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IBUPROFEN 600MG TABLETS BP
Active substance(s): IBUPROFEN / IBUPROFEN / IBUPROFEN
NAME OF THE MEDICINAL PRODUCT
Ibuprofen 600mg Tablets BP
QUALITATIVE AND QUANTITATIVE COMPOSITION
For excipients, see 6.1.
Film coated tablet.
Pink oblong film coated tablet.
Relief of mild to moderate pain; rheumatoid arthritis; ankylosing spondylitis;
osteoarthritis; sero-negative arthropathies; pain relief of peri-articular disorders; pain
relief of soft tissue injuries.
Posology and method of administration
For oral administration. Swallow the tablets with a drink of water, preferably with or
Adults: Take one tablet to start, followed by one tablet every 6 hours if necessary.
Do not take more than 4 tablets in any 24 hour period.
Elderly: The elderly are at increased risk of the 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.
Children: Not recommended.
Undesirable effects may be minimised by using the lowest effective dose for the
shortest duration necessary to control symptoms (see section 4.4)
Contraindicated in those with known hypersensitivity to ibuprofen or to any of
the other constituents. Should not be given to patients with active, or history
of recurrent peptic ulcer/haemorrhage (two or more distinct episodes of proven
ulceration or bleeding) and to patients in whom ibuprofen, aspirin or other
non-steroidal anti-inflammatory drugs induce hypersensitivity reactions (e.g.
asthma, rhinitis, angioedema or urticaria).
Severe heart failure (NYHA Class IV), hepatic failure and renal failure (see
During the last trimester of pregnancy (see section 4.6)
History of gastrointestinal bleeding or perforation, related to previous NSAIDs
Ibuprofen should not be given to patients with conditions involving an
increased tendency to bleeding.
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).
As with other NSAIDs, ibuprofen may mask the signs of infection.
The use of ibuprofen 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.
Caution is required if administered to patients suffering from, or with a
previous history of bronchial asthma, since NSAIDs have been reported to
cause bronchospasm in such patients.
Cardiovascular, Renal and Hepatic Impairment:
The administration of an NSAID may cause a dose dependent reduction in
prostaglandin formation and precipitate renal failure. Patients at greatest risk
of this reaction are those with impaired renal function, cardiac impairment,
liver dysfunction, those taking diuretics and the elderly. Renal function should
be monitored in these patients (see also section 4.3).
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
(2400mg/day) 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/day) is associated with an increased risk of arterial thrombotic events.
Patients with uncontrolled hypertension, congestive heart failure (NYHA II-III),
established ischaemic heart disease, peripheral arterial disease, and/or cerebrovascular
disease should only be treated with ibuprofen after careful consideration and high
doses (2400 mg/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
(2400 mg/day) are required.
Caution should be used when initiating treatment with ibuprofen in patients with
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-dependent reduction in prostaglandin formation and, secondarily, in
renal blood flow, which may precipitate overt renal decompensation. 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 pretreatment state.
Gastrointestinal bleeding, ulceration and perforation:
GI bleeding, ulceration or perforation, which can be fatal, has been reported with all
NSAIDs at any time 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 GI toxicity, particularly when elderly, should report any
unusual abdominal symptoms (especially GI bleeding) particularly in the initial stages
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.
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).
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 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.
Ibuprofen, like other NSAIDs, can interfere with platelet aggregation and has been
shown to 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.
Impaired female fertility:
The use of ibuprofen 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 ibuprofen should be
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.
Anti-hypertensives, beta-blockers and diuretics: NSAIDs may reduce the effect of
anti-hypertensives, such as ACE inhibitors, 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.
Colestyramine: The concomitant administration of ibuprofen and colestyramine 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 co-administration 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 pregnancy
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).
Acetylsalicylic acid: Concomitant administration of ibuprofen and acetylsalicylic acid
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 acetylsalicylic acid 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 ibuprofen use (see
Corticosteroids: increased risk of gastrointestinal bleeding or ulceration 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
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 NSAIDs.
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
Congenital abnormalities have been reported in association with NSAID
administration in man; however, these are low in frequency and do not appear to
follow any discernible pattern. In view of the known effects of NSAIDs on the foetal
cardiovascular system (risk of closure of the ductus arteriosus), use in the last
trimester of pregnancy is contraindicated. The onset of labour may be delayed and
duration of labour increased with an increased bleeding tendency in both mother and
child (see section 4.3). NSAIDs should not be used during the first two trimesters of
pregnancy or labour unless the potential benefit to the patient outweighs the potential
risk to the foetus.
In the limited studies so far available, NSAIDs can appear in breast milk in very low
concentration. NSAIDs should, if possible, be avoided when breastfeeding.
See section 4.4 Special warnings and precautions for use, regarding female fertility.
