingredients Ibuprofen and Codeine phosphate. Nurofen Plus is used to provide temporary relief of acute moderate pain and inflammation. For more information, see Section 1. Why am I using Nurofen Plus? in the full CMI. 2. What should I know before I use Nurofen Plus?

Nurofen Plus contains the active ingredients Ibuprofen and Codeine phosphate. Ibuprofen belongs to a family of medicines called non-steroidal anti-inflammatory drugs (NSAIDS). These medicines work by relieving pain and/or inflammation (swelling, redness, soreness) and fever. Codeine is an opioid analgesic that works in the brain and spinal cord to relieve pain. Hypotensive effects of antihypertensive agents may be potentiated when used concurrently with codeine and lead to orthostatic hypotension. NSAIDs may diminish the effects of antihypertensives and diuretics. Diuretics can increase the risk of nephrotoxicity of NSAIDs.CYP2D6 metabolism. Nurofen Plus is contraindicated for use in patients who are CYP2D6 ultra-rapid metabolisers. Do not worry if you occasionally forget to use ibuprofen gel, mousse or spray, just carry on using it when you remember. If you put on too much ibuprofen gel, mousse or spray Nurofen Plus may cause dizziness light-headedness or drowsiness in some people. If this occurs, do not drive or operate machinery.

Tolerance to Nurofen Plus may develop, which means that the effect of the medicine may decrease. If this happens, more may be needed to maintain the same effect. 3. What if I am taking other medicines? Antiperistaltic antidiarrhoeals (including kaolin, pectin, loperamide). Concurrent use of these agents with codeine may increase the risk of severe constipation.Anticoagulants. Concurrent use of NSAIDs and warfarin has been associated with severe, sometimes fatal haemorrhage. The mechanism of this interaction is not known but may involve increased bleeding from NSAID-induced gastrointestinal ulceration or an additive effect of NSAID inhibition of platelet function with the anticoagulant effect of warfarin. Nurofen Plus should only be used in patients taking warfarin if absolutely necessary. Patients taking this combination must be closely monitored.