Nurofen Plus is a combination pain medication containing ibuprofen and codeine as active ingredients. NSAIDs, such as ibuprofen, have analgesic, antipyretic and anti-inflammatory actions. They inhibit the synthesis of prostaglandins by inhibiting cyclo-oxygenase (COX), present as COX-1 and COX-2. Their analgesic and anti-inflammatory effects are a consequence of COX-2 inhibition.
Codeine belongs to a class of medications called opiate (narcotic) analgesics and to a class of medications called antitussives. When codeine is used to treat pain, it works by changing the way the brain and nervous system respond to pain.
Each tablet of Nurofen Plus contains 200mg of ibuprofen and 12.8mg of codeine. The combination of 2 drugs with different modes of action results in an additive rather than a synergistic effect; the efficacy of the combination in acute pain is roughly similar to the sum of the efficacies of individual agents.
What is Nurofen Plus used for?
Nurofen Plus is used for the treatment, control, prevention, & improvement of the following diseases, conditions and symptoms:
- Menstruation pain
- Back pain
- Pain in teeth
- Muscles pain
- Joint pain
- Pain in body
How is Nurofen Plus taken?
For treatment of mild to moderate pain with or without fever, 1-2 tablets of Nurofen Plus are taken every 4 hours. Users have reported thrice a day and twice a day as the most common frequency of using Nurofen Plus. Please follow your doctor’s advice on how often you need to use Nurofen Plus. Do not exceed 12 tablets in 2 hours. This medication contains ibuprofen, excess ibuprofen can cause serious nervous system problems such as seizures (neurotoxicity), low blood pressure (hypotension), low temperature (hypothermia), and other severe metabolic problems.
You should not take Nurofen Plus if:
- Your doctor has advised you not to
- You are allergic to codeine
- You are not able to take the paracetamol or ibuprofen provided with the medication
- You need to do anything other than sleep for the next four hours.
- You may be tested for drugs of abuse.
How long should I take Nurofen Plus?
If you have bought Nurofen Plus from a pharmacy, do not use it for more than 3 days. If you still have pain, talk to your pharmacist or doctor. It’s important to ask them for advice about ongoing pain relief.
What if I forget to take it?
Take the missed dose as soon as you remember, unless it’s almost time for your next dose. In this case, skip the missed dose and take your next one as normal. Never take a double dose of Nurofen Plus to make up for a forgotten one.
What if I take too much?
Overdosing on Nurofen Plus can be dangerous.
It can cause side effects, such as:
- feeling very sleepy, sick, or dizzy
- finding it difficult to breathe or changes in your heart rate (it can become slower or faster)
- becoming unconscious, if you take a lot
The amount of Nurofen Plus that can lead to an overdose varies from person to person.
Can a pregnant or breastfeeding woman take Nurofen Plus?
While a short course of combined Nurofen Plus could be taken up to 28 weeks of pregnancy, other painkillers are likely to be more suitable. Ibuprofen can affect your baby’s circulation and amniotic fluid if you take it after 28 weeks, or for more than a few days at a time.
Codeine can affect your baby, especially towards the end of pregnancy. Your baby may get used to having codeine and may have withdrawal symptoms when they’re born. There is a slightly higher risk of your baby having breathing problems. These are usually temporary, but your baby may need to stay in the hospital for extra monitoring.
As a result, Nurofen Plus is not recommended during pregnancy. Other medicines are more suitable. Ask your doctor or pharmacist for advice.
Nurofen Plus is not also recommended while breastfeeding. Small amounts of codeine may get into breast milk and can cause breathing problems in your baby.
What are the side effects of Nurofen Plus?
The following is a list of possible side-effects that may occur from all constituting ingredients of Nurofen Plus. This is not a comprehensive list. These side-effects are possible but do not always occur. Some of the side effects may be rare but serious. Consult your doctor if you observe any of the following side effects, especially if they do not go away.
