Nurofen Gold Flu instructions for use. Drugs with similar effects

Name:

Coldflu

Pharmachologic effect:

Coldflu – combination drug, used for the symptomatic treatment of acute respiratory diseases. The drug has antipyretic, antiallergic, analgesic and anti-inflammatory effects, reduces the symptoms of rhinitis, and has some stimulating effect on the central nervous system. Mechanism of action and pharmacological effects The drug is determined by the properties of its active components.

Paracetamol is a drug from the group of non-steroidal anti-inflammatory drugs, a para-aminophenol derivative. The mechanism of action of paracetamol is associated with its ability to inhibit the enzyme cyclooxygenase, as a result of which the metabolism of arachidonic acid and the synthesis of prostaglandins are disrupted. Paracetamol inhibits both isoforms of cyclooxygenase - cyclooxygenase-1 and cyclooxygenase-2. The drug reduces the amount of prostaglandins in the tissues of the central nervous system, as a result of which the sensitivity of receptors to chemical stimuli decreases and the intensity decreases pain. Due to its direct effect on the thermoregulation center in the hypothalamus, paracetamol has an antipyretic effect. The peripheral effect of the drug is weakly expressed, since the drug is inactivated by cellular peroxidases.

Caffeine is an alkaloid obtained from tea and coffee beans; in addition, caffeine is synthesized from uric acid and xanthine. The drug has a stimulating effect on the central nervous system, enhances and regulates excitation processes in the cerebral cortex. Caffeine increases physical and mental performance, increases the excitability of the respiratory and vasomotor centers. When taking the drug, there is an increase in heart rate and an increase in the intensity of contractions of the heart muscle. An increase in blood pressure under the influence of caffeine is observed only during shock and collapse, while normal arterial pressure caffeine has no significant effect. The drug stimulates gland function internal secretion. There was a slight decrease in platelet aggregation with caffeine. The mechanism of action of the drug is based on its ability to bind to adenosine receptors in the brain. Communication with receptors occurs due to the structural similarity of the caffeine and adenosine molecules. Since adenosine leads to a decrease in excitation processes, its replacement with caffeine helps stimulate the nervous system. However, with prolonged use of the drug, nervous exhaustion may develop.

Chlorpheniramine maleate is a drug from the group of H1-histamine receptor blockers. The drug competitively blocks H1-histamine receptors. The drug is most effective for the prevention and treatment of allergic reactions of the immediate type, in which there is a release large quantity histamine from mast cells into the blood. The drug has a lower affinity for H1-histamine receptors than histamine, therefore, when it is used, there is no competitive displacement of histamine from already formed bonds. Chlorpheniramine can only prevent the binding of histamine to receptors. The drug has antihistamine, anticholinergic, sedative and atropine-like effects. Chlorpheniramine helps normalize vascular permeability, reduce itching, eliminate smooth muscle spasm and other effects caused by histamine. In addition, the drug is a blocker of seretonin and m-cholinergic receptors and has a pronounced sedative effect. The drug has a short-term effect, so it must be used during the entire period of influence of the allergen.

Phenylpropanolamine hydrochloride is a drug with adrenomimetic activity. Phenylpropanolamine hydrochloride stimulates the release of norepinephrine into the synaptic cleft, resulting in vasoconstriction in the nasal mucosa. The drug helps reduce swelling and improve nasal breathing. In addition, phenylpropanolamine hydrochloride reduces phenomena such as redness of the nasal mucosa, sneezing, lacrimation and rhinorrhea.

All active components of the drug are well absorbed in the gastrointestinal tract after oral administration. The maximum concentration of paracetamol in the blood plasma is achieved within 30-60 minutes after oral administration, phenylpropanolamine hydrochloride - within 1-2 hours, chlorpheniramine maleate - within 30-60 minutes. Caffeine is evenly distributed in the body and penetrates well through the blood-brain barrier. Paracetamol is metabolized in the liver to form glucuronide, sulfate and cysteine ​​compounds. Caffeine is metabolized in the body through demethylation and oxidation. Phenylpropanolamine is not metabolized in the body. Chlorpheniramine maleate is characterized by a first-pass effect through the liver. Phenylpropanolamine is excreted unchanged from the body in the urine. Rest active substances excreted mainly in the form of metabolites in the urine, a small part is excreted unchanged. The half-life of paracetamol is about 2 hours, phenylpropanolamine - 3-5 hours, caffeine - 4-5 hours, chlorpheniramine maleate - 1-1.5 hours.

The therapeutic effect of the drug occurs 30 minutes after use and lasts about 12 hours after oral administration.

