Cuprofen (Ibuprofen)

How does it work?

Cuprofen tablets and Cuprofen maximum strength tablets both contain the active ingredient ibuprofen, which is a type of medicine called a non-steroidal anti-inflammatory drug (NSAID). (NB. Ibuprofen is also available without a brand name, ie as the generic medicine.) Ibuprofen is a simple painkilling medicine used to relieve mild to moderate pain, inflammation and fever.

Ibuprofen works by blocking the action of a substance in the body called cyclo-oxygenase (COX). Cyclo-oxygenase is involved in the production of various chemicals in the body, some of which are known as prostaglandins. Prostaglandins are produced in response to injury and certain diseases and conditions, and cause pain, swelling and inflammation. NSAIDs block the production of these prostaglandins and are therefore effective at reducing inflammation and pain.

Ibuprofen also reduces fever by reducing the production of prostaglandins. Fever is associated with an increase in prostaglandins in the brain, and these prostaglandins cause the body temperature to increase. By reducing prostaglandins in the brain, ibuprofen lowers body temperature and hence reduces fever.

Ibuprofen reduces inflammation and related pain and so can be used to relieve muscular and rheumatic aches and pains. It can also be used to relieve other painful conditions such as headaches, migraine, toothache, nerve pain (neuralgia) and period pain. It is also useful for reducing fever and discomfort associated with colds and flu.

What is it used for?

• Mild to moderate pain including rheumatic and muscular pain, sprains and strains, backache, nerve pain (neuralgia), migraine, headache, toothache, period pain.
• Feverishness and symptoms of colds and flu.

Warning!

• Do not exceed the dose recommended in the leaflet supplied with the medicine.
• The minimum effective dose should be used for the shortest time necessary to relieve your symptoms. If symptoms persist despite treatment, seek medical advice from your doctor or pharmacist.
• Ibuprofen is generally well-tolerated and most people do not experience any side effects. The most common side effects are related to stomach irritation and include abdominal pain, indigestion and nausea. These can mainly be avoided by taking the ibuprofen with food. Rarely, serious side effects such as ulceration or bleeding in the stomach or intestines may occur. These are more likely with high doses and in elderly people. If you experience any sign of bleeding from the stomach or bowels after taking this medicine, for example vomiting blood and/or passing black/tarry/bloodstained stools, you should stop taking this medicine and consult your doctor immediately.
• Very rarely, NSAIDS may cause serious blistering or peeling skin reactions (eg Stevens-Johnson syndrome, toxic epidermal necrolysis, exfoliative dermatitis). For this reason, you should stop taking this medicine and consult your doctor if you get a skin rash or sores inside your mouth while taking this medicine. This side effect is very rare, but if it occurs, is most likely to happen in the first month of treatment.

Use with caution in

• Elderly people.
• History of disorders affecting the stomach or intestines.
• Inflammatory bowel disease such as Crohn's disease or ulcerative colitis.
• Kidney disease.
• Liver disease.
• Heart failure.
• High blood pressure (hypertension).
• People with blood clotting problems or taking anticoagulant medicines.
• History of asthma.
• History of allergies.
• Diseases affecting connective tissue, eg systemic lupus erythematosus.

Not to be used in

• People in whom aspirin or other NSAIDs, eg diclofenac, cause allergic reactions such as asthma attacks, itchy rash (urticaria), nasal inflammation (rhinitis) or swelling of the lips, tongue and throat (angioedema).
• Active peptic ulcer or bleeding in the gut.
• People who have had recurrent peptic ulcers or bleeding from the gut (two or more episodes).
• People who have ever experienced bleeding or perforation of the gut as a result of previous treatment with an NSAID.
• Severe heart failure.
• Severe kidney failure.
• Severe liver failure.
• Third trimester of pregnancy.
• People taking other NSAIDs, including COX-2 inhibitors (see end of factsheet for more details).
• Cuprofen tablets should not be given to children under 12 years of age. There are other preparations of ibuprofen that are more suitable for this age group - see end of factsheet for more details.

