Nurofen Long - Instructions For Use, Price, Reviews, Composition, Analogues

2024 Author: Rachel Wainwright | [email protected]. Last modified: 2023-12-15 07:39

Nurofen Long

Nurofen Long: instructions for use and reviews

1. 1. Release form and composition
2. 2. Pharmacological properties
3. 3. Indications for use
4. 4. Contraindications
5. 5. Method of application and dosage
6. 6. Side effects
7. 7. Overdose
8. 8. Special instructions
9. 9. Application during pregnancy and lactation
10. 10. Use in childhood
11. 11. In case of impaired renal function
12. 12. For violations of liver function
13. 13. Use in the elderly
14. 14. Drug interactions
15. 15. Analogs
16. 16. Terms and conditions of storage
17. 17. Terms of dispensing from pharmacies
18. 18. Reviews
19. 19. Price in pharmacies

Latin name: Nurofen long

ATX code: M01AE51

Active ingredient: Ibuprofen (Ibuprofen), Paracetamol (Paracetamol)

Manufacturer: Reckitt Benckiser Healthcare International Ltd. (United Kingdom)

Description and photo update: 2018-22-10

Prices in pharmacies: from 103 rubles.

Buy

Nurofen Long is a combined drug with an analgesic effect.

Release form and composition

The dosage form of Nurofen Long is film-coated tablets: capsule-shaped, biconvex, from white to almost white with a pearlescent tint, a symbol is placed on one side (in blisters of 4, 5, 6, 8, 10 or 12 pcs., In cardboard box 1 or 2 blisters).

Composition of Nurofen Long (1 tablet):

• active substances: paracetamol - 500 mg, ibuprofen - 200 mg;
• auxiliary components: croscarmellose sodium - 30 mg, microcrystalline cellulose - 120 mg, colloidal silicon dioxide - 3 mg, magnesium stearate - 5 mg, stearic acid - 4 mg;
• shell: white film shell (titanium dioxide - 25%, polyvinyl alcohol - 40%, macrogol - 20.2%, talc - 14.8%) - 13 mg; a film shell with a pearlescent effect (pearlescent pigment based on mica - 10%, talc - 27%, polyvinyl alcohol - 47%, macrogol - 13.3%, polysorbate - 2.7%) - 7 mg.

Pharmacological properties

Pharmacodynamics

Nurofen Long is one of the combined drugs, its action is due to its active substances. It has a targeted analgesic, antipyretic and anti-inflammatory effect. In place and mechanism of action, paracetamol and ibuprofen differ. Due to their mutually reinforcing effect, Nurofen Long has a more pronounced analgesic and antipyretic effect than the drugs alone.

Ibuprofen is a propionic acid derivative from the NSAID group (non-steroidal anti-inflammatory drugs). It has anti-inflammatory, anti-edema, analgesic and antipyretic properties. The mechanism of action of the substance is due to the inhibition of the synthesis of prostaglandins, which are mediators of the hyperthermic reaction, inflammation and pain, which occurs due to the indiscriminate inhibition of the activity of COX-1 and COX-2 (cyclooxygenase-1 and cyclooxygenase-2). The analgesic effect is provided by its inhibitory effect at the peripheral level. Ibuprofen inhibits the migration of leukocytes to the site of inflammation. The antipyretic effect of the substance is associated with the central inhibition of the synthesis of prostaglandins in the hypothalamus. In addition, ibuprofen reversibly inhibits platelet aggregation.

Paracetamol is a non-narcotic analgesic agent with mild anti-inflammatory, antipyretic and analgesic effects. Indiscriminately blocks COX-2, mainly in the central nervous system. Also, paracetamol can stimulate the activity of the descending pathways of serotonin, due to which the transmission of the pain impulse in the spinal cord is stopped. At the peripheral level, the substance has a mild effect on COX-1 and COX-2.

Nurofen Long has a faster therapeutic effect than the active ingredients alone. The analgesic effect after taking 1 tablet is noted on average after 15 minutes, a clinically significant analgesic effect is achieved after 40 minutes and lasts for 8 hours. After taking 2 tablets, the analgesic effect is usually noted after 18 minutes, the clinically significant analgesic effect after 45 minutes, the duration of the effect is 9 hours.

Pharmacokinetics

Pharmacokinetic parameters and bioavailability of ibuprofen and paracetamol taken as part of Nurofen Long do not change with single / multiple use.

Ibuprofen

Has a high absorption, absorbed from the gastrointestinal tract quickly and almost completely. The connection with blood plasma proteins is 90%.