- Abdominal pain
- Swollen facial features
- Feeling sick
- Dry mouth
- Abdominal cramps
- Shortness of breath
- Allergic reactions
- Gastrointestinal distress
- Visual disturbances
- Respiratory depression
- Circulatory depression
- Respiratory arrest
- Cardiac arrest
- Skin rash
- Bleeding from the skin or nose
- Abnormal blood counts
- Severe skin reactions
- High blood pressure
- Loose motions
- Liver problems
- Kidney problems
- Severe skin allergies
- Feeling of sickness
- Skin reddening
- Liver damage
- Abnormalities of blood cells
- Liver toxicity
- Less white blood cells
- Acute renal tubular necrosis
- Blood dyscrasias
Nurofen Plus may also cause side effects not listed here. If you notice other side effects not listed above, contact your doctor for medical advice. You may also report side effects to your local food and drug administration authority.
Nurofen Plus Safety Information
Codeine-containing medicines like Nurofen Plus should only be used to treat acute (short-lived) moderate pain in children above 12 years of age, and only if it cannot be relieved by other painkillers such as ibuprofen, because of the risk of respiratory depression associated with codeine use.
Nurofen Plus contains an opiate (codeine) which comes with a high risk of its users developing tolerance and eventually dependence on it. Although many people begin using codeine to relieve a legitimate condition, it is frequently abused as tolerance develops. Many codeine users begin to turn to the drug to cope with all of their physical pain and eventually their emotional pain as well.
Nurofen Plus should not be used at all in children (aged below 18 years) who undergo surgery for the removal of the tonsils or adenoids to treat obstructive sleep apnea, as these patients are more susceptible to respiratory problems.
The risk of side effects with Nurofen Plus may also apply to adults. Codeine should therefore not be used in people of any age who are known to be ultra-rapid metabolizers nor in breastfeeding mothers (because codeine can pass to the baby through breast milk).
Short-term studies of Nurofen Plus in acute pain have not identified specific safety concerns other than those already known to be associated with the individual active ingredients.
How to cope with Nurofen Plus side effects
What to do about:
• Headaches – if you get headaches after taking combined ibuprofen and codeine, do not take any more and see if the headache goes away. It might be better to try another painkiller, like paracetamol. Talk to your doctor if the headaches do not go away or are severe.
• Feeling Sleepy – do not drive, cycle or use tools or machinery if you’re feeling drowsy. Do not drink any alcohol as this will make you feel more tired.
• Feeling Dizzy – if you begin to feel dizzy, lie down so you do not faint. If you feel dizzy when you stand up, try getting up very slowly or stay sitting down until you feel better. Do not drive or use tools or machinery while you feel like this.
• Constipation – eat more high-fibre foods, such as fresh fruit and vegetables and cereals. Try to drink several glasses of water or another non-alcoholic liquid each day. If you can, it may also help to increase your level of exercise. Watch a short video on how to treat constipation.
• Feeling Or Being Sick – take ibuprofen and codeine with or just after a meal or snack. Feelings of sickness normally wear off. Talk to your doctor if it bothers you. Take small, frequent sips of water or squash if you’re being sick to avoid dehydration. Signs of dehydration include peeing less than usual or having dark, strong-smelling pee. Do not take any other medicines to treat vomiting without speaking to a pharmacist or doctor.
• Indigestion And Heartburn (Acid Reflux) – stop taking the medicine and speak to your pharmacist or doctor if it does not go away. If you need something to ease the discomfort, try taking an antacid, but do not put off speaking to your pharmacist or doctor if the symptoms do not go away.
• Wind – try not to eat foods that cause wind (like lentils, beans and onions). Eat smaller meals, eat and drink slowly, and exercise regularly if you can. There are pharmacy medicines that can also help, such as simethicone.
What medicines can interact with Nurofen Plus?
Nurofen Plus does not mix well with some medicines.
Tell your doctor if you’re taking these medicines before you start taking combined ibuprofen and codeine:
• anticoagulants, such as warfarin
• other anti-inflammatory painkillers, such as aspirin (including a daily low dose of 75mg), diclofenac, mefenamic acid, and naproxen
• medicines for high blood pressure
• steroids that you swallow, such as prednisolone
• other antidepressants called monoamine oxidase inhibitors (MAOIs)
• methotrexate (a medicine for psoriasis and rheumatoid arthritis)
• lithium (a medicine for mental health problems)
• other medicines that can make you sleepy, such as sleeping pills or tranquilizers
Mixing Nurofen Plus with herbal remedies and supplements
There’s not enough research to know whether complementary medicines and herbal remedies are safe to take with combined ibuprofen and codeine. They are not tested in the same way as other medicines.