This medicine should not be used if you are allergic to one or any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy.If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.

Pregnancy and breastfeeding

Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.

• This medicine should not be used during pregnancy unless considered essential by your doctor. This is particularly important in the first and third trimesters. It should not be taken in the third trimester because it may delay labour, increase the length of labour and cause complications in the newborn baby. Some evidence suggests that NSAIDs should also be avoided by women attempting to conceive, as they may temporarily reduce female fertility during treatment and may also increase the risk of miscarriage or malformations. Seek medical advice from your doctor.
• This medicine may pass into breast milk, but in such small quantities that it is unlikely to harm the baby. However, as with all medicines, seek medical advice from your doctor before taking this medicine if you are breastfeeding.

Label warnings

• Take this medication with or after food.

Side effects

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with short-term use of ibuprofen in non-prescription doses. Just because a side effect is stated here does not mean that all people using this medicine will experience that or any side effect.

The side effects listed above may not include all of the side effects reported by the medicine's manufacturer.For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.

How can this medicine affect other medicines?

It is important to tell your doctor or pharmacist what medicines you are already taking, including those bought without a prescription and herbal medicines, before taking this medicine. Similarly, check with your doctor or pharmacist before taking any new medicines while taking this one, to ensure that the combination is safe.

Ibuprofen should not be taken in combination with painkilling doses of aspirin (above 75mg per day) or any other oral NSAID, (eg naproxen, diclofenac) as this increases the risk of side effects on the stomach and intestines. People taking selective inhibitors of COX-2 such as celecoxib or etoricoxib should not take ibuprofen for the same reason.

There may be an increased risk of ulceration or bleeding in the gut if ibuprofen is taken with corticosteroids such as prednisolone.

There may also be an increased risk of bleeding in the gut if ibuprofen is taken with the following medicines:

• anti-blood-clotting (anticoagulant) medicines such as warfarin
• antiplatelet medicines to reduce the risk of blood clots or 'thin the blood', eg dipydridamole, clopidogrel
• dabigatran
• erlotinib
• SSRI antidepressants, eg fluoxetine, paroxetine, citalopram
• venlafaxine.

There may be an increased risk of side effects on the kidneys if ibuprofen is taken in combination with any of the following medicines:

• ACE inhibitors, eg enalapril
• ciclosporin
• diuretics, eg furosemide
• tacrolimus.

Ibuprofen may reduce the removal of the following medicines from the body and so may increase the blood levels and risk of side effects of these medicines:

• digoxin
• lithium
• methotrexate.

Ibuprofen may oppose the blood pressure lowering effects of certain medicines to treat high blood pressure, such as the following:

• amlodipine
• ACE inhibitors such as captopril
• beta-blockers such as atenolol.

If this medicine is used in combination with quinolone antibiotics, such as ciprofloxacin or norfloxacin there may be an increased risk of seizures (fits). This may occur in people with or without a previous history of epilepsy or convulsions.

Other medicines containing the same active ingredient

Other brands of ibuprofen that are taken by mouth:

Anadin ibuprofen	Anadin joint pain	Anadin ultra
Arthrofen	Brufen	Calprofen
Cuprofen for children	Feminax express	Fenbid spansules
Feverfen	Galprofen	Ibufem
Librofem	Mandafen	Mandafen for children
Nurofen	Nurofen for children	Orbifen for children

Ibuprofen tablets, capsules, caplets and suspensions are also widely available without brand names, ie as the generic medicine.

Ibuprofen is also available as creams, gels and sprays that are applied to the skin to relieve muscle and joint pain:

Cuprofen gel	Fenbid gel	Ibugel
Ibuleve	Ibumousse	Ibuspray
Mentholatum ibuprofen gel	Nurofen gel	Phorpain gel
Proflex cream	Radian B ibuprofen gel/massage stick

The quantity and strength of ibuprofen supplied in the container or packet will determine whether it is only available on prescription, or can be bought from pharmacies only, or from other retail outlets such as supermarkets and garages.