Indications for use:

The drug is used for the symptomatic treatment of acute respiratory diseases of different nature(including acute respiratory viral diseases), including respiratory diseases, which are accompanied by rhinitis, swelling of the nasal mucosa, and fever.

In addition, the drug is used to treat pain of mild to moderate intensity, including headache and diseases of the ENT organs, which are accompanied by pain.

Method of application:

The dosage of the drug and the duration of the course of treatment are determined by the attending physician individually, depending on the nature of the disease and the personal characteristics of the patient.

Adults are usually prescribed 1 tablet of the drug 3-4 times a day.

Children over 12 years of age are usually prescribed 1/2 tablet of the drug 3-4 times a day.

The duration of treatment is no more than 7 days.

Swallow the tablet whole, without chewing or crushing, with a sufficient amount of water. If necessary, the tablet can be divided.

Adverse events:

The drug is usually well tolerated by patients, however, the following side effects associated with taking Coldflu may develop:

From the outside gastrointestinal tract: nausea, vomiting, anorexia, indigestion, pain and discomfort in the epigastric region, dry mouth.

From the central nervous system: headache, dizziness, drowsiness, disturbance of sleep and wakefulness, increased excitability, irritability.

From the hematopoietic system: anemia, thrombocytopenia.

Allergic reactions: skin rash, itching. Patients with hypersensitivity may develop anaphylactic reactions.

In addition, when using the drug, some patients experienced the development of accommodation disturbances and increased intraocular pressure.

In isolated cases, the development of urination disorders was noted.

Contraindications:

Increased individual sensitivity to the components of the drug.

The drug is not prescribed to women during pregnancy and lactation, as well as to children under the age of 12 years.

The drug should be prescribed with caution to patients suffering from severe impairment of liver and/or kidney function, arterial hypertension and chronic heart failure.

In addition, caution must be exercised when prescribing the drug to patients with hyperthyroidism, diabetes mellitus, and prostate adenoma, which is accompanied by urinary problems.

During pregnancy:

The drug is not prescribed during pregnancy.

If it is necessary to prescribe the drug during lactation, it is recommended to resolve the issue of stopping breastfeeding.

Interaction with other drugs:

The interaction of the drug Coldflu with other drugs is due to the properties of its active components, in particular:

Paracetamol, when used simultaneously, enhances the effects of anticoagulants, a group of coumarin derivatives, and increases the risk of developing liver damage when using drugs with hepatotoxic properties.

When used simultaneously, atropine, peptidine and other drugs with antispasmodic effects increase the time to reach the maximum plasma concentration of paracetamol.

Barbiturates, rifampicin, ethyl alcohol and antiepileptic drugs, when used simultaneously with paracetamol, increase the risk of developing toxic liver damage due to increased breakdown of paracetamol to hepatotoxic compounds.

Microsomal oxidation inhibitors (cimetidine) reduce the risk of liver damage when using paracetamol.

Caffeine, when used simultaneously, enhances the effects of drugs that stimulate the central nervous system and reduces the effectiveness of sleeping pills and narcotic drugs.

Barbiturates, primidone, nicotine and anticonvulsants enhance metabolism and excretion of caffeine.

Ciprofloxacin, disulfiram, norfloxacin, cimetidine and oral contraceptives increase the concentration of caffeine in the blood.

When using high doses of caffeine simultaneously with monoamine oxidase inhibitors, selegiline, procarbazine and furazolidone, the risk of developing arrhythmia and arterial hypertension increases. The drug increases the toxicity of cardiac glycosides.

Caffeine reduces the absorption of calcium ions in the gastrointestinal tract.

An increase in the excretion of lithium preparations was noted when they were used simultaneously with caffeine.

With the simultaneous use of caffeine and beta-blockers, a mutual decrease in the effectiveness of these drugs is observed.

Chlorpheniramine maleate, when used concomitantly with monoamine oxidase inhibitors and furazolidone, increases the risk of developing hyperpyrexia and hypertensive crisis. The drug is not prescribed simultaneously with calcium chloride, kanamycin sulfate, phenobarbital and norepinephrine.

With simultaneous use of chlorpheniramine maleate with ethyl alcohol, tranquilizers and other drugs that depress the central nervous system, there is an increase in the sedative effect of chlorpheniramine.

Phenylpropanolamine, when used simultaneously with monoamine oxidase inhibitors, increases blood pressure and increases the risk of developing a hypertensive crisis. Reserpine helps reduce the effectiveness of phenylpropanolamine.

