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BRUFEN TABLETS 400MG
Active substance(s): IBUPROFEN / IBUPROFEN / IBUPROFEN
NAME OF THE MEDICINAL PRODUCT
Brufen Tablets 400 mg
QUALITATIVE AND QUANTITATIVE COMPOSITION
Each Brufen tablet contains 400 mg Ibuprofen.
Excipient with known effect: 26.67 mg Lactose monohydrate
For the full list of excipients, see section 6.1.
A white, pillow-shaped, film-coated tablet.
Brufen is indicated for its analgesic and anti-inflammatory effects in the
treatment of rheumatoid arthritis (including juvenile rheumatoid arthritis or
Still's disease), ankylosing spondylitis, osteoarthritis and other non-rheumatoid
In the treatment of non-articular rheumatic conditions, Brufen is indicated in
periarticular conditions such as frozen shoulder (capsulitis), bursitis,
tendonitis, tenosynovitis and low back pain; Brufen can also be used in softtissue injuries such as sprains and strains.
Brufen is also indicated for its analgesic effect in the relief of mild to moderate
pain such as dysmenorrhoea, dental and post-operative pain and for the
symptomatic relief of headache including migraine headache.
Posology and method of administration
Undesirable effects may be minimised by using the lowest effective dose for the
shortest duration necessary to control symptoms (see section 4.4).
Adults and children over 12 years of age: The recommended dosage of Brufen
is 1200-1800 mg daily in divided doses. Some patients can be maintained on
600-1200 mg daily. In severe or acute conditions, it can be advantageous to
increase the dosage until the acute phase is brought under control, provided
that the total daily dose does not exceed 2400 mg in divided doses.
Children: The daily dosage of Brufen is 20 mg/kg of body weight in divided
For young children, more suitable formulations are available.
In Juvenile Rheumatoid Arthritis, up to 40 mg/kg of body weight daily in
divided doses may be taken.
Not recommended for children weighing less than 7 kg.
Elderly: The elderly are at increased risk of serious consequences of adverse
reactions. If an NSAID is considered necessary, the lowest effective dose should be
used and for the shortest possible duration. The patient should be monitored regularly
for GI bleeding during NSAID therapy. If renal or hepatic function is impaired,
dosage should be assessed individually.
For oral administration. It is recommended that patients with sensitive
stomachs take Brufen with food. If taken shortly after eating, the onset of
action of Brufen may be delayed. To be taken preferably with or after food,
with plenty of fluid. Brufen tablets should be swallowed whole and not
chewed, broken, crushed or sucked on to avoid oral discomfort and throat
Brufen is contraindicated in patients with hypersensitivity to the active substance or to
any of the excipients.
Brufen should not be used in patients who have previously shown
hypersensitivity reactions (e.g. asthma, urticaria, angioedema or rhinitis) after
taking ibuprofen, aspirin or other NSAIDs.
Brufen is also contraindicated in patients with a history of gastrointestinal
bleeding or perforation, related to previous NSAID therapy. Brufen should not
be used in patients with active, or history of, recurrent peptic ulcer or
gastrointestinal haemorrhage (two or more distinct episodes of proven
ulceration or bleeding).
Brufen should not be given to patients with conditions involving an increased
tendency to bleeding.
Brufen is contraindicated in patients with severe heart failure (NYHA Class
IV), hepatic failure and renal failure (see section 4.4).
Brufen is contraindicated during the last trimester of pregnancy (see section
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 section 4.2, and GI and
cardiovascular risks below).
Patients with rare hereditary problems of galactose intolerance, the Lapp lactose
deficiency or glucose-galactose malabsorption should not take this medication.
As with other NSAIDs, ibuprofen may mask the signs of infection.
The use of Brufen with concomitant NSAIDs, including cyclooxygenase-2
selective inhibitors, should be avoided due to the increased risk of ulceration
or bleeding (see section 4.5).
The elderly have an increased frequency of adverse reactions to NSAIDs, especially
gastrointestinal bleeding and perforation, which may be fatal (see section 4.2).
There is a risk of renal impairment in dehydrated children and adolescents.
Gastrointestinal bleeding, ulceration and perforation
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 serious 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. Combination therapy with
protective agents (e.g. misoprostol or proton pump inhibitors) should be considered
for these patients, and also for patients requiring concomitant low dose aspirin, or
other drugs likely to increase gastrointestinal risk (see below and section 4.5).
