Nurofen Forte

Nurofen Forte is a non-steroidal anti-inflammatory agent that belongs to the group of propionic acid derivatives.

[1]

Indications Nurofen Forte

Indications for use

• Appearance of headaches and dental pain.
• The onset of migraines.
• The presence of painful menstruation.
• The appearance of signs of neuralgia.
• The occurrence of pain in the back, muscle, rheumatic and other types of pain.
• Presence of feverish states at signs of a flu and diseases of catarrhal character.

[2], [3]

Release form

Nurofen Forte is made in the form of biconvex tablets, which are covered with sugar shell. It has a white color and an overprint of red color on one side of the tablet - "Nurofen 400". The tablets are placed in a blister pack of twelve pieces each. One blister is packed in a cardboard box and supplied with a leaflet with instructions.

Each tablet contains four hundred milligrams of the active substance - ibuprofen, as well as a number of auxiliary components: sodium croscarmellose, sodium lauryl sulfate, sodium citrate, stearic acid, colloidal silicon anhydride, carmellose sodium, talc, acacia, sucrose, titanium dioxide, macrogol 6000, Opacode S-1-9460 HV brown, industrial methylated alcohol, purified water.

Pharmacodynamics

Nurofen Forte has analgesic, antipyretic and anti-inflammatory properties. The active component of the drug, ibuprofen, leads to non-selective blocking of cyclooxygenases 1 and 2. The effect of the action of the drug results from the inhibition of the synthesis of prostaglandins, which are mediators of pain, inflammation and hyperthermia.

[4], [5]

Pharmacokinetics

Nurofen Forte has a low degree of absorption. The maximum concentration of the active component in the blood plasma is observed one or two hours after the use of the drug. The percentage of binding to blood proteins reaches ninety percent.

The active substance is capable of slow penetration into the joint cavities and is retained in the synovial tissues, in which larger concentrations of the drug are created than in the blood plasma. After the absorption has taken place, approximately sixty percent of the inactive form of the substance is converted into an active form at a slow rate. Ibuprofen is capable of undergoing metabolic processes. It is excreted from the body with the help of the kidneys - an unchanged substance, up to fifteen percent. A smaller amount of ibuprofen is removed from the body by bile. The half-life is two hours.

[6], [7],

Dosing and administration

The medication is taken orally by washing with water. Adults and children from twelve years take one tablet once. Within twenty-four hours a patient can take no more than three tablets. The maximum daily amount of Nurofen Forte, intended for adults is one thousand two hundred milligrams, children from twelve to seventeen years - one thousand milligrams.

If symptoms persist for two to three days, Nurofen Forte should cancel its use and consult with a specialist.

[11], [12], [13]

Use Nurofen Forte during pregnancy

Nurofen Forte is contraindicated for use during pregnancy. Very carefully it is necessary to apply during breast-feeding.

Contraindications

Presence of hypersensitivity to any of the components of Nurofen Forte.

The presence of hypersensitivity to acetylsalicylic acid or other non-steroidal anti-inflammatory drugs. This includes the occurrence of bronchial obstruction, rhinitis, urticaria, as allergic reactions, as well as symptoms of complete or incomplete intolerance to acetylsalicylic acid with manifestations of rhinosinusitis, urticaria, the appearance of polyps of the nasal mucosa, the emergence of bronchial asthma.

[8], [9]

Side effects Nurofen Forte

Gastrointestinal tract - the appearance of gastropathy caused by non-steroidal anti-inflammatory drugs, which is characterized by the following symptoms: the presence of abdominal pain, nausea, vomiting, heartburn, decreased appetite, diarrhea, flatulence, constipation. In some cases, the appearance of ulcers of the mucous membrane of the gastrointestinal tract. Sometimes these ulcers are accompanied by the appearance of tissue perforation and bleeding. There is also the appearance of irritation or dryness of the oral mucosa, the appearance of pain in the mouth, the appearance of ulcers of gums, aphthous stomatitis and pancreatitis.

Hepatobiliary system - the onset of hepatitis.

Respiratory system - the appearance of dyspnoea and bronchitis.

