NUROFEN MELTLETS LEMON

Active substance: IBUPROFEN

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SUMMARY OF PRODUCT CHARACTERISTICS

1

NAME OF THE MEDICINAL PRODUCT

Nurofen Meltlets Lemon

2

QUALITATIVE AND QUANTITATIVE COMPOSITION
Ibuprofen 200 mg
Excipient(s) with known effect:
Aspartame
For the full list of excipients, section see 6.1.

3

PHARMACEUTICAL FORM

Orodispersible tablet
White to off-white tablets.

4

CLINICAL PARTICULARS

4.1
Therapeutic indications
For the relief of mild to moderate pain, such as headache, backache, period pain,
dental pain, neuralgia, rheumatic and muscular pain, migraine, cold and flu symptoms
and feverishness.

4.2

Posology and method of administration
For oral administration and short-term use only.
Adults, the elderly and children and adolescents between 12 and 18 years:
The lowest effective dose should be used for the shortest duration necessary to
relieve symptoms.
If in children and adolescents this medicinal product is required for more than
3 days, or if symptoms worsen a doctor should be consulted.

Adults should consult a doctor if symptoms persist or worsen, or if the product
is required for more than 10 days.
Children and Adolescents between 12 and 18 years: Take 1 or 2 tablets up
to three times a day as required.
Adults: Take 1 or 2 tablets up to three times a day as required.

Place a tablet on the tongue, allow it to dissolve and then swallow; no water is
required.
Leave at least 4 hours between doses.
Do not exceed six tablets in any 24 hours.
Not for use by children under 12 years.

4.3

Contraindications

Hypersensitivity to ibuprofen or any of the excipients in the product.
Patients who have previously shown hypersensitivity reactions (e.g. asthma, rhinitis,
angioedema, or urticaria) in response to aspirin or other non-steroidal anti-inflammatory
drugs.
Active or history of recurrent peptic ulcer/haemorrhage (two or more distinct episodes of
proven ulceration or bleeding).
History of gastrointestinal bleeding or perforation, related to previous NSAIDs therapy.
Severe heart failure, renal failure or hepatic failure (see section 4.4)
Last trimester of pregnancy

4.4

Special warnings and precautions for use
Undesirable effects may be minimised by using the lowest effective dose for the
shortest duration necessary to control symptoms (see GI and cardiovascular risks
below).
The elderly have an increased frequency of adverse reactions to NSAIDs especially
gastrointestinal bleeding and perforation which may be fatal.
Respiratory:
Bronchospasm may be precipitated in patients suffering from, or with a previous
history of bronchial asthma or allergic disease.

Other NSAIDs:
The use of ibuprofen with concomitant NSAIDs including cyclooxygenase-2
selective inhibitors should be avoided (see section 4.5).
SLE and mixed connective tissue disease:
Systemic lupus erythematosus and mixed connective tissue disease – increased risk of
aseptic meningitis (see section 4.8).
Renal:
Renal impairment as renal function may further deteriorate (see sections 4.3 and 4.8).

There is a risk of renal impairment in dehydrated children and adolescents
Hepatic:
Hepatic dysfunction (see sections 4.3 and 4.8)
Cardiovascular and cerebrovascular effects:
Caution (discussion with doctor or pharmacist) is required prior to starting treatment
in patients with a history of hypertension and/or heart failure as fluid retention,
hypertension and oedema have been reported in association with NSAID therapy.
Clinical trial and epidemiological data suggest that use of ibuprofen, particularly at
high doses (2400mg daily) and in long-term treatment may be associated with a small
increased risk of arterial thrombotic events (for example myocardial infarction or
stroke). Overall, epidemiological studies do not suggest that low dose ibuprofen (e.g.
1200mg daily) is associated with an increased risk of myocardial infarction.