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
Infections and infestations: rhinitis and aseptic meningitis (especially in
patients with existing auto-immune disorders, such as systemic lupus
erythematosus, mixed connective tissue disease) with symptoms such as stiff
neck, headache, nausea, vomiting, fever or disorientation (see section 4.4).
Blood and lymphatic system disorders: leucopenia, thrombocytopenia,
pancytopenia, neutropenia, agranulocytosis, aplastic anaemia and haemolytic
Immune system disorders: hypersensitivity reactions have been reported
following treatment with NSAIDs. These may consist of (a) non-specific
allergic reactions 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,
angiodema and more rarely exfoliative and bullous dermatoses (including
Stevens-Johnson syndrome, toxic epidermal necrolysis and erythema
Psychiatric disorders: insomnia, anxiety, depression, confusion, hallucinations.
Nervous system disorders: optic neuritis, headaches, paraesthesia, dizziness
Eye disorders: visual disturbances, toxic optic neuropathy.
Ear and labyrinth disorders: hearing impaired, tinnitus and vertigo.
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 a high dose (2400
mg/day) may be associated with a small increased risk of arterial thrombotic
events (for example myocardial infarction or stroke) (see section 4.4).
Gastrointestinal disorders: the most commonly observed adverse events are
gastro- intestinal 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, exacerbation of colitis and
Crohn’s disease (see section 4.4) have been reported following administration.
Less frequently, gastritis has been observed. Gastrointestinal perforation has
been rarely reported with ibuprofen use. Pancreatitis has also been reported
Hepatobiliary disorders: abnormal liver function, hepatic failure, hepatitis and
Skin and subcutaneous tissue disorders: various skin rashes, bullous reactions
including Stevens-Johnson syndrome and toxic epidermal necrolysis (very
Renal and urinary disorders: impaired renal function and nephrotoxicity in
various forms, including interstitial nephritis, nephrotic syndrome, renal
failure, papillary necrosis.
General disorders and administration site conditions: malaise, fatigue.
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:
Overdose symptoms, emergency procedures, antidotes
Signs and symptoms of toxicity have generally not been observed at doses below 100
mg/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 400 mg/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
b) Therapeutic measures
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 toxic
Frequent or prolonged convulsions should be treated with intravenous diazepam.
Other measures may be indicated by the patients clinical condition.
Ibuprofen is a phenylpropionic acid derivative which has analgesic, antiinflammatory and antipyretic actions.
Experimental data suggest that ibuprofen may competitively inhibit the effect of low
dose acetylsalicylic acid on platelet aggregation when they are dosed concomitantly.
Some pharmcodynamic studies show that when single doses of ibuprofen 400mg
were taken within 8 h before or within 30 min after immediate release acetylsalicyclic
acid dosing (81mg), a decreased effect of acetylsalicylic acid 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, long-term use of ibuprofen may reduce the cardioprotective effect of lowdose acetylsalicylic acid cannot be excluded. No clinically relevant effect is
considered to be likely for occasional ibuprofen use (see section 4.5).
Ibuprofen is absorbed from the gastro-intestinal tract and peak plasma concentrations
occur about 1 to 2 hours after ingestion. It is extensively bound to plasma proteins
and has a half-life of about 2 hours. It is rapidly excreted in the urine as metabolites
and their conjugates. About 1% is excreted in the urine as unchanged ibuprofen and
about 14% as conjugated ibuprofen.
Preclinical safety data
No data of relevance which is additional to that already included in other sections of
List of Excipients
Colloidal Anhydrous Silica
Sodium Starch Glycollate
(Using individual coating powder ingredients):
Polyethylene Glycol 400
Erythrosine Aluminium Lake (E127)
Titanium Dioxide (E171)
(Using single ingredient coating powder):
Opadry 20B640005 Pink [contains Hydroxypropylcellulose,
Hydroxypropylmethylcellulose, Polyethylene Glycol 400, Erythrosine
Aluminium Lake (E127) and Titanium Dioxide (E171)]
Special precautions for storage
Do not store above 25°C. Store in the original container.
Keep the container tightly closed.
Blister: Do not store above 25°C. Store in the original package.
Nature and contents of container
PP or HDPE tablet containers of 50, 100 250 or 500 tablets.
Plastic tablet containers of 50 tablets.
Blister comprised of Aluminium foil (20μm) and PVC (250 μm) enclosed in an outer
carton containing 84 tablets.
Not all pack sizes may be marketed.
Special precautions for disposal
MARKETING AUTHORISATION HOLDER
Dalkeith Laboratories Ltd
2 Park Street
MARKETING AUTHORISATION NUMBER(S)
DATE OF FIRST AUTHORISATION/RENEWAL OF THE
19/03/2002 / 03/07/2008
DATE OF REVISION OF THE TEXT
Source: Medicines and Healthcare Products Regulatory Agency
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