It penetrates into the joint cavity slowly, lingering in the synovial fluid and creating high concentrations in it in comparison with plasma. It is detected in blood plasma 5 minutes after taking the drug on an empty stomach, the time to reach C _max (maximum concentration of the substance) is 1–2 hours. When taking ibuprofen with food, there may be a decrease in its plasma concentration in the blood and an increase in the time to reach T _max (maximum concentration). The degree of absorption does not depend on food intake.

Metabolism occurs in the liver. After absorption, the pharmacologically inactive R-form (approximately 60%) is slowly transformed into the active S-form. T _1/2 (half-life) is 2 hours.

Excretion occurs mainly in the form of metabolites (unchanged - up to 1%) by the kidneys, to a lesser extent - with bile. There are no significant differences in the pharmacokinetic profile of ibuprofen in older patients compared with younger people. There is evidence that low concentrations of ibuprofen are found in breast milk.

Paracetamol

Possesses high absorption, is rapidly absorbed from the gastrointestinal tract. When taken in therapeutic doses, the connection with blood plasma proteins is weak (in case of an overdose, it increases slightly). After taking the drug on an empty stomach in the blood plasma is detected after 5 minutes, the time to reach C _max in the blood plasma is 30–40 minutes. When taken simultaneously with food, its concentration in blood plasma can decrease and T _{max can} increase. The degree of absorption of the substance does not depend on food intake.

Metabolism occurs in the liver. It is excreted by the kidneys mainly in the form of sulfated conjugates and glucuronides (with the formation of glutathione conjugates - about 10%), unchanged - up to 5% of the dose taken. T _1/2 is 3 hours. The hydroxylated metabolite N-acetyl-p-benzoquinone imine, which is formed in the liver and kidneys in small amounts, is usually detoxified by binding to glutathione; in case of an overdose, it can accumulate and lead to liver tissue damage. In elderly patients, no significant differences in the pharmacokinetic profile of paracetamol in comparison with younger people were found.

Indications for use

Nurofen Long is prescribed for the following conditions: joint pain, back pain, rheumatic and muscle pain, neuralgia, headache and toothache, painful menstruation, migraine, sore throat, flu and cold symptoms, fever.

In particular, the drug is indicated for the symptomatic treatment of pain requiring a more pronounced analgesic effect than paracetamol or ibuprofen alone.

Contraindications

Absolute:

• combined use with drugs containing paracetamol;
• active liver disease, severe liver failure;
• a combination (complete / partial) of bronchial asthma, recurrent polyposis of the paranasal sinuses / nose and intolerance to acetylsalicylic acid or other NSAIDs (including a burdened history);
• burdened history of bleeding / perforation of gastrointestinal ulcers associated with the use of NSAIDs;
• period after coronary artery bypass grafting;
• erosive and ulcerative diseases of the gastrointestinal tract (including peptic ulcer and duodenal ulcer, ulcerative colitis, Crohn's disease), ulcerative bleeding in the active phase, or the presence of a burdened history (from two confirmed episodes of peptic ulcer or ulcer bleeding);
• diagnosed hyperkalemia;
• hemorrhagic diathesis;
• decompensated heart failure;
• severe renal failure (with creatinine clearance <30 ml / min);
• cerebrovascular or other bleeding;
• hemophilia and other blood clotting disorders (including hypocoagulation);
• age up to 12 years;
• III trimester of pregnancy;
• individual intolerance to the components of the drug.

Relative (diseases / conditions in the presence of which the appointment of Nurofen Long requires caution):

• arterial hypertension / heart failure, cerebrovascular diseases;
• the presence of a burdened history of a single episode of gastric ulcer or ulcerative bleeding of the gastrointestinal tract;
• presence of Helicobacter pylori infection, gastritis, colitis, enteritis, ulcerative colitis;
• peripheral arterial disease;
• bronchial asthma or allergic diseases in an exacerbation stage or a burdened history (associated with the likelihood of bronchospasm);
• combined use with other NSAIDs;
• blood diseases of unknown origin (anemia and leukopenia), hyperlipidemia;
• diabetes;
• nephrotic syndrome;
• renal failure, including with dehydration (with creatinine clearance less than 30-60 ml / min);
• systemic lupus erythematosus or mixed connective tissue diseases (Sharp's syndrome) (associated with an increased risk of aseptic meningitis);
• liver failure, liver cirrhosis with portal hypertension, hyperbilirubinemia;
• combined use with drugs that may increase the likelihood of ulceration or bleeding, including oral glucocorticosteroids, anticoagulants, selective serotonin reuptake inhibitors or antiplatelet agents;
• frequent alcohol consumption;
• I – II trimesters of pregnancy, breastfeeding period;
• elderly age.