Impaired female fertility:
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 upon withdrawal of treatment.
Gastrointestinal:
NSAIDs should be given with care to patients with a history of gastrointestinal
disease (ulcerative colitis, Crohn’s disease) as these conditions may be exacerbated
(see section 4.8).
GI bleeding, ulceration or perforation, which can be fatal has been reported with all
NSAIDs at anytime during treatment, with or without warning symptoms or a
previous history of GI events.
The risk of GI bleeding, ulceration or perforation is higher with increasing NSAID
doses, in patients with a history of ulcer, particularly if complicated with

haemorrhage or perforation (see section 4.3), and in the elderly. These patients should
commence treatment on the lowest dose available.
Patients with a history of GI toxicity, particularly the elderly, should report any
unusual abdominal symptoms (especially GI bleeding) particularly in the initial stages
of treatment.
Caution should be advised in patients receiving concomitant medications which could
increase the risk of ulceration or bleeding, such as oral corticosteroids, anticoagulants
such as warfarin, selective serotonin-reuptake inhibitors or anti-platelet agents such as
aspirin (see section 4.5).
When GI bleeding or ulceration occurs in patients receiving ibuprofen, the treatment
should be withdrawn.
Dermatological:
Serious skin reactions, some of them fatal, including exfoliative dermatitis, StevensJohnson syndrome, and toxic epidermal necrolysis, have been reported very rarely in
association with the use of NSAIDs (see section 4.8). Patients appear to be at highest
risk for these reactions early in the course of therapy: the onset of the reaction
occurring in the majority of cases within the first month of treatment. Ibuprofen
should be discontinued at the first appearance of skin rash, mucosal lesions, or any
other sign of hypersensitivity.
Caution is required in patients with phenylketonuria or who are intolerant to
phenylalanine. The product contains aspartame which is a source of phenylalanine.
Each orodispersible tablet contains a source equivalent to 14 mg of phenylalanine.
The label will include:
Read the enclosed leaflet before taking this product
Do not take if you:




have (or have had two or more episodes of ) a stomach ulcer, perforation or
bleeding
are allergic to ibuprofen, to any of the ingredients, or to aspirin or other
painkillers
are taking other NSAID pain killers or aspirin with a daily dose above 75mg

Speak to a pharmacist or your doctor before taking if you:


have or have had asthma, diabetes, high cholesterol, high blood pressure, a stroke,
heart, liver, kidney or bowel problems or are dehydrated
• Are a smoker
• Are pregnant
If symptoms persist or worsen, consult your doctor or pharmacist.

4.5

Interaction with other medicinal products and other forms of interaction

Ibuprofen should be avoided in combination with:
Aspirin: unless low-dose aspirin (not above 75mg daily) has been advised by a doctor
as this may increase the risk of adverse reactions (see section 4.4).
Experimental data suggest that ibuprofen may inhibit the effect of low dose aspirin on
platelet aggregation when they are dosed concomitantly. However, the limitations of
these data and the uncertainties regarding extrapolation of ex vivo data to the clinical
situation imply that no firm conclusions can be made for regular ibuprofen use, and no
clinically relevant effect is considered to be likely for occasional ibuprofen use (see
section 5.1).
Other NSAIDs including cyclooxygenase-2 selective inhibitors: Avoid concomitant
use of two or more NSAIDs as this may increase the risk of adverse effects (see
section 4.4)
Ibuprofen should be used with caution in combination with:
Anticoagulants. NSAIDs may enhance the effects of anti-coagulants, such as warfarin
(see section 4.4).
Antihypertensives and diuretics: NSAIDs may diminish the effects of these drugs. In
some patients with compromised renal function (e.g. dehydrated patients or elderly
patients with compromised renal function) the co-administration of an ACE inhibitor
or Angiotensin II antagonist and agents that inhibit cyclo-oxygenase may result in
further deterioration of renal function, including possible acute renal failure, which is
usually reversible. These interactions should be considered in patients taking a coxib
concomitantly with ACE inhibitors or angiotensin II antagonists. Therefore, the
combination should be administered with caution, especially in the elderly. Patients
should be adequately hydrated and consideration should be given to monitoring of
renal function after initiation of concomitant therapy, and periodically thereafter.
Diuretics can increase the risk of nephrotoxicity of NSAIDs.
Corticosteroids: Increased risk of gastrointestinal ulceration or bleeding (see section
4.4)
Anti-platelet agents and selective serotonin reuptake inhibitors (SSRIs): Increased risk
of gastrointestinal bleeding (see section 4.4).
Cardiac glycosides: NSAIDs may exacerbate cardiac failure, reduce GFR and
increase plasma glycoside levels.
Lithium: There is evidence for potential increases in plasma levels of lithium.

