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IBUPROFEN MAXIMUM STRENGTH 400MG TABLETS
Active substance(s): IBUPROFEN
NAME OF THE MEDICINAL PRODUCT
Ibuprofen Maximum Strength 400mg Tablets
QUALITATIVE AND QUANTITATIVE COMPOSITION
Each tablet contains ibuprofen BP 400mg
For a full list of excipients see section 6.1
Pink sugar coated tablets
Rheumatic or muscular pain, backache, neuralgia, migraine, headache, dental pain,
dysmenorrhoea, feverishness, symptoms of colds and influenza.
Posology and method of administration
For oral administration and short-term use only.
Adults, elderly and children over 12 years:
The lowest effective dose should be used for the shortest duration necessary to relieve
symptoms. The patient should consult a doctor if the symptoms persist or worsen, or
the product is required for more than 10 days.
One tablet to be taken every four hours if necessary, up to three times a day, with or
after food. Tablets should be swallowed with water. The dosage should not be
repeated more frequently than every four hours and no more than 3 tablets should be
taken in any 24 hour period.
Hypersensitivity to Ibuprofen or any of the constituents 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 antiinflammatory drugs.
Active or history of recurrent peptic ulcer/haemorrhage (two or more distinct episodes
of proven ulceration or bleeding).
History of upper gastrointestinal bleeding or perforation, related to previous NSAIDs
Severe heart failure, renal failure or hepatic failure (see section 4.4)
Last trimester of pregnancy (see section 4.6).
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
The elderly have an increased frequency of adverse reactions to NSAIDs especially
gastrointestinal bleeding and perforations which may be fatal.
Bronchospasm may be precipitated in patients suffering from or with a previous
history of bronchial asthma or allergic disease.
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 impairment as renal function may further deteriorate (see sections 4.3 and 4.8).
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.
Patients with uncontrolled hypertension, congestive heart failure, established
ischaemic heart disease, peripheral arterial disease, and/or cerebrovascular disease
should only be treated with ibuprofen after careful consideration. Similar
consideration should be made before initiating longer-term treatment of patients with
risk factors for cardiovascular events (e.g. hypertension, hyperlipidaemia, diabetes
Impaired female fertility:
There is limited evidence that drugs which inhibit cyclo-oxygenase/ prostaglandin
synthesis may cause impairment of female fertility by an effect on ovulation. This is
reversible upon withdrawal of treatment.
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 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.
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.
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 NSAIDSs (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.
Intolerance to some sugars:
Patients with rare hereditary problems of galactose intolerance, fructose intolerance,
the Lapp lactase deficiency, glucose-galactose malabsorption or sucrase-isomaltase
insufficiency should not take this medicine.
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
are allergic to ibuprofen or any other ingredient of the product, aspirin or other
are taking other NSAID painkillers, 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
are a smoker
If symptoms persist or worsen, consult your doctor.
Do not exceed the stated dose.
Not to be given to children under the 12 years of age.
Keep all medicines out reach and sight of children.
Interaction with other medicinal products and other forms of interaction
Ibuprofen should not be used 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).
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
Concurrent aspirin or other NSAIDs may result in an increased incidence of adverse
reactions. May enhance the effects of anti-coagulants and Lithium. NSAIDs may
diminish the effect of anti-hypertensives or thiazide diuretics.
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).
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 effect of these drugs.
Diuretics can increase the risk of nephrotoxicity of NSAIDs.
Corticosteroids: Increased risk of gastrointestinal ulceration or bleeding (see section
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
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
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.
Pregnancy and lactation
Whilst no teratogenic effects have been demonstrated in animal experiments, the use
of Ibuprofen 400 mg Tablets BP should, if possible, be avoided during the first 6
months of pregnancy.
During the 3rd trimester, ibuprofen in contraindicated, as there is a risk of premature
closure of the foetal ductus arteriosus with possible persistent pulmonary
hypertension. The onset of labour may be delayed and the duration may be increased
with an increased bleeding tendency in both mother and child (see section 4.3).
In limited studies, ibuprofen appears in breast milk in very low concentrations and is
unlikely to affect the breast fed infant adversely.
See section 4.4 regarding female fertility.
Effects on ability to drive and use machines
Hypersensitivity reactions have been reported and these may consist of:
(a) non-specific allergic reactions and anaphylaxis
(b) respiratory tract reactivity, e.g. asthma, aggravated asthma, bronchospasm,
(c) various skin reactions, e.g. pruritus, urticaria, angioedema and more rarely
exfoliative and bullous dermatoses (including epidermal necrolysis and erythema
The following list of adverse effects relates to those experienced with ibuprofen at
OTC doses, for short-term use. In the treatment of chronic conditions, under longterm treatment, additional adverse effects may occur.
