The drug "Nurofen Forte" refers to the clinical and pharmacological group of non-steroidal anti-inflammatory drugs. Below we consider the detailed instructions for this drug, as well as find out the opinion of consumers about it.
The composition of Nurofen Forte and the form of release
The tablets of this drug are white coated. In their shape, they are round and have a red overprint with the inscription Nurofen 400. One tablet of the drug contains 400 milligrams of ibuprofen, which is the active component of the drug. According to the instructions for Nurofen Forte (400 mg), the following components serve as excipients:
- Croscarmellose sodium - 60 milligrams.
- Sodium lauryl sulfate - 1 milligram.
- Sodium citrate - 87 milligrams.
- Stearic acid - 4 milligrams.
- Silicon dioxide - 2 milligrams.
The shell of Nurofen Forte tablets (400 mg) is made from carmellose sodium, talc, acacia gum, sucrose and titanium dioxide.
pharmachologic effect
Nurofen Forte is capable of exerting a quick action that is directed against pain. Thus, the medicine is analgesic, antipyretic and anti-inflammatory.
What does the instruction for Nurofen Forte tablets indicate to us?
The mechanism of action of ibuprofen, which is a derivative of propionic acid, is determined by the process of inhibiting the synthesis of prostaglandins, which are mediators of pain, inflammation, and, in addition, a hyperthermic reaction. The drug acts in such a way that it inhibits the synthesis of prostaglandins. In addition, ibuprofen reversibly inhibits platelet aggregation. The analgesic effect of the drug lasts, as a rule, up to eight hours.
Pharmacokinetics of the drug
The absorption process of the drug is high. The drug "Nurofen Forte" is quickly and almost completely absorbed from the digestive system.
As for the connection with blood plasma proteins, it is equal to ninety percent. The drug "Nurofen Forte" slowly penetrates into the joints, lingering in the synovial fluid, in which it creates higher concentrations in comparison with blood plasma. A lower concentration of ibuprofen is found in the cerebrospinal fluid than in the blood. As part of a limited study, ibuprofen was found in breast milk at extremely low concentrations. This is confirmed by the instructions for use for Nurofen Fort.
After the absorption process, about sixty percent of the pharmacologically inactive “R-form” slowly goes into the active phase. This drug is metabolized in the liver. The drug is excreted by the kidneys within two hours. To a lesser extent, excretion with bile occurs.
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Indications for use of the drug
The presented non-steroidal anti-inflammatory drug "Nurofen Forte" should be taken against the background of the following symptoms and ailments:
- Presence of headache and migraine.
- The appearance of toothache.
- The development of algodismenorea.
- The appearance of neuralgia, myalgia, or back pain.
- The occurrence of rheumatic pains.
- The appearance of fever with influenza and otolaryngological diseases.
Contraindications
In relation to taking the presented drug "Nurofen Forte" in tablets, there are quite a few different contraindications, for example:
- The presence of a complete, and in addition, incomplete combination of bronchial asthma and, in addition, a recurring polyposis of the paranasal sinuses along with intolerance to acetylsalicylic acid and other non-steroidal anti-inflammatory drugs, including a history.
- The presence of erosive and ulcerative diseases of the digestive system. Possible ulcerative bleeding.
- The presence of bleeding or perforation of digestive system ulcers in the anamnesis, which was triggered by the use of non-steroidal anti-inflammatory drugs.
- The development of severe liver failure.
- Liver disease in the active phase.
- The development of severe renal failure.
- The presence of a confirmed diagnosis of hyperkalemia.
- The development of decompensated heart failure.
- The period after undergoing coronary artery bypass grafting.
- The appearance of cerebrovascular or other bleeding.
- Fructose intolerance along with galactose malabsorption and sucrose deficiency.
- The presence of hemophilia and other disorders associated with blood coagulation, including hypocoagulation.
- The appearance of hemorrhagic diathesis.
- Third trimester of pregnancy.
- Children's age up to twelve years.
- The presence of hypersensitivity to ibuprofen or another component that is part of the drug.