Instructions for use of Nurofen Long: method and dosage

Nurofen Long is taken orally with water.

The drug is intended for short-term therapy only.

Usually Nurofen Long is prescribed 1 tablet, the frequency of administration is up to 3 times a day (a break is at least 6 hours).

Maximum doses: single - 2 tablets; daily - 4 or 6 tablets (for children 12-18 years old or adults).

The recommended course duration is no longer than 3 days. In cases where, after 2-3 days of taking the drug, the symptoms persist / worsen, the therapy is canceled.

Side effects

When Nurofen Long is taken in compliance with the recommended dosing regimen for a short course, the likelihood of adverse reactions is minimal. Elderly patients are at higher risk for disorders (mainly gastrointestinal bleeding and perforation, sometimes fatal).

Side effects are usually dose-related.

Possible adverse reactions (> 10% - very often;> 1% and 0.1% and 0.01% and <0.1% - rarely; <0.01% - very rare; with an unknown frequency - in cases where it is impossible to estimate the frequency of occurrence of violations):

• immune system: infrequently - hypersensitivity reactions, including nonspecific allergic / anaphylactic reactions, reactions from the respiratory tract (dyspnea, shortness of breath, bronchospasm, bronchial asthma, including its exacerbation), skin reactions (urticaria, itching, Quincke's edema, purpura, less often - bullous / exfoliative dermatoses, including Stevens-Johnson syndrome, Lyell's syndrome, erythema multiforme), eosinophilia, allergic rhinitis; very rarely - severe hypersensitivity reactions (nonspecific allergic / anaphylactic reactions), including edema of the face, larynx and tongue, tachycardia, shortness of breath, low blood pressure (anaphylaxis, severe anaphylactic shock or Quincke's edema);
• blood / lymphatic system: very rarely - hematopoietic disorders, including thrombocytopenia, anemia, agranulocytosis, leukopenia, aplastic anemia, pancytopenia, hemolytic anemia (the first symptoms of violations are superficial ulcers in the oral cavity, fever, subcutaneous hemorrhages, nosebleeds, flu symptoms sore throat, severe weakness, bruising and bleeding of unknown origin);
• cardiovascular system: with an unknown frequency - peripheral edema, heart failure; with prolonged use - an increase in the likelihood of thrombotic complications, increased blood pressure;
• nervous system: infrequently - headache; very rarely - aseptic meningitis; in isolated cases in patients with autoimmune disorders (systemic lupus erythematosus, mixed connective tissue diseases) - symptoms of aseptic meningitis (manifested in the form of headache, stiff neck, nausea, vomiting, confusion, fever, disorientation, hallucinations, depression);
• respiratory system, mediastinal and chest organs: with an unknown frequency - bronchospasm, shortness of breath, bronchial asthma, including its exacerbation;
• biliary tract / liver: very rarely - functional disorders of the liver (especially during a long course), jaundice, increased activity of hepatic transaminases, hepatitis;
• laboratory indicators: often - an increase in hepatic function indicators (above the normal range), plasma concentration of creatinine and urea, the level of gamma-glutamyl transpeptidase, alanine aminotransferase; infrequently - increased levels of alkaline phosphatase, aspartate aminotransferase, creatinine phosphokinase, platelets, decreased hemoglobin levels;
• digestive system: infrequently - nausea, abdominal pain, dyspepsia, including heartburn and bloating; rarely - vomiting, flatulence, diarrhea, constipation; very rarely - melena, peptic ulcer, gastritis, ulcerative stomatitis, perforation or gastrointestinal bleeding, bloody vomiting (in some cases fatal, especially in elderly patients); with an unknown frequency - exacerbation of colitis and Crohn's disease;
• kidneys / urinary tract: very rarely - compensated / decompensated acute renal failure (especially during a long course, in combination with an increase in the concentration of urea in the blood plasma and the appearance of edema, proteinuria and hematuria), cystitis, interstitial nephritis, papillary necrosis, nephritic / nephrotic syndrome;
• skin / subcutaneous tissue: often - hyperhidrosis.