The simultaneous use of phenylpropanolamine with drugs that stimulate the central nervous system is not recommended, since phenylpropanolamine increases the risk of developing tremor, arterial hypertension and increased excitability.

When phenylpropanolamine is used simultaneously with beta-blockers, levodopa and digitalis preparations, the risk of developing arrhythmias increases.

When using the drug before inhalation anesthesia, severe arrhythmias may develop after the administration of inhalation anesthesia.

Overdose:

When taking the drug in doses exceeding the recommended ones, the development of nausea, vomiting, dry mouth, drowsiness, and headache is observed. With a further increase in dose, arrhythmia, arterial hypertension, urinary disorders and thrombocytopenia may develop.

There is no specific antidote. In case of an overdose of the drug, gastric lavage, enterosorbents and symptomatic therapy. If a headache develops associated with taking high doses of the drug, further use of the drug to relieve pain is contraindicated.

Hemodialysis and peritoneal dialysis are not effective.

Release form of the drug:

Tablets, 4 pieces in strips, 1 strip in an envelope.

Storage conditions:

Shelf life – 4 years.

Synonyms:

Compound:

1 tablet contains:

Paracetamol – 500 mg,

Caffeine – 30 mg,

Phenylpropanolamine hydrochloride – 25 mg,

Chlorpheniramine maleate – 2 mg,

Excipients.

Drugs with similar effects:

Kofol (ointment) (Kofol) Kofol (lozenges) (Kofol) Humer 050 (Humer) Humer 150 / Humer monodose (Humer) Combigripp (syrup) (Combigripp)

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Ibuprofen+Pseudoephedrine

Group:

Active ingredients:

Pharmachologic effect:

Combined remedy; has a vasoconstrictor, antipyretic and analgesic effect. Pseudoephedrine is a sympathomimetic, reduces swelling of the mucous membrane of the nasal cavity, nasopharynx, paranasal sinuses. The onset of action is 30 minutes after administration, duration is 4-5 hours. Ibuprofen is an NSAID that blocks COX1 and COX2, changes the metabolism of arachidonic acid, suppresses the exudative and proliferative phases of inflammation. Reduces capillary permeability; stabilizes lysosomal membranes; reduces pain sensitivity at the site of inflammation of any etiology.

Indications:

Feverish syndrome ("colds" and infectious diseases), rhinitis, rhinorrhea, sinusitis; nasopharyngitis; flu.

Contraindications:

Hypersensitivity; childhood(up to 12 years old); pregnancy (first trimester). With caution. Pregnancy (II-III trimesters), lactation period; erosive and ulcerative lesions of the gastrointestinal tract ( peptic ulcer stomach and duodenum, ulcerative colitis); congenital hyperbilirubinemia (Gilbert, Dubin-Johnson and Rotor syndromes); arterial hypertension, IHD, CHF, bronchial asthma; hemophilia, hypocoagulation, blood diseases; thyrotoxicosis; diabetes; hepatic or renal failure, hearing loss, pathology of the vestibular apparatus, deficiency of glucose-6-phosphate dehydrogenase; pheochromocytoma; simultaneous use of tricyclic antidepressants and other adrenergic stimulants, MAO inhibitors (and for 2 weeks after their discontinuation).

Side effects:

Dyspepsia, NSAID gastropathy; tachycardia, edema syndrome, increased blood pressure, chest pain; headache, dizziness, increased fatigue, sleep disturbances, tremors, agitation, hallucinations, hearing loss, tinnitus, depression; allergic reactions: urticaria, bronchospasm, itching, angioedema; impaired liver and kidney function, agranulocytosis, leukopenia, anemia, thrombocytopenia, bleeding (gastrointestinal, gingival, uterine, hemorrhoidal); dry mucous membranes, thirst, increased sweating; myasthenia gravis. Overdose. Symptoms: nausea, vomiting, sleep disturbances, agitation, tachycardia. Treatment: symptomatic.

Directions for use and dosage:

Nurofen Stopcold is taken orally, in an initial single dose - 400 mg of ibuprofen and 60 mg of pseudoephedrine hydrochloride, then 200-400 mg of ibuprofen and 30-60 mg of pseudoephedrine hydrochloride with an interval of 4 hours. Maximum daily dose- 1200 mg ibuprofen and 180 mg pseudoephedrine hydrochloride.