When should it be prescribed with caution?
With caution, the drug "Nurofen Forte" 400 mg should be prescribed in the following situations:
- In the case of the simultaneous administration of other non-steroidal anti-inflammatory drugs.
- The presence in the history of gastric ulcer along with bleeding of the digestive system.
- The development of gastritis, enteritis, colitis.
- The presence of Helicobacter pylori infection or ulcerative colitis.
- The development of bronchial asthma or allergic pathologies during the exacerbation and history, as there is a risk of bronchospasm.
- Systemic lupus erythematosus or mixed pathology of connective tissues, for example, Sharpe syndrome. In this case, there is an increased risk of aseptic meningitis.
- Renal failure, including dehydration.
- The appearance of nephrotic syndrome.
- Hepatic failure along with cirrhosis with portal hypertension, and, in addition, hyperbilirubinemia.
- The development of arterial hypertension along with heart failure and cerebrovascular diseases.
- Blood pathology of unknown etiology. The development of leukopenia or anemia.
- Severe somatic diseases.
- The development of hyperlipidemia, and in addition, diabetes.
- Diseases of the peripheral arteries.
- The simultaneous use of medical devices that can increase the risk of ulcers and bleeding.
- Smoking along with the frequent use of alcoholic beverages.
- The first and second trimester in pregnant women, as well as with breastfeeding.
- Elderly patients.
Drug dosage
The drug "Nurofen Forte" (400 mg) is taken orally. Medicinal tablets must be washed down with water. Patients who suffer from increased sensitivity of the stomach are recommended to take this medication with meals. It should be noted that it is suitable for short-term use only.
For adults and children over the age of twelve, one tablet is prescribed up to three times a day. The interval between taking the drug should be at least six hours. It also describes the instructions for use with Nurofen Fort.
The maximum daily dose is 1200 milligrams - these are three tablets of the drug. The maximum daily dose for children and adolescents from twelve to eighteen years old is 800 milligrams (two tablets). In the event that the symptoms persist or intensify during the course of three days during the use of the drug, it will be necessary to stop the therapy, and then consult your doctor.
Next, we will understand what side effects can be from taking Nurofen Forte tablets and capsules. Instructions for use of the drug contain such information.
Possible side effects after using the drug
The risk of side effects is usually minimized if you take the medicine in a short course at the minimum dosage required to eliminate the symptoms.
Among elderly patients, an increased frequency of adverse reactions is observed against the background of the use of non-steroidal anti-inflammatory drugs. Most often, gastrointestinal bleeding and perforation can be observed, in some cases a fatal outcome is not excluded.
Side effects according to the instructions for capsules "Nurofen Forte" for the most part depend on the dosage. The following adverse reactions were noted against the background of short-term use of ibuprofen in a dose not exceeding 1200 milligrams of the drug per day (three tablets). In the treatment of chronic conditions, and in addition, with prolonged use, other adverse reactions are likely to occur. So, we consider what side effects are likely to occur while taking the drug "Nurofen Forte" 400 mg (instructions confirm this):
- The hematopoietic system can very rarely respond with various disorders, which will be expressed, for example, in anemia, leukopenia, aplastic or hemolytic anemia, thrombocytopenia, pancytopenia or agranulocytosis. The first symptoms of such disorders may be fever along with sore throat, superficial ulcers in the oral cavity, flu-like symptoms, severe weakness, nosebleeds and subcutaneous hemorrhages, and, in addition, bruises of unknown etiology.
- The immune system is infrequent, but can respond with hypersensitivity in the form of bronchial asthma, shortness of breath and dyspnea. Itching of hives or purpura is not ruled out. Phenomena such as exfoliative and bullous dermatosis and Stevens-Johnson syndrome along with erythema multiforme, allergic rhinitis, or eosinophilia can also be observed. Even more rarely, more severe hypersensitivity reactions can be expected in the form of swelling of the face and larynx, shortness of breath, tachycardia, arterial hypotension or severe anaphylactic shock.