Patients with a history of gastrointestinal disease, particularly when elderly, should
report any unusual abdominal symptoms (especially gastrointestinal 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 Brufen, the treatment
should be withdrawn.
NSAIDs should be given with care to patients with a history of ulcerative
colitis or Crohn’s disease as these conditions may be exacerbated (see section
Respiratory disorders and hypersensitivity reactions
Caution is required if Brufen is administered to patients suffering from, or
with a previous history of, bronchial asthma, chronic rhinitis or allergic
diseases since NSAIDs have been reported to precipitate bronchospasm,
urticaria or angioedema in such patients.
Cardiac, renal and hepatic impairment
The administration of an NSAID may cause a dose dependent reduction in
prostaglandin formation and precipitate renal failure. The habitual concomitant
intake of various similar painkillers further increases this risk. Patients at
greatest risk of this reaction are those with impaired renal function, cardiac
impairment, liver dysfunction, those taking diuretics and the elderly. For these
patients, use the lowest effective dose, for the shortest possible duration and
monitor renal function especially in long-term treated patients (see also section
Brufen should be given with care to patients with a history of heart failure or
hypertension since oedema has been reported in association with ibuprofen
Cardiovascular and cerebrovascular effects
Appropriate monitoring and advice are required for patients with a history of
hypertension and/or mild to moderate congestive heart failure as fluid
retention and oedema have been reported in association with NSAID therapy.
Clinical studies suggest that use of ibuprofen, particularly at a high dose (2400
mg/ day) may be associated with a small increased risk of arterial thrombotic
events such as myocardial infarction or stroke. Overall, epidemiological
studies do not suggest that low dose ibuprofen (e.g. ≤ 1200mg/day) is
associated with an increased risk of arterial thrombotic events.
Patients with uncontrolled hypertension, congestive heart failure (NYHA IIIII), established ischaemic heart disease, peripheral arterial disease, and/or
cerebrovascular disease should only be treated with ibuprofen after careful
consideration and high doses (2400mg/day) should be avoided. Careful
consideration should also be exercised before initiating long-term treatment of
patients with risk factors for cardiovascular events (e.g. hypertension,
hyperlipidaemia, diabetes mellitus, smoking), particularly if high doses of
ibuprofen (2400mg/day) are required.
Caution should be used when initiating treatment with ibuprofen in patients
with considerable dehydration.
As with other NSAIDs, long-term administration of ibuprofen has resulted in renal
papillary necrosis and other renal pathologic changes. Renal toxicity has also been
seen in patients in whom renal prostaglandins have a compensatory role in the
maintenance of renal perfusion. In these patients, administration of an NSAID may
cause a dose-dependant reduction in prostaglandin formation and, secondarily, in
renal blood flow, which may cause renal failure. Patients at greatest risk of this
reaction are those with impaired renal function, heart failure, liver dysfunction, those
taking diuretics and ACE inhibitors and the elderly. Discontinuation of NSAID
therapy is usually followed by recovery to the pre-treatment state.
SLE and mixed connective tissue disease
In patients with systemic lupus erythematosus (SLE) and mixed connective tissue
disorders there may be an increased risk of aseptic meningitis (see below and section
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 of these reactions early in the course of therapy, the onset of the reaction
occurring within the first month of treatment in the majority of cases. Brufen should
be discontinued at the first appearance of skin rash, mucosal lesions, or any other sign
Ibuprofen, like other NSAIDs, can interfere with platelet aggregation and prolong
bleeding time in normal subjects.
Aseptic meningitis has been observed on rare occasions in patients on ibuprofen
therapy. Although it is probably more likely to occur in patients with systemic lupus
erythematosus and related connective tissue diseases, it has been reported in patients
who do not have an underlying chronic disease.
mpaired female fertility
The use of Brufen may impair female fertility and is not recommended in
women attempting to conceive. In women who have difficulties conceiving or
who are undergoing investigation of infertility, withdrawal of Brufen should
Interaction with other medicinal products and other forms of interaction
Care should be taken in patients treated with any of the following drugs as
interactions have been reported in some patients.