Uncommon: Hypersensitivity reactions with urticaria and pruritus.
Very rare: severe hypersensitivity reactions. Symptoms could be: facial, tongue and
laryngeal swelling, dyspnoea, tachycardia, hypotension, (anaphylaxis, angioedema or
Exacerbation of asthma and bronchospasm.
The most commonly-observed adverse events are gastrointestinal in nature.
Uncommon: abdominal pain, nausea, dyspepsia.
Rare: diarrhoea, flatulence, constipation and vomiting
Very rare: peptic ulcer, perforation or gastrointestinal haemorrhage, melaena,
haematemesis, sometimes fatal, particularly in the elderly. Ulcerative stomatitis,
Exacerbation of colitis and Crohn’s disease (see section 4.4).
Very rare: Aseptic meningitis – single cases have been reported very rarely.
Very rare: Acute renal failure, papillary necrosis, especially in long-term use,
associated with increased serum urea and oedema.
Very rare: liver disorders.
Very rare: 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.
Uncommon: Various skin rashes
Very rare: Severe forms of skin reactions such as bullous reactions, including
Stevens-Johnson Syndrome, erythema multiforme and toxic epidermal necrolysis can
In patients with existing auto-immune disorders (such as systemic lupus
erythematosus, mixed connective tissue disease) during treatment with ibuprofen,
single cases of symptoms of aseptic meningitis, such as stiff neck, headache, nausea,
vomiting, fever or disorientation have been observed (see section 4.4).
Cardiovascular and Cerebrovascular:
Oedema, hypertension and cardiac failure have been reported in association with
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).
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.
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 the actions of circulating clotting
factors. Acute renal failure and liver damage may occur. Exacerbation of asthma is
possible in asthmatics.
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 one
hour of ingestion of a potentially toxic amount. If frequent of prolonged, convulsions
should be treated with intravenous diazepam or lorazepam. Give bronchodilators for
M01A E01, Non-steroidal antiinflammatory.
Pharmacotherapeutic group: Anti-inflammatory and anti-rheumatic
product, non-steroid, propionic acid
Ibuprofen is a propionic acid derivative NSAID that has demonstrated its efficacy by
inhibition of prostaglandin synthesis. In humans, ibuprofen reduces inflammatory
pain, swellings and fever. Furthermore, ibuprofen reversibly inhibits platelet
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 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. 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 like for occasional ibuprofen
Ibuprofen is rapidly absorbed following administration and is rapidly distributed
throughout the whole body. The excretion is rapid and complete via the kidneys.
Maximum plasma concentrations are reached 45 minutes after ingestion if taken on
an empty stomach. When taken with food, peak levels are observed
after 1 to 2
hours. These times may vary with different dosage forms.
The half-life of ibuprofen is about 2 hours.
In limited studies, ibuprofen appears in the breast milk in very low concentrations.
Preclinical safety data
There is no pre-clinical data of relevance to a prescriber which is additional to that
already included in other sections of the SmPC.
List of excipients
Sodium starch glycollate
Colloidal anhydrous silica
Titanium dioxide (E171)
Sucrose, titanium dioxide (E171)
Sunset yellow (E110)
Sodium benzoate (E211)
Special precautions for storage
Ibuprofen Tablets should be stored in a dry place. Do not store above 25°C.
Nature and contents of container
Ibuprofen Tablets are available in blister packs of 6, 12, 24, 48
Specification details of blister packs :
- PVC (white, rigid, opaque) : 250 microns
- Aluminium foil (hard tempered) : 20 microns
- Primer (nitrocellulose) : 1.5 -2.5 gsm
- Heat seal lacquer : 6.5 - 8.5 gsm
The tablets are also available in a Pharmapac bottle of 12.
Specification for Pharmapac: High density polypropylene containers with low density
Special precautions for disposal
Ibuprofen Tablets should be taken orally with a drink of water.
Always read instructions on the label / carton and the Patient Information Leaflet
Keep all medicines out of the reach and sight of children.
Do not use after the expiry date.
MARKETING AUTHORISATION HOLDER
East Midlands Pharma
16 Rancliffe Avenue
MARKETING AUTHORISATION NUMBER(S)
DATE OF FIRST AUTHORISATION/RENEWAL OF THE
05/05/2005 / 23/02/2009
DATE OF REVISION OF THE TEXT
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.