Nurofen Plus 200mg/12.8mg – 24 Tablets

Do not take this medicine:

This medicine contains codeine which can cause addiction if you take it continuously for more than three days. This can give you withdrawal symptoms from the medicine when you stop taking it

• If you take a painkiller for headaches for more than three days it can make them worse
• If you have (or have had two or more episodes of) a stomach ulcer, perforation or bleeding
• If you have breathing difficulties
• If you are allergic to ibuprofen, codeine or any of the other ingredients or to aspirin or other painkillers
• If you suffer from severe liver, kidney or heart problems
• If you suffer from chronic constipation
• If you have had gastrointestinal bleeding or perforation when previously taking NSAIDs
• If you have had a worsening of asthma, skin rash, itchy runny nose or facial swelling when previously taking ibuprofen, aspirin or similar medicines
• If you are taking other NSAID painkillers or aspirin with a daily dose above 75mg
• If you are pregnant
• If you are breastfeeding
• If you are under 12 years old
• If you are taking Monoamine Oxidase Inhibitors or if you have taken them within the last 14 days
• For pain relief in children and adolescents (0-18 years of age) after removal of their tonsils or adenoids due to obstructive sleep apnoea syndrome
• If you know that you metabolise codeine into morphine very rapidly.

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

• have or have had asthma
• have kidney, heart, liver or bowel problems or are dehydrated
• have low or high blood pressure
• have a head injury or raised intracranial pressure
• suffer from a thyroid disorder
• have Systemic Lupus Erythematosus (a condition of the immune system causing joint pain, skin changes and other organ disorders
• have high cholesterol
• have had a heart attack or stroke
• have a history of gastrointestinal disease (such as ulcerative colitis, Crohn’s disease)
• are a smoker
• have gallstones
• suffer from myasthenia gravis (a condition that causes muscle weakness)
• have an infection. This medicine may hide signs of infections such as fever and pain. It is therefore possible that this medicine may delay appropriate treatment of infection, which may lead to an increased risk of complications. This has been observed in pneumonia caused by bacteria and bacterial skin infections related to chickenpox. If you take this medicine while you have an infection and your symptoms of the infection persist or worsen, consult a doctor without delay.

Skin reactions

• Serious skin reactions have been reported in association with this medicine. You should stop taking this medicine and seek medical attention immediately, if you develop any skin rash, lesion of the mucous membranes, blisters or other signs of allergy since this can be the first signs of a very serious skin reaction.

Care should be taken in elderly patients due to increased risk of breathing problems.

Can you take this medicine with other medicines?

Some anticoagulant medicines (i.e. thin blood/prevent clotting e.g. aspirin/acetylsal icylic acid, warfarin, ticlopidine), some medicines that reduce high blood pressure (ACE-inhibitors such as captopril, beta-blockers such as atenolol, or angiotensin-II receptor antagonists such as losartan), and other medicines may affect or be affected by treatment with ibuprofen.
The following medicines are know to interact with codeine (present in this medicine).
Moclobemide (for depression), Hydroxyzine (an anti-anxiety medicine), loperamide and kaolin (medicines to treat diarrohoea), Qunidine or Mexiletine (to treat abnormal heart rhythms), metoclopromide or domperidone (anti-sickness medicines), Cimetidine (to treat stomach ulcers and naloxone.
Medicines called Monoamine oxidase inhibitors (MAOIs) for the treatment of depression may affect or be affected by treatment with codeine.

You should therefore always seek the advice of your doctor or pharmacist before you take this medicine with other medicines.

Other warnings

• This medicine belongs to a group of medicines which may impair fertility in women. This is reversible on stopping the medicine. It is unlikely that this medicine, used occasionally will affect your chances of becoming pregnant. However, tell your doctor before taking this medicine if you have problems becoming pregnant.
• Medicines such as this medicine may be associated with a small increased risk of heart attack or stroke.
  Any risk is more likely with high doses or prolonged treatment.
  Do not exceed the recommended dose or take for longer than necessary to control your symptoms (3 days)
• If you have heart problems, have had a stroke or think that you might be at risk of these conditions (for example if you have high blood pressure, diabetes, high cholesterol or are a smoker), you should discuss your treatment with your doctor or pharmacist.
• Codeine is transformed to morphine in the liver by an enzyme.
  Morphine is the substance that produces pain relief. Some people have a variation of this enzyme and this can affect people in different ways. In some people, morphine is not produced or produced in very small quantities, and it will not provide enough pain relief. Other people are more likely to get serious side effects because a very high amount of morphine is produced. If you notice any of the following side effects, you must stop taking this medicine and seek immediate medical advice: slow or shallow breathing, confusion, sleepiness, small pupils, feeling or being sick, constipation, lack of appetite.

Children and adolescents

Use in children and adolescents after surgery:
Codeine should not be used for pain relief in children and adolescents after removal of their tonsils or adenoids due to Obstructive Sleep Apnoea Syndrome.
Use in children with breathing problems:
Codeine is not recommended in children with breathing problems, since the symptoms of morphine toxicity may be worse in these children.

Pregnancy and breastfeeding

Do not take this product during pregnancy. Do not take codeine while you are breastfeeding. Codeine and morphine passes into breast milk.

Driving and using machines

This medicine can affect your ability to drive as it may make you sleepy or dizzy or cause drowsiness.

• Do not drive while taking this medicine until you know how it affects you
• If affected, do not drive or operate machinery
• It may be an offence to drive when taking this medicine
• However, you would not be committing an offence if:
  The medicine has been taken to treat a medical or dental problem and
  You have taken it according to the information provided with the medicine and
  It was not affecting your ability to drive safely