Overdose

Paracetamol

The main symptoms during the first 24 hours are pallor of the skin, abdominal pain, vomiting, nausea, anorexia. Liver damage can occur 12 to 48 hours after ingestion, so a doctor should be consulted even if no symptoms are present. Possible metabolic acidosis and impaired glucose metabolism. Liver failure in severe poisoning can progress with the following complications: hypoglycemia, hemorrhage, encephalopathy, cerebral edema and death. Even in the absence of severe liver damage, it is possible to develop acute renal failure with acute tubular necrosis (manifests itself as back pain, hematuria and proteinuria). There is information about pancreatitis and cardiac arrhythmias.

In case of paracetamol overdose, immediate initiation of treatment is required. Despite the lack of significant early symptoms, patients need to be urgently taken to the hospital for immediate medical examination. Symptoms may be limited to vomiting or nausea and may not be consistent with the severity of the overdose or the likelihood of organ damage. Activated carbon therapy is indicated if less than 1 hour has passed since the drug was taken. Plasma concentration of paracetamol should be measured 4 hours or later after ingestion (earlier measurement of concentration is unreliable). Treatment with N-acetylcysteine can be carried out up to 24 hours after taking paracetamol, however, the maximum protective effect is usually achieved when used 8 hours after taking paracetamol. With later use, the effectiveness of the antidote gradually decreases. If necessary, N-acetylcysteine is administered intravenously in accordance with the established regimen. Outside the hospital, in the absence of vomiting, methionine may be administered orally. Patients who present with severe hepatic dysfunction 24 hours after the application of Nurofen Long should be referred to a poisoning specialist.

An increased risk of liver damage from an overdose of paracetamol is noted in the following cases:

• long-term combined use with carbamazepine, phenobarbitone, phenytoin, primidone, rifampicin, St. John's wort and other enzyme-inducing drugs;
• drinking alcohol in quantities higher than recommended;
• depletion of glutathione (eg, in eating disorders, cystic fibrosis, HIV infection, cachexia, and fasting).

Ibuprofen

Overdose symptoms in children can be observed after taking a dose of more than 400 mg / kg. In adult patients, the dose-dependent effect of overdose is less pronounced.

The main symptoms are vomiting, nausea, epigastric pain; in more rare cases, tinnitus, diarrhea, gastrointestinal bleeding, and headache develop. Severe overdose may be accompanied by disorders of the central nervous system, which manifest themselves in the form of drowsiness, more rarely - excitement, seizures, disorientation, coma. It is also possible a decrease in blood pressure, respiratory depression, an increase in prothrombin time, the development of metabolic acidosis, renal failure, liver tissue damage and cyanosis. In patients with bronchial asthma, its exacerbation is possible.

Therapy is carried out symptomatic, which, up to the normalization of the patient's condition, includes the mandatory provision of airway patency, monitoring of the ECG and vital signs. Activated charcoal or gastric lavage is usually given within 1 hour after taking a potentially toxic dose of ibuprofen. If ibuprofen has already been absorbed, alkaline drinking and forced diuresis may be prescribed. When bronchial asthma worsens, the use of bronchodilators is indicated. Frequent / prolonged seizures should be treated with intravenous lorazepam or diazepam.

special instructions

When carrying out a long treatment course, monitoring of the peripheral blood picture and the state of renal / hepatic function is required.

If symptoms of gastropathy appear, they must be carefully monitored, including esophagogastroduodenoscopy, fecal occult blood test, complete blood count (hemoglobin determination). Before the study for the determination of 17-ketosteroids, Nurofen Long is canceled 48 hours before.

It is not recommended to take ethanol during treatment.

In case of renal failure, before starting to take Nurofen Long, you need to consult a doctor, since there is a possibility of deterioration in the functional state of the kidneys.

In case of hypertension, including in history, and / or chronic heart failure, the drug should also be taken with caution, since therapy can lead to increased blood pressure, edema and fluid retention.

When planning pregnancy, women should take into account that Nurofen Long affects ovulation, inhibits the synthesis of prostaglandins and cyclooxygenase, and disrupts female reproductive function (it is reversible).

Application during pregnancy and lactation

The third trimester of pregnancy is a contraindication to taking Nurofen Long.

It must be taken into account that the drug can delay the onset and prolong labor, it also contributes to increased bleeding in the child and mother.

The negative effect of paracetamol on the fetus (subject to the recommended dose) has not yet been noted.

Reception of Nurofen Long in the I – II trimesters of pregnancy, if possible, should be avoided. If it is necessary to use the drug during this period, as well as during childbirth, it is first necessary to carefully balance the benefits with the risk.

