Drugs List

     GOFEN 400mg ,GOFEN 200

       Calprofen syrup

      ANADIN IBUPROFEN 200mg tablets

• ANADIN JOINT PAIN 200mg tablets
• ANADIN ULTRA 200mg liquid capsules
• BRUFEN 100mg/5ml syrup
• BRUFEN 400mg tablets
• BRUFEN 600mg granules
• BRUFEN RETARD 800mg tablets
• CALPROFEN 100mg/5ml oral suspension
• CALPROFEN 100mg/5ml oral suspension (sachets)
• CUPROFEN MAXIMUM STRENGTH 400mg tablets
• FENPAED 100mg/5ml oral suspension
• FLARIN 200mg soft capsules
• IBUCALM 200mg tablets
• IBUCALM 400mg tablets
• ibuprofen 100mg chewable capsule
• ibuprofen 100mg/5ml oral suspension
• ibuprofen 100mg/5ml oral suspension sugar-free (sachets)
• ibuprofen 100mg/5ml suspension sugar-free
• ibuprofen 200mg liquid capsules
• ibuprofen 200mg orodispersible tablets sugar-free
• ibuprofen 200mg tablets
• ibuprofen 200mg/5ml oral suspension sugar-free
• ibuprofen 300mg modified release capsules
• ibuprofen 400mg liquid capsules
• ibuprofen 400mg tablets
• ibuprofen 600mg granules
• ibuprofen 600mg tablets
• ibuprofen 800mg modified release tablet
• IBUPROFEN SEVEN PLUS PAIN RELIEF 200mg/5ml oral suspension
• IBUPROFEN TWELVE PLUS PAIN RELIEF 200mg/5ml oral suspension
• NUROFEN 200mg caplets
• NUROFEN 200mg tablets
• NUROFEN BACK PAIN SR 300mg capsules
• NUROFEN EXPRESS 200mg liquid capsules
• NUROFEN EXPRESS 400mg liquid capsules
• NUROFEN EXPRESS PERIOD PAIN 200mg soft capsules
• NUROFEN FOR CHILDREN 100mg chewable capsule
• NUROFEN FOR CHILDREN 100mg/5ml suspension sugar-free
• NUROFEN FOR CHILDREN 3 MONTHS TO 9 YEARS 100mg/5ml oral suspension
• NUROFEN FOR CHILDREN BABY 100mg/5ml oral suspension
• NUROFEN FOR CHILDREN COLD PAIN AND FEVER 100mg/5ml suspension
• NUROFEN FOR CHILDREN orange 200mg/5ml oral suspension sugar-free
• NUROFEN FOR CHILDREN strawberry 100mg/5ml oral suspension sugar-free (sachets)
• NUROFEN FOR CHILDREN strawberry 200mg/5ml oral suspension sugar-free
• NUROFEN JOINT & BACK PAIN RELIEF 200mg liquid capsules
• NUROFEN MELTLETS 200mg dissolving tablets
• NUROFEN MELTLETS LEMON 200mg orodispersible tablet

Therapeutic Indications

Uses

Ankylosing spondylitis
Fever
Juvenile idiopathic arthritis
Musculo-skeletal conditions
Osteoarthritis
Pain - mild to moderate
Post immunisation pyrexia

Dosage

Rheumatoid arthritis

Monitor renal function and sodium and water retention in patients with renal impairment.

The Renal Drug Handbook suggests the following dose adjustments:
Glomerular Filtration Rate (GFR)
GFR 10 to 50ml/minute: Dose as in normal renal function, but avoid if possible.
GFR less than 10ml/minute: Dose as in normal renal function but only use if patient is on dialysis.

Contraindications

Neonates under 1 month
Predisposition to haemorrhage
Asthma, urticaria or acute rhinitis associated with NSAIDS
Gastrointestinal haemorrhage
Gastrointestinal perforation
History of gastrointestinal bleeding
History of peptic ulcer
New York Heart Association class IV failure
Peptic ulcer
Severe cardiac dysfunction
Severe hepatic impairment
Severe renal impairment
Third trimester of pregnancy

Precautions and Warnings

Allergic disposition
Children aged 1 to 3 months
Elderly
Females attempting to conceive
Restricted sodium intake
Risk factors for cardiovascular disorder
Varicella
Acute porphyria
Asthma
Breastfeeding
Cardiac impairment
Cerebrovascular disorder
Chronic inflammatory bowel disease
Coagulopathy
Connective tissue disorder
Crohn's disease
First trimester of pregnancy
Galactosaemia
Gastrointestinal disorder
Glucose-galactose malabsorption syndrome
Hepatic impairment
Hereditary fructose intolerance
History of asthma
History of cardiac disorder
History of cardiac failure
History of colitis
History of gastrointestinal disorder
Hypertension
Ischaemic heart disease
Lactose intolerance
New York Heart Association class II failure
Peripheral arterial circulatory disorder
Phenylketonuria
Renal impairment
Second trimester of pregnancy
Severe dehydration
Systemic lupus erythematosus