Special instructions:

Individual selection doses are carried out in cases of severe impairment of liver and/or kidney function, in elderly people. During treatment, gastrointestinal function monitoring, peripheral blood analysis and functional state liver and kidneys, blood pressure. When determining 17-ketosteroids, the drug should be discontinued 48 hours before the test. During the treatment period, care must be taken when driving vehicles and engaging in other potentially hazardous activities that require increased concentration and speed of psychomotor reactions.

Interaction:

Pseudoephedrine enhances the effect of oral anticoagulants, adrenergic stimulants, weakens the effect of diuretics, guanethidine; increases the arrhythmogenic effect of cardiac glycosides, quinidine, tricyclic antidepressants. Guanethidine, reserpine, methyldopa weaken the effect of pseudoephedrine. Tricyclic antidepressants can either increase or decrease the effectiveness of pseudoephedrine. Ibuprofen reduces the effectiveness of uricosuric, antihypertensive drugs and diuretics, enhances - anticoagulants, antiplatelet agents, fibrinolytics, sulfonylurea derivatives, side effects of MCS and GCS, estrogens. The hypertensive effect and the risk of developing tachycardia increase when combined with tricyclic antidepressants, other sympathomimetics, anorexigenic drugs, amphetamine psychostimulants; weakens the effect of antihypertensive drugs. Antacids and cholestyramine reduce the absorption of ibuprofen. Increases the concentration of Li+ drugs in the blood and increases the toxicity of methotrexate.

The non-steroidal anti-inflammatory drug Nurofen is available in various forms for more convenient use. Pharmacological companies produce the drug not only in pure form, but also in the form of complex medications that combine several active ingredients. One of these drugs is Nurofen Stopcold, which has a more pronounced anti-inflammatory and antipyretic effect, unlike regular Nurofen.

Composition and release forms

Nurofen Stopcold contains two main substances, and not one, as in other types of anti-inflammatory drugs. One of the main components of Nurofen Stopcold is ibuprofen, and the other is pseudoephedrine hydrochloride. The drug is produced only in the form of tablets coated with a special coating. Thanks to its complex composition, this type of anti-inflammatory drug copes well with the symptoms of acute viral infections. respiratory infections(flu) and colds.

Basics active substance- ibuprofen is a non-steroidal anti-inflammatory substance derived from propionic acid. In addition to its antipyretic effect, ibuprofen has a pronounced anti-inflammatory and analgesic effect. The action of ibuprofen is aimed at inhibiting the production of specific prostaglandins, as well as stimulating the production of natural protein secreted by cellular structures immune system in response to invasion of pathogenic viral microorganisms.

Another active component of Nurofen Stopcold, pseudoephedrine, is an adrenergic agonist, a bronchial dilator and a vasoconstrictor. Pseudoephedrine is an alkaloid obtained from the shoots of horsetail ephedra. This alkaloid has a pronounced effect on the central nervous system, increases blood pressure and stimulates the receptors of the mucous membrane lining the bronchial tree. In addition, pseudoephedrine helps reduce tissue hyperemia, relieves swelling and nasal congestion.

Pharmacodynamics of the drug

Combined medicine Nurofen Stopcold can have a pronounced vasoconstrictor, analgesic, anti-inflammatory and antipyretic effect. Ephedra alkaloid is a sympathomimetic, reduces swelling of the mucous membrane of the nasopharynx and sinuses. Nurofen Stopcold begins to act 30-40 minutes after taking the tablet. The duration of the effect depends on the individual characteristics of the body and the dose of the medicine taken, but, as a rule, it is at least 5 hours. The active base component ibuprofen is able to block cycloxygenases 1 and 2 (enzymes involved in the production of prostaglandins from arachidonic acid), suppressing the phase inflammatory process- proliferative and exudative.

Read also: Instructions for use of Nurofen Express Neo

When taken orally, Nurofen Stopcold is well absorbed from digestive tract. The maximum concentration of the substance in the plasma elements of the blood is achieved after 60 minutes (on an empty stomach) and after 1.5-2.5 hours when taking the medicine after meals. Ibuprofen in combination with pseudoephedrine hydrochloride binds to the protein components of blood plasma by 92%.

Indications for use

The instructions for use of Nurofen Stopcold indicate that the combined medication is indicated for use in patients with severe signs of acute respiratory viral infections, as well as febrile syndrome. It is also recommended to use Nurofen Stopcold in complex therapy rhinitis, severe discharge from the nasal sinuses, inflammation of the maxillary and sinus sinuses, nasopharyngotracheitis and influenza.