Organs of the senses - the occurrence of hearing impairment, expressed in its decrease, the appearance of ringing or noise in the ears; the appearance of visual impairment, manifested in toxic damage to the optic nerve, unclear vision or double vision, the appearance of scotoma, dryness and irritation of the eyes, edema of the conjunctiva and eyelids of allergic origin.

Central and peripheral nervous system - the appearance of headaches, dizziness, insomnia, anxiety, nervousness, irritability, signs of psychomotor agitation, drowsiness, depression, confusion, hallucinations. In rare cases, there may be signs of aseptic meningitis.

Cardiovascular system - the appearance of heart failure, tachycardia, increased blood pressure.

The urinary system - the emergence of acute renal failure, allergic nephritis, nephrotic syndrome, accompanied by edema, polyuria, cystitis.

Allergic manifestations - the onset of a skin rash of erythematous nature or urticaria, the appearance of skin itch, Quincke's edema, anaphylactic reactions, anaphylactic shock, bronchospasm or dyspnoea, fever, multi-form exudative erythema, toxic epidermal necrolysis, eosinophilia, allergic rhinitis.

Organs of hematopoiesis - the occurrence of anemia (including its hemolytic and aplastic forms), thrombocytopenia, thrombocytopenic purpura, agragulocytosis, and leukopenia.

[10]

Overdose

The appearance of pain in the abdomen, nausea and vomiting, retardation, drowsiness, depression, headache, tinnitus, metabolic acidosis, coma, acute kidney failure, lowering blood pressure, bradycardia, tachycardia, atrial fibrillation, stopping breathing.

In this case, it is necessary to resort to gastric lavage within the first hour after taking Nurofen Forte. Also it is necessary to assign activated charcoal, alkaline drink, forced diuresis and symptomatic therapy.

[14], [15], [16], [17]

Interactions with other drugs

It is not recommended the simultaneous use of Nurofen Forte and acetylsalicylic acid and other non-steroidal anti-inflammatory drugs.

Anticoagulants and thrombolytic drugs - Alteplase, Streptokinase, Urokinase - when taken together with medications increase the risk of severe bleeding from the gastrointestinal tract.

With the simultaneous administration of cefamandole, cefaperazone, cefotetan, valproic acid and plikamycin, the incidence of hypoprothrombinemia increases.

The effects of cyclosporine and gold preparations lead to an increase in the effect of ibuprofen on the production of prostaglandins, which is carried out by the kidneys. Such a joint action of drugs leads to an increase in nephrotoxicity. The active component of the drug stimulates an increase in the plasma concentration of cyclosporine, which can cause a hepatotoxic effect.

Medications that are able to block secretion in the tubules lead to a decrease in excretion and an increase in the amount of ibuprofen in the blood plasma.

Preparations, which are inducers of microsomal oxidation, contribute to an increase in the production of active hydroxylated metabolites. At the same time, the possibility of obtaining a severe degree of intoxication is increased. This applies to phenytoin, ethanol, barbiturates, phenylbuzaton and tricyclic antidepressants.

Preparers capable of blocking microsomal oxidation, when taken together, can lead to a decrease in the hepatotoxic effect.

Simultaneous use of medication and vasodilators leads to a decrease in the effectiveness of drugs of the uricosuric group. The same method together with drugs natriyuretic group - furosemide and hydrochlorothiazide - leads to a decrease in the effectiveness of the latter.

When combined, the efficacy of the drugs of the uricosuric group decreases, but the effectiveness of anticoagulants, antiaggregants and fibrinolytics increases.

Simultaneous use of the medication enhances the side effects of such drugs as mineralocorticoids, glucocorticoids, estrogens, ethanol. Also, the effect of oral hypoglycemic drugs and insulin. Joint intake leads to a decrease in the absorption of antacids and cholestyramine.

With simultaneous use, there is an increase in the concentration in the blood plasma of substances such as digoxin, lithium preparations and methotrexate.

The intake of caffeine leads to an increase in the analgesic effect of the medication.

[18], [19], [20]

Storage conditions

Nurofen Forte - with a temperature regime of no higher than twenty degrees Celsius and in a place that is inaccessible to children.

[21], [22], [23]

Shelf life

Nurofen Forte - thirty-six months from the date of production.

[24]