Antihypertensives, beta-blockers and diuretics: NSAIDs may reduce the effect
of anti-hypertensives, such as ACE inhibitors, angiotensin-II receptor
antagonists, beta-blockers and diuretics. Diuretics can also increase the risk
of nephrotoxicity of NSAIDs.
Cardiac glycosides: NSAIDs may exacerbate cardiac failure, reduce GFR and
increase plasma cardiac glycoside levels.
Cholestyramine; The concomitant administration of ibuprofen and
cholestyramine may reduce the absorption of ibuprofen in the gastrointestinal
tract. However, the clinical significance is unknown.
Lithium: Decreased elimination of lithium.
Methotrexate: NSAIDs may inhibit the tubular secretion of methotrexate and
reduce clearance of methotrexate.
Ciclosporin: Increased risk of nephrotoxicity.
Mifepristone: A decrease in the efficacy of the medicinal product can
theoretically occur due to the antiprostaglandin properties of NSAIDs. Limited
evidence suggests that coadministration of NSAIDs on the day of
prostaglandin administration does not adversely influence the effects of
mifepristone or the prostaglandin on cervical ripening or uterine contractility
and does not reduce the clinical efficacy of medicinal termination of
Other analgesics and cyclooxygenase-2 selective inhibitors: Avoid
concomitant use of two or more NSAIDs, including Cox-2 inhibitors, as this
may increase the risk of adverse effects (see section 4.4).
Aspirin (Acetylsalicylic acid): As with other products containing NSAIDs,
concomitant administration of ibuprofen and aspirin is not generally
recommended because of the potential of increased adverse effects.
Experimental data suggest that ibuprofen may competitively inhibit the effect of low
dose aspirin on platelet aggregation when they are dosed concomitantly. Although
there are uncertainties regarding extrapolation of these data to the clinical situation,
the possibility that regular, long-term use of ibuprofen may reduce the
cardioprotective effect of low-dose acetylsalicylic acid cannot be excluded. No
clinically relevant effect is considered to be likely for occasional use (see section 5.1).
Corticosteroids: Increased risk of gastrointestinal ulceration or bleeding with
NSAIDs (see section 4.4).
Anticoagulants: NSAIDs may enhance the effects of anticoagulants, such as
warfarin (see section 4.4).
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.
Sulfonylureas: NSAIDs may potentiate the effects of sulfonylurea
medications. There have been rare reports of hypoglycaemia in patients on
sulfonylurea medications receiving ibuprofen.
Anti-platelet agents and selective serotonin reuptake inhibitors (SSRIs):
Increased risk of gastrointestinal bleeding with NSAIDs (see section 4.4).
Tacrolimus: Possible increased risk of nephrotoxicity when NSAIDs are given with
Zidovudine: Increased risk of haematological toxicity when NSAIDs are given with
zidovudine. There is evidence of an increased risk of haemarthroses and haematoma
in HIV(+) haemophiliacs receiving concurrent treatment with zidovudine and
Aminoglycosides: NSAIDs may decrease the excretion of aminoglycosides.
Herbal extracts: Ginkgo biloba may potentiate the risk of bleeding with
CYP2C9 Inhibitors: Concomitant administration of ibuprofen with CYP2C9
inhibitors may increase the exposure to ibuprofen (CYP2C9 substrate). In a
study with voriconazole and fluconazole (CYP2C9 inhibitors), an increased
S(+)-ibuprofen exposure by approximately 80 to 100% has been shown.
Reduction of the ibuprofen dose should be considered when potent CYP2C9
inhibitors are administered concomitantly, particularly when high-dose
ibuprofen is administered with either voriconazole or fluconazole.