Methotrexate: There is a potential for an increase in plasma methotrexate.
Ciclosporin: Increased risk of nephrotoxicity.
Mifepristone: NSAIDs should not be used for 8-12 days after mifepristone
administration as NSAIDs can reduce the effect of mifepristone.
Tacrolimus: Possible increased risk of nephrotoxicity when NSAIDs are given with
tacrolimus.
Zidovudine: Increased risk of haematological toxicity when NSAIDs are given with
zidovudine. There is evidence of an increased risk haemarthroses and haematoma in
HIV (+) haemophiliacs receiving concurrent treatment with zidovudine and ibuprofen.
Quinolone antibiotics:Animal data indicate that NSAIDs can increase the risk of
convulsions associated with quinolone antibiotics. Patients taking NSAIDs and
quinolones may have an increased risk of developing convulsions.

4.6

Pregnancy and lactation

Pregnancy:
Inhibition of prostaglandin synthesis may adversely affect the pregnancy and/or the
embryo/foetal development. Data from epidemiological studies suggest an increased
risk of miscarriage and of cardiac malformation and gastroschisis after use of a
prostaglandin synthesis inhibitor in early pregnancy. The absolute risk for
cardiovascular malformation was increased from less than 1%, up to approximately
1.5%. The risk is believed to increase with dose and duration of therapy. In animals,
administration of a prostaglandin synthesis inhibitor has been shown to result in
increased pre- and post-implantation loss and embryfoetal lethality. In addition,
increased incidences of various malformations, including cardiovascular, have been
reported in animals given a prostaglandin synthesis inhibitor during the organogenetic
period. During the first and second trimester of pregnancy, Nurofen should not be
given unless clearly necessary. If Nurofen is used by a woman attempting to conceive,
or during the first and second trimester of pregnancy, the dose should be kept as low
and duration of treatment as short as possible.
During the third trimester of pregnancy, all prostaglandin synthesis inhibitors may
expose the foetus to:
- cardiopulmonary toxicity (with premature closure of the ductus arteriosus and
pulmonary hypertension);
- renal dysfunction, which may progress to renal failure with oligohydroamniosis;

the mother and the neonate, at the end of the pregnancy, to:
- possible prolongation of bleeding time, an anti-aggregating effect which may occur
even at very low doses;
- inhibition of uterine contractions resulting in delayed or prolonged labour.
Consequently, Nurofen is contraindicated during the third trimester of pregnancy.

Lactation/Breastfeeding:
In limited studies, ibuprofen appears in the breast milk in very low concentration and
is unlikely to affect the breast-fed infant adversely.
See section 4.4 regarding female fertility.

4.7

Effects on ability to drive and use machines

None expected at recommended doses and duration of therapy.

4.8

Undesirable effects
Adverse events which have been associated with Ibuprofen are given below, listed by
system organ class and frequency. Frequencies are defined as: very common ( 1/10),
common ( 1/100 to <1/10), uncommon ( 1/1000 to <1/100), rare ( 1/10,000 to
<1/1000), very rare (<1/10,000) and not known (cannot be estimated from the
available data). Within each frequency grouping, adverse events are presented in
order of decreasing seriousness.









The list of the following adverse events relates to those experienced with ibuprofen at
OTC doses, for short-term use. In the treatment of chronic conditions, under longterm treatment, additional adverse events may occur.
The adverse events observed most often are gastrointestinal in nature. Adverse events
are mostly dose-dependent, in particular the risk of occurrence of gastrointestinal
bleeding is dependent on the dosage range and duration of treatment.
Clinical trial and epidemiological data suggest that use of ibuprofen (particularly at
high doses 2400mg daily) and in long-term treatment may be associated with a small
increased risk of arterial thrombotic events (for example myocardial infarction or
stroke), (see section 4.4).
System Organ Class
Blood and Lymphatic
System Disorders