An insignificant amount of ibuprofen and its metabolites passes into breast milk, there is no information about the negative impact on the health of the child. Paracetamol is excreted in breast milk, but there is no clinically significant effect.

Pediatric use

According to the instructions, Nurofen Long is not prescribed for children under 12 years old.

With impaired renal function

• severe renal failure (with creatinine clearance <30 ml / min) - the use of Nurofen Long is contraindicated;
• renal failure, including dehydration (with creatinine clearance <30-60 ml / min), nephrotic syndrome - the drug is prescribed with caution.

For violations of liver function

• severe liver failure or liver disease in the active phase - the use of Nurofen Long is contraindicated;
• liver failure, liver cirrhosis with portal hypertension, hyperbilirubinemia - the drug is prescribed with caution.

Use in the elderly

The use of Nurofen Long in old age requires caution.

Drug interactions

Paracetamol

Possible interactions:

• drugs with antiemetic action (metoclopramide, domperidone): a decrease in the rate of absorption of paracetamol;
• cholestyramine: reducing the rate of absorption of paracetamol;
• anticoagulants (with prolonged combined use): strengthening their action, increasing the risk of bleeding.

Ibuprofen

Combinations not recommended:

• acetylsalicylic acid (except for use in low doses - up to 75 mg per day): its anti-inflammatory / antiplatelet effect decreases; the likelihood of side effects increases (the incidence of acute coronary insufficiency in patients may increase when receiving small doses of acetylsalicylic acid as an antiplatelet agent after starting Nurofen Long);
• selective inhibitors of COX-2 and other NSAIDs: the likelihood of adverse reactions increases.

Combinations that require caution:

• selective serotonin reuptake inhibitors and antiplatelet agents: there is an increased risk of gastrointestinal bleeding;
• glucocorticosteroids: the likelihood of ulceration of the gastrointestinal tract and gastrointestinal bleeding may increase;
• quinolone antibiotics: the risk of seizures may increase;
• thrombolytic drugs and anticoagulants: there may be an increase in their action;
• lithium preparations: an increase in the plasma concentration of lithium in the blood is possible;
• methotrexate: its plasma concentration may increase;
• cyclosporine: the risk of nephrotoxicity may increase;
• drugs with an antihypertensive effect (angiotensin-converting enzyme inhibitors, angiotensin II antagonists) and diuretics: their effectiveness may decrease and the nephrotoxicity of Nurofen Long may increase. Sometimes, with impaired renal function, its deterioration is possible with / without the development of acute renal failure (usually of a reversible nature). The combination should be administered with caution in elderly patients. Prevent dehydration in patients and consider monitoring renal function;
• cardiac glycosides: heart failure may worsen, the glomerular filtration rate may decrease and the plasma concentration of these drugs in the blood may increase;
• myelotoxic drugs: manifestations of hematotoxicity may increase;
• mifepristone: you can start taking Nurofen Long no earlier than 8-12 days after taking mifepristone, which is associated with the likelihood of a decrease in its effectiveness;
• tacrolimus: the risk of nephrotoxicity may increase;
• caffeine: analgesic effect may increase;
• zidovudine: hematotoxicity may increase; there is evidence of an increased risk of hematomas / hemarthrosis in HIV-positive patients with hemophilia.

Analogs

The analogues of Nurofen Long are: Ibuklin, Next, Brustan, Brufika Plus, Khairumat.

Terms and conditions of storage

Store at temperatures up to 25 ° C. Keep out of the reach of children.

The shelf life is 3 years.

Terms of dispensing from pharmacies

Available without a prescription.

Reviews about Nurofen Long

According to reviews, Nurofen Long has a quick (within 10-15 minutes) and long-term (up to 8 hours) analgesic effect. It is noted that the drug is effective for various types of pain.

Price for Nurofen Long in pharmacies

The approximate price for Nurofen Long (6 or 12 tablets per pack) is 175-195 or 310 rubles.

Nurofen Long: prices in online pharmacies

Drug name Price Pharmacy

Nurofen Long 200 mg + 500 mg film-coated tablets 6 pcs. RUB 103 Buy

Nurofen Long 200 mg + 500 mg film-coated tablets 12 pcs. 194 r Buy

Anna Kozlova Medical journalist About the author

Education: Rostov State Medical University, specialty "General Medicine".

Information about the drug is generalized, provided for informational purposes only and does not replace the official instructions. Self-medication is hazardous to health!