Pregnancy and lactation
Inhibition of prostaglandin synthesis may adversely affect the pregnancy and/or
embryo/foetal development. Data from epidemiological studies suggest an increased
risk of miscarriage and of cardiac malformation and gastroschisis after the use of a
prostaglandin synthesis inhibitor in early pregnancy. The risk is believed to increase
with dose and duration of therapy. In animals, the administration of a prostaglandin
synthesis inhibitor has been shown to result in increased pre- and post-implantation
losses and embryo/foetal 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, Brufen should not be given unless
clearly necessary. If Brufen is used by a woman attempting to conceive, or during the
first or 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 the following:
• Cardiopulmonary toxicity (with premature closure of the ductus arteriosus
and pulmonary hypertension)
• Renal dysfunction, which may progress to renal failure with
At the end of pregnancy, prostaglandin synthesis inhibitors may expose the mother
and the neonate to the following:
• Possible prolongation of bleeding time
• Inhibition of uterine contractions, which may result in delayed or prolonged
Consequently, Brufen is contraindicated during the third trimester of
In the limited studies so far available, NSAIDs can appear in the breast milk in
very low concentrations. NSAIDs should, if possible, be avoided when
See section 4.4 Special warnings and precautions for use, regarding female
Effects on ability to drive and use machines
Undesirable effects such as dizziness, drowsiness, fatigue and visual disturbances are
possible after taking NSAIDs. If affected, patients should not drive or operate
Gastrointestinal disorders: The most commonly observed adverse events are
gastrointestinal in nature. Peptic ulcers, perforation or GI bleeding, sometimes fatal,
particularly in the elderly, may occur (see section 4.4). Nausea, vomiting, diarrhoea,
flatulence, constipation, dyspepsia, abdominal pain, melaena, haematemesis,
ulcerative stomatitis, gastrointestinal haemorrhage and exacerbation of colitis and
Crohn’s disease (see section 4.4) have been reported following ibuprofen
administration. Less frequently, gastritis ,duodenal ulcer, gastric ulcer and
gastrointestinal perforation have been observed.
Immune system disorders: Hypersensitivity reactions have been reported
following treatment with NSAIDs. These may consist of (a) non-specific
allergic reaction and anaphylaxis, (b) respiratory tract reactivity comprising
asthma, aggravated asthma, bronchospasm or dyspnoea, or (c) assorted skin
disorders, including rashes of various types, pruritus, urticaria, purpura,
angioedema and, very rarely, erythema multiforme, bullous dermatoses
(including Stevens- Johnson syndrome and toxic epidermal necrolysis).
Cardiac disorders and vascular disorders: Oedema, hypertension and cardiac
failure have been reported in association with NSAID treatment. Clinical
studies suggest that use of ibuprofen, particularly at high dose (2400 mg/day)
may be associated with a small increased risk of arterial thrombotic events
such as myocardial infarction or stroke (see section 4.4).
Infections and infestations: Rhinitis and aseptic meningitis (especially in
patients with existing autoimmune disorders, such as systemic lupus
erythematosus and mixed connective tissue disease) with symptoms of stiff
neck, headache, nausea, vomiting, fever or disorientation (see section 4.4).
Exacerbation of infection-related inflammations coinciding with the use of
NSAIDs has been described. If signs of an infection occur or get worse during
use of Ibuprofen the patient is therefore recommended to go to a doctor
Skin and subcutaneous tissue disorders: In exceptional cases, severe skin
infections and soft-tissue complications may occur during a varicella infection
(see also "Infections and infestations")
The following adverse reactions possibly related to ibuprofen and displayed by
MedDRA frequency convention and system organ classification. Frequency
groupings are classified according to the subsequent conventions: Very
common (≥1/10), Common (≥1/100 to <1/10), Uncommon (≥1/1,000 to
<1/100), Rare (≥1/10,000 to <1/1,000), Very rare (<1/10,000) and Not known
(cannot be estimated from the available data).
System organ class
Meningitis aseptic (see section
aplastic anaemia , haemolytic
Depression, confusional state
Toxic optic neuropathy
Blood and lymphatic Rare
Ear and labyrinth
Respiratory, thoracic Uncommon
Renal and urinary
Hearing impaired , tinnitus,
Dyspepsia, diarrhoea, nausea,
vomiting, abdominal pain,
Gastritis, duodenal ulcer, gastric
ulcer, mouth ulceration,
Exacerbation of Colitis and
Hepatitis, jaundice, hepatic
Urticaria, pruritus, purpura,
Severe forms of skin reactions (
e.g. Erythema multiforme,
bullous reactions, including
toxic epidermal necrolysis)
Nephrotoxity in various forms
nephrotic syndrome and renal
Cardiac failure, myocardial
see section 4.4)
Reporting of suspected adverse reactions
Reporting suspected adverse reactions after authorisation of the medicinal
product is important. It allows continued monitoring of the benefit/risk balance
of the medicinal product. Healthcare professionals are asked to report any
suspected adverse reactions via the Yellow Card Scheme at:
Signs and symptoms of toxicity have generally not been observed at doses
below 100mg/kg in children or adults. However, supportive care may be
needed in some cases. Children have been observed to manifest signs and
symptoms of toxicity after ingestion of 400mg/kg or greater.