Immune System

Frequency
Very rare:

Adverse Event
Haematopoietic
disorders
(anaemia,
leucopenia,
thrombocytopenia,
pancytopenia, agranulocytosis).
First signs are: fever, sore throat, superficial
mouth ulcers, flu-like symptoms, severe
exhaustion, unexplained bleeding and
bruising.
Hypersensitivity reactions consisting of1:

Disorders
Uncommon

Urticaria and pruritus

Very rare

Severe hypersensitivity reactions.
Symptoms could be facial, tongue and
laryngeal swelling, dyspnoea, tachycardia,
hypotension (anaphylaxis, angioedema or
severe shock).

Not Known

Respiratory tract reactivity comprising
asthma, aggravated asthma, bronchospasm
or dyspnoea.

Uncommon

Headache

Very rare

Aseptic meningitis2

Cardiac Disorders

Not Known

Cardiac failure and oedema

Vascular Disorders

Not Known

Hypertension

Gastrointestinal
Disorders

Uncommon

Abdominal pain, nausea, dyspepsia

Rare

Diarrhea, flatulence, constipation and
vomiting

Very rare

Peptic ulcer, perforation or gastrointestinal
haemorrhage, sometimes fatal, particularly
in the elderly. Melaena, haematemesis,
ulcerative stomatitis, gastritis.

Not Known

Nervous System
Disorders

Hepatobiliary Disorders

Very rare

Exacerbation of ulcerative colitis and
Crohn's disease (section 4.4).
Liver disorders

Skin and Subcutaneous
Tissue Disorders

Uncommon

Various skin rashes

Very rare

Severe forms of skin reactions such as
bullous reactions including StevensJohnson syndrome, erythema multiforme
and toxic epidermal necrolysis can occur.

Very rare

Acute renal failure, papillary necrosis,
especially in long-term use, associated with
increased serum urea and oedema.

Not Known

Renal insufficiency

Renal and Urinary Disorders

Investigations

Very rare

Decreased haemoglobin levels

Description of Selected Adverse Reactions
1

Hypersensitivity reactions have been reported following treatment with ibuprofen.
These may consist of (a) non-specific allergic reactions and anaphylaxis, (b)
respiratory tract activity comprising asthma, aggravated asthma, bronchospasm,
dyspnoea or (c) assorted skin disorders, including rashes of various types pruritus,
urticaria, purpura, angioedema and more rarely exfoliative and bullous dermatoses
(including epidermal necrolysis and erythema multiforme).

2

The pathogenic mechanism of drug-Induced aseptic meningitis is not fully
understood. However, the available data on NSAID-related aseptic meningitis points
to a hypersensitivity reaction (due to a temporal relationship with drug intake, and
disappearance of symptoms after drug discontinuation). Of note, single cases of
symptoms of aseptic meningitis (such as stiff neck, headache, nausea, vomiting, fever
or disorientation) have been observed during treatment with ibuprofen, in patients
with existing auto-immune disorders (such as systemic lupus erythematosus, mixed
connective tissue disease).

4.9

Overdose

In children ingestion of more than 400mg/kg may cause symptoms. In adults the dose
response effect is less clear cut. The half-life in overdose is 1.5-3 hours.
Symptoms
Most patients who have ingested clinically important amounts of NSAIDs will
develop no more than nausea, vomiting, epigastric pain, or more rarely diarrhoea. Tinnitus,
headache and gastrointestinal bleeding are also possible. In more serious poisoning, toxicity is
seen in the central nervous system, manifesting as drowsiness, occasionally excitation and
disorientation or coma. Occasionally patients develop convulsions. In serious poisoning
metabolic acidosis may occur and the prothrombin time/ INR may be prolonged, probably due
to interference with the actions of circulating clotting factors. Acute renal failure and liver
damage may occur. Exacerbation of asthma is possible in asthmatics.

Management
Management should be symptomatic and supportive and include the maintenance of a clear
airway and monitoring of cardiac and vital signs until stable. Consider oral administration of
activated charcoal if the patient presents within 1 hour of ingestion of a potentially toxic
amount. If frequent or prolonged, convulsions should be treated with intravenous diazepam or
lorazepam. Give bronchodilators for asthma.