May mask symptoms or signs of infections
NSAIDs may provoke or exacerbate asthma
Sodium content of formulation may be significant
Some formulations contain aspartame - caution in phenylketonuria
Some formulations contain more than 1mmol (23mg) sodium per dose
Consider other first line treatment options in the elderly
Consider the need for combination therapy with gastroprotective agents
High dose increases cardiovascular risk
Not all available brands are licensed for all age groups
Not all available brands are licensed for all body weights
Not all available brands are licensed for all indications
Contains potassium; caution in low potassium diets
Oral solution with maltitol unsuitable in hereditary fructose intolerance
Presentations with sorbitol unsuitable in hereditary fructose intolerance
Some formulations contain glucose
Some formulations contain lactose
Some formulations contain propylene glycol
Some formulations contain sucrose
Some formulations contain wheat starch
Some presentations may contain benzyl alcohol
Some products may contain soya or soya derivative
Discontinue if signs of gastro-intestinal bleeding occur
Elderly - monitor for gastro-intestinal bleeding over initial 4 weeks
Monitor renal function in elderly patients
Advise patients to report signs or symptoms of gastro-intestinal ulcer
May cause bronchospasm
Discontinue if patient is attempting to conceive
Discontinue if symptoms of peptic ulcer occur
Discontinue treatment if skin rash or other allergic reaction occurs
Dose varies with brand
Maintain treatment at the lowest effective dose
Not licensed for all indications in all age groups
Reduce dose in elderly
Start treatment at lowest recommended dose
Female: Reduced fertility (reversible) possible with long term use
Advise patient to consult physician if condition worsens / does not improve

The inhibition of renal prostaglandin synthesis by NSAIDs may interfere with renal function, especially in the presence of renal disease. A deterioration in renal function could possible lead to renal failure. Avoid NSAID therapy if possible. If not, check serum creatinine 48-72 hours after initiating treatment and discontinue if levels are raised.

Patients with mixed connective tissue disorders such as systemic lupus erythematosus may be especially susceptible to aseptic meningitis. This has also been reported in patients with no underlying chronic disease.

Use with caution in patients with coagulopathies as NSAIDs including ibuprofen can interfere with platelet aggregation and can prolong bleeding time.

There is limited evidence that drugs which inhibit cyclooxygenase/ prostaglandin synthesis may cause impairment of female fertility by an effect on ovulation. This is reversible on withdrawal of treatment. The use of ibuprofen is therefore not recommended in women attempting to conceive (Briggs, 2015).

Avoid high dose ibuprofen (2400mg per day or more) in patients with cardiovascular disorders or risk factors for cardiovascular events.

Risk of renal impairment in dehydrated children and adolescents.

Pregnancy and Lactation

Pregnancy

Ibuprofen is contraindicated in the third trimester of pregnancy.

Use of any NSAID is considered contraindicated during the third trimester of pregnancy.

First trimester exposure to NSAIDs has been associated with an increased risk spontaneous abortions and of birth defects (notably cardiac septal defects). There is conflicting evidence, however, from various studies and the risk appears to be low (Briggs, 2015).

Ibuprofen should be used with caution in the first and second trimesters. Schaefer (2015) considers that use of NSAIDs in early pregnancy does not require termination of pregnancy or invasive diagnostic procedures.

Ibuprofen is a prostaglandin synthetase inhibitor and may have effects during the second and third trimesters, including pulmonary and cardiac toxicity in the foetus/newborn from the beginning of the sixth month and increases in risk if administration is close to full term. Other effects also include, functional renal injury in the foetus, inhibition of uterine contractions with delayed onset and prolongation of labour, increased possibility of bleeding in mother and child, and increased risk of maternal oedema formation. When used in the perinatal period, necrotising enterocolitis and intraventricular haemorrhages have been reported in very pre-term and very low birth weight infants.

Lactation

Use ibuprofen with caution during breastfeeding.

Ibuprofen appears in breast milk in very low concentrations and unlikely to affect the breastfed infant adversely (Lactmed, 2018).

Due to ibuprofens extremely low levels in breast milk and short half-life ibuprofen is a preferred choice as an analgesic or anti-inflammatory agent in nursing mothers (Schaefer, 2015).

Side Effects

Abdominal pain
Abnormal liver function
Acute generalised exanthematous pustulosis
Acute renal failure (reversible)
Anaphylactic reaction
Angioedema
Anxiety
Aseptic meningitis
Asthma
Blood disorders
Bronchospasm
Bullous reactions
Cardiac failure
Colitis
Confusion
Constipation
Depression
Diarrhoea
Dizziness
Drug rash with eosinophilia and systemic symptoms (DRESS)
Duodenal ulcer
Dyspepsia
Dyspnoea
Epidermal necrolysis
Erythema multiforme
Exacerbation of colitis
Exacerbation of Crohn's disease
Exacerbation of pre-existing asthma
Exfoliative dermatitis
Flatulence
Fluid retention
Gastric ulceration
Gastritis
Gastro-intestinal haemorrhage
Gastro-intestinal perforation
Gastro-intestinal symptoms
Gastro-intestinal ulceration with occult bleeding
Haematemesis
Haematuria
Headache
Hearing disturbances
Hepatic failure
Hepatic impairment
Hepatitis
Hypersensitivity reactions
Hypertension
Interstitial fibrosis
Interstitial nephritis
Jaundice
Laryngeal oedema
Melaena
Mouth ulcers
Myocardial infarction
Nausea
Nephrotic syndrome
Oedema
Optic neuritis
Pancreatitis
Papillary necrosis
Paraesthesia
Peptic ulceration
Photosensitivity
Pruritus
Purpura
Rash
Rhinitis
Somnolence
Stevens-Johnson syndrome
Tinnitus
Toxic epidermal necrolysis
Ulcerative stomatitis
Urticaria
Vertigo
Visual disturbances
Vomiting