Most patients who have ingested significant amounts of ibuprofen will
manifest symptoms within 4 to 6 hours.
The most frequently reported symptoms of overdose include nausea, vomiting,
abdominal pain, lethargy and drowsiness. Central nervous system (CNS)
effects include headache, tinnitus, dizziness, convulsion, and loss of
consciousness. Nystagmus, metabolic acidosis, hypothermia, renal effects,
gastrointestinal bleeding, coma, apnoea, diarrhoea and depression of the CNS
and respiratory system have also been rarely reported. Disorientation,
excitation, fainting and cardiovascular toxicity, including hypotension,
bradycardia and tachycardia have been reported. In cases of significant
overdose, renal failure and liver damage are possible. Large overdoses are
generally well tolerated when no other drugs are being taken.
Patients should be treated symptomatically as required. Within one hour of
ingestion of a potentially toxic amount, activated charcoal should be
considered. Alternatively, in adults, gastric lavage should be considered within
one hour of ingestion of a potentially life-threatening overdose.
Good urine output should be ensured.
Renal and liver function should be closely monitored.
Patients should be observed for at least four hours after ingestion of potentially
Frequent or prolonged convulsions should be treated with intravenous
diazepam. Other measures may be indicated by the patient’s clinical condition.
Pharmacotherapeutic classification: Anti-inflammatory and antirheumatic
products, nonsteroidal; propionic acid derivatives.
ATC code: M01AE01
Ibuprofen is a propionic acid derivative with analgesic, anti-inflammatory and
anti-pyretic activity. The drug's therapeutic effects as an NSAID is thought to
result from its inhibitory effect on the enzyme cyclo-oxygenase, which results
in a marked reduction in prostaglandin synthesis.
Experimental data suggest that ibuprofen may competitively inhibit the effect of low
dose aspirin on platelet aggregation when they are dosed concomitantly. Some
pharmacodynamic studies show that when single doses of ibuprofen 400mg were
taken within 8 hours before or within 30 minutes after immediate release aspirin
dosing (81mg), a decreased effect of aspirin on the formation of thromboxane or
platelet aggregation occurred. Although there are uncertainties regarding
extrapolation of these data to the clinical situation, the possibility that regular, longterm use of ibuprofen may reduce the cardioprotective effect of low-dose
acetylsalicylic acid cannot be excluded. No clinically relevant effect is considered to
be likely for occasional ibuprofen use. (see section 4.5)
Ibuprofen is rapidly absorbed from the gastrointestinal tract, peak serum
concentrations occurring 1-2 hours after administration. The elimination halflife is approximately 2 hours.
Ibuprofen is metabolised in the liver to two 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.
Ibuprofen is extensively bound to plasma proteins.
Preclinical safety data
List of excipients
Colloidal anhydrous silica
Opaspray white M-1-7111B*
Dry colour dispersion, white 06A28611**
*Opaspray white M-1-7111B comprises industrial methylated spirit, purified
water, hypromellose 2910 and titanium dioxide
** or combination of Opaspray white M-1-7111B, hypromellose and talc
NB industrial methylated spirit and purified water are removed during the
PVC or PVC/PVDC blister packs: 36 months
Special precautions for storage
PVC or PVC/PVDC blister packs: Do not store above 25°C, store in the
Nature and contents of container
Blister pack comprising of transparent polyvinyl chloride (PVC) with
aluminium foil backing – pack size 60 tablets or 100 tablets.
Blister pack comprising of transparent polyvinyl chloride (PVC) film coated
on one face with polyvinylidene chloride (PVDC) with aluminium foil backing
– pack size 60 or 100 tablets.
Not all pack sizes are marketed.
Special precautions for disposal
MARKETING AUTHORISATION HOLDER
Mylan Products Ltd.
20 Station Close
MARKETING AUTHORISATION NUMBER(S)
DATE OF FIRST AUTHORISATION/RENEWAL OF THE
DATE OF REVISION OF THE TEXT
Source: Medicines and Healthcare Products Regulatory Agency
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