5

PHARMACOLOGICAL PROPERTIES

5.1

Pharmacodynamic properties

ATC Code: M01AE01
Ibuprofen is a propionic acid derivative, having analgesic, anti-pyretic and antiinflammatory activity. The drug's therapeutic effects as a non-steroidal antiinflammatory drug are thought to result from inhibitory activity on prostaglandin
synthesis. Furthermore, ibuprofen reversibly inhibits platelet aggregation.
Experimental data suggest that ibuprofen may inhibit the effect of low dose aspirin on
platelet aggregation when they are dosed concomitantly. In one study, when a single
dose of ibuprofen 400mg was taken with 8 h before or within 30 min after immediate
release aspirin dosing (81mg), a decreased effect of ASA on the formation of
thromboxane or platelet aggregation occurred. However, the limitations of these data
and the uncertainties regarding extrapolation of ex vivo data to the clinical situation
imply that no firm conclusions can be made for regular ibuprofen use, and no relevant
effect is considered to be likely for occasional ibuprofen use.

5.2
Pharmacokinetic properties
Nurofen Meltlets Lemon consist of taste masked ibuprofen granules incorporated into
a compressed tablet. When the tablet is placed on the tongue it rapidly dissolves to
release the ibuprofen granules. The ibuprofen granules can then be swallowed without
the need for water.
Ibuprofen is well absorbed from the gastrointestinal tract. Ibuprofen is extensively
bound to plasma proteins. Ibuprofen diffuses into the synovial fluid.
Peak plasma concentrations from Nurofen Meltlets Lemon occur approximately 1
hour 50 minutes after administration. When taken with food, peak plasma levels may
be delayed.
Ibuprofen is metabolised in the liver to two major inactive metabolites and these
together with unchanged ibuprofen are excreted by the kidney either as such or as
conjugates. Excretion by the kidney is both rapid and complete.
Elimination half life is approximately 2 hours.
No significant differences in pharmacokinetic profile are observed in the elderly.

5.3
Preclinical safety data
No relevant information additional to that elsewhere in the Summary of Product
Characteristics.

6

PHARMACEUTICAL PARTICULARS

6.1
List of excipients
Ethylcellulose (E462),
Silicon Dioxide (E551),
Hypromellose (E464),
Mannitol (E420),
Aspartame (E951),
Croscarmellose Sodium (E468),
Magnesium Stearate (E572),
Flavour (lemon flavours, maltodextrin).

6.2
Incompatibilities
Not applicable

6.3
Shelf life
3 years

6.4
Special precautions for storage
Do not store above 25°C.

6.5
Nature and contents of container
The orodispersible tablets are packed in a cold formed blister pack. The blister
pockets are formed from 60 μm PVC/ 45 μm aluminium / 25 μm polyamide film heat
sealed to the 20μm aluminium foil blister lid .
The blister trays are packed into cardboard cartons containing 4, 6, 10, 12, 14, 16, 18,
20, 22, 24, 30, 36, 40 or 48 orodispersible tablets. Not all pack sizes may be marketed.

6.6
Special precautions for disposal
None

7

MARKETING AUTHORISATION HOLDER

Reckitt Benckiser Healthcare (UK) Ltd
Slough
SL1 4AQ

8

MARKETING AUTHORISATION NUMBER(S)

PL 00063/0382

9

DATE OF FIRST AUTHORISATION/RENEWAL OF THE
AUTHORISATION

06/03/2009

10

DATE OF REVISION OF THE TEXT
07/08/2014

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Source: Medicines and Healthcare Products Regulatory Agency

Disclaimer: Every effort has been made to ensure that the information provided here is accurate, up-to-date and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. This information has been compiled for use by healthcare practitioners and consumers in the United States. The absence of a warning for a given drug or combination thereof in no way should be construed to indicate that the drug or combination is safe, effective or appropriate for any given patient. If you have questions about the substances you are taking, check with your doctor, nurse or pharmacist.

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