- The condition of the digestive system may be accompanied by abdominal pain, nausea, dyspepsia, heartburn, bloating. Rarely, signs of diarrhea, flatulence, constipation, and vomiting may occur. Even less likely, peptic ulcers, perforations or gastrointestinal bleeding, melena, and bloody vomiting may occur. In extremely rare cases, death can occur, especially this is possible among elderly patients. In addition, the digestive system can react with ulcerative stomatitis, gastritis, as well as exacerbation of colitis or Crohn's disease.
- Bile ducts can very rarely respond with impaired liver function. Also, an increase in the activity of hepatic transaminases along with the appearance of hepatitis and jaundice is not ruled out.
- The urinary system extremely rarely can respond with acute renal failure of a compensated or decompensated form. In particular, this is likely against the background of prolonged use of the drug presented. In addition, there may be an increase in the concentration of urea in the blood along with edema, hematuria and proteinuria. The occurrence of nephritic syndrome, papillary necrosis, interstitial nephritis and cystitis is also possible.
- The nervous system rarely reacts with a headache, even less so with aseptic meningitis.
- In the framework of adverse reactions, heart failure with peripheral edema can also develop, and in the case of prolonged use of the drug, the risk of thrombotic complications in the form of myocardial infarction increases. Also, cardiovascular activity can respond by increasing pressure.
- The respiratory system responds with bronchial asthma, bronchospasm and shortness of breath.
Against the background of laboratory parameters, hematocrit along with hemoglobin can decrease. In turn, the duration of bleeding increases. Glucose concentration may decrease, and creatinine clearance may decrease. Directly plasma creatinine concentration increases. As for hepatic transaminases, they increase. In the event of any of the listed side effects, it is extremely important to stop taking the medicine and go to the doctor.
Drug overdose
In children, the symptoms of an overdose of Nurofen Forte tablets may occur after taking the drug in a dose that exceeds 400 milligrams per kilogram of body weight. In adults, the effect of an overdose is not so pronounced. Symptoms of an overdose, as a rule, are as follows:
- The appearance of nausea, vomiting, pain in the epigastric region.
- The development of diarrhea.
- The appearance of tinnitus along with a headache
- Gastrointestinal bleeding.
In more severe situations, manifestations from the nervous system are observed in the form of drowsiness, agitation, convulsions, disorientation and coma. In cases of more serious poisoning, the development of metabolic acidosis is not excluded, along with an increase in prothrombin time, renal failure, damage to liver tissue, decreased pressure, respiratory depression and cyanosis. In patients suffering from bronchial asthma, an exacerbation of this disease can be observed.
Treatment in this case requires symptomatic. First of all, it is required to ensure airway patency, and in addition, to monitor the electrocardiogram and basic vital signs until the patient is completely normalized. Oral administration of activated charcoal is also recommended along with gastric lavage for an hour after an overdose of a potentially toxic dose of ibuprofen. In the event that ibuprofen has already been absorbed, an alkaline drink should be prescribed in order to excrete the acid derivative through the kidneys. Frequent and prolonged cramps are stopped by the intravenous administration of drugs such as Diazepam or Lorazepam. Against the background of aggravation of bronchial asthma, bronchodilators are recommended.
Drug interaction
In particular, the simultaneous use of ibuprofen with the following medical devices should be avoided:
- Acetylsalicylic acid. The exception is its use in low doses of not more than 75 milligrams per day. In other cases, combined use can increase the risk of side effects. In the framework of the simultaneous use of ibuprofen reduces the anti-inflammatory effect of acetylsalicylic acid, as a result of this there is a risk of an increase in the incidence of acute coronary insufficiency. This is possible among patients who receive acetylsalicylic acid in a small dose as an antiplatelet drug immediately after starting ibuprofen.
- It is important to avoid the simultaneous use of two drugs from the category of non-steroidal anti-inflammatory drugs in connection with the possibility of increasing the risk of side effects.
With great caution, it is recommended to use the presented drug simultaneously with the following medical devices:
- Use with anticoagulants. Nonsteroidal anti-inflammatory drugs can significantly enhance the effect of anticoagulants.
- Use with antihypertensive drugs. Nonsteroidal anti-inflammatory drugs may decrease the effectiveness of this group of drugs. Some patients with impaired renal function may experience even greater deterioration. In this regard, the appearance of acute renal failure is not excluded. The combined use of the above drugs should be prescribed with great care, especially in relation to the elderly. It is required to prevent dehydration in patients, and in addition, to consider the possibility of monitoring renal function after the beginning of such combined treatment. This should be done periodically in the future.
- With simultaneous use with antiplatelet agents and selective serotonin inhibitors, the risk of gastrointestinal bleeding increases.
- Use with cardiac glycosides. The simultaneous administration of non-steroidal anti-inflammatory drugs with cardiac glycosides can lead to aggravation of heart failure, and, in addition, to a decrease in glomerular filtration rate.
- There is evidence of a likely increase in plasma lithium levels due to the use of non-steroidal anti-inflammatory drugs.
- There is evidence of a likely increase in the content of Methotrexate in the blood due to the use of non-steroidal anti-inflammatory drugs.
- There is evidence of a likely increase in the content of Cyclosporine in the blood when using non-steroidal anti-inflammatory drugs.
- Acceptance of non-steroidal anti-inflammatory drugs should not begin earlier than twelve days after Mifepristone, as otherwise it may reduce the effectiveness of the drug.
- With the simultaneous administration of non-steroidal anti-inflammatory drugs and Tacrolimus, the risk of nephrotoxicity may increase.
- The simultaneous use of non-steroidal anti-inflammatory drugs and “Zidovudine” can lead to an increase in hematotoxicity. There is evidence of an increased risk of hemarthrosis among HIV-positive patients with hemophilia.
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Patients who experience dizziness along with drowsiness, lethargy, or visual impairment while taking ibuprofen are advised to avoid driving vehicles.
With caution, the use of Nurofen Forte is prescribed for patients who are in old age.
Pregnancy and lactation
As already noted above, the use of the drug is contraindicated in the third trimester, and in the first and second, if necessary, you should first consult with your doctor.
There is evidence that small amounts of ibuprofen can pass into breast milk without causing negative effects on the health of the baby, and therefore, as part of a short-term intake, the need to stop breastfeeding, as a rule, does not arise. In the event that you want to take this drug for a long time, you should consult a doctor to resolve the issue of interrupting breastfeeding for the duration of treatment with Nurofen Forte. The instruction confirms this.
Use in childhood
In childhood, the described drug can not be taken in the following cases:
- The use of this drug is strictly contraindicated in children under twelve years of age.
- The presence of impaired renal function.
- The drug is contraindicated against the background of renal failure, which is in a severe degree of development. According to the instructions for use, Nurofen Forte (400 mg) is suitable only for adults.
With great care, children are prescribed this drug in the following cases:
- With dehydration, with nephrotic syndrome.
- The presence of impaired liver function.
- The presence of liver failure along with cirrhosis, hyperbilirubinemia and portal hypertension.
Conditions of dispensing from pharmacies and shelf life of the drug
As indicated by the instructions for use, Nurofen Forte tablets are approved for use as over-the-counter medicine. The conditions, and in addition, the periods of its storage are as follows: it should be kept out of the reach of children, and the temperature, in turn, should not exceed 25 ° C. This drug is suitable for use for three years.
Next, we find out what consumers say about him, who happened to take it.
Reviews about Nurofen Fort
Regarding the reviews about this drug, it should be noted that there are a lot of positive and satisfied comments on the effect of this drug on the Internet.
For example, people write that this medicine really helps to cope with various kinds of pain, acting very quickly. Also, many note its availability.
Among the dissatisfied reviews there are complaints about certain side effects, as well as the fact that not every pharmacy manages to get this medicine. Someone also complains about the long wait for the effect. But in general, as already noted, most comments on the drug are positive in color.
We examined how Nurofen Forte helps, as well as instructions for it.