Contraindications and side effects

Nurofen Stopcold should be taken with great caution and only after consulting a doctor. This will avoid unwanted consequences and complications. The main contraindications for use are:

• individual intolerance to one of the components of the drug;
• children under 12 years of age;
• the period of bearing a child (prohibited in the 1st trimester and prescribed with great caution in the 2nd-3rd trimester);
• breastfeeding period;
• defeats digestive system- stomach ulcers and duodenum, colitis and enteritis;
• congenital anomalies of the development of liver structures;
• arterial hypertension;
• cardiac ischemia;
• chronic myocardial failure;
• disorders of the thyroid gland;
• diseases of the hematopoietic system;
• kidney and liver failure;
• joint use of tricyclic antidepressants;
• joint use of adrenergic stimulants and monoamine oxidase inhibitors.

If strict dosage is observed and individual characteristics are taken into account, side effects occur extremely rarely. Violation of the rules of admission entails the development of the following pathological processes:

• dyspeptic disorders;
• gastropathy;
• heart rhythm disturbances;
• swelling of the lower and upper extremities;
• increased blood pressure;
• headaches and dizziness;
• increased fatigue;
• sleep disturbance;
• trembling of limbs;
• overexcitation of the nervous system, hallucinations;
• hearing impairment - the appearance of tinnitus;
• depressive states.

Excipients: croscarmellose sodium - 30 mg, sodium lauryl sulfate - 0.5 mg, sodium citrate dihydrate - 43.5 mg, stearic acid - 2 mg, colloidal silicon dioxide - 1 mg.

Shell composition: carmellose sodium - 0.7 mg, talc - 33 mg, acacia gum - 0.6 mg, sucrose - 116.1 mg, titanium dioxide - 1.4 mg, macrogol 6000 - 0.2 mg, black ink [Opacode S-1-277001] (shellac 28.225%, dye iron oxide black (E172) 24.65%, propylene glycol 1.3%, isopropanol* 0.55%, butanol* 9.75%, ethanol* 32.275%, purified water* 3.25%).

* solvents that have evaporated after the printing process.

6 pcs. - blisters (2) - cardboard packs.
8 pcs. - blisters (1) - cardboard packs.
8 pcs. - blisters (2) - cardboard packs.
10 pieces. - blisters (1) - cardboard packs.
10 pieces. - blisters (2) - cardboard packs.
10 pieces. - blisters (3) - cardboard packs.
12 pcs. - blisters (1) - cardboard packs.
12 pcs. - blisters (2) - cardboard packs.
12 pcs. - blisters (3) - cardboard packs.
12 pcs. - blisters (4) - cardboard packs.
12 pcs. - blisters (8) - cardboard packs.

pharmachologic effect

NSAIDs, a derivative of phenylpropionic acid. It has anti-inflammatory, analgesic and antipyretic effects.

The mechanism of action is associated with inhibition of the activity of COX, the main enzyme in the metabolism of arachidonic acid, which is a precursor of prostaglandins, which play a major role in the pathogenesis of inflammation, pain and fever. The analgesic effect is due to both peripheral (indirectly, through suppression of prostaglandin synthesis) and central mechanisms (inhibition of prostaglandin synthesis in the central and peripheral nervous system). Suppresses platelet aggregation.

When applied externally, it has an anti-inflammatory and analgesic effect. Reduces morning stiffness and helps increase range of motion in joints.

Pharmacokinetics

When taken orally, ibuprofen is almost completely absorbed from the gastrointestinal tract. Concomitant food intake slows down the rate of absorption. Metabolized in the liver (90%). T 1/2 is 2-3 hours.

80% of the dose is excreted in the urine mainly in the form of metabolites (70%), 10% - unchanged; 20% is excreted through the intestines in the form of metabolites.

Indications

Inflammatory and degenerative diseases of the joints and spine (including rheumatic and ankylosing spondylitis, osteoarthritis), articular syndrome with exacerbation of gout, psoriatic arthritis, ankylosing spondylitis, tendonitis, bursitis, radiculitis, traumatic inflammation of soft tissues and the musculoskeletal system. Neuralgia, myalgia, pain syndrome for infectious and inflammatory diseases of the ENT organs, adnexitis, algodismenorrhea, headache and toothache. Fever in infectious and inflammatory diseases.

Contraindications

Erosive and ulcerative lesions of the gastrointestinal tract in the acute phase, diseases optic nerve, “aspirin triad”, hematopoietic disorders, severe renal and/or liver dysfunction; III trimester of pregnancy; increased sensitivity to ibuprofen.

Dosage

Set individually, depending on the nosological form of the disease, severity clinical manifestations. When taken orally or rectally for adults, the single dose is 200-800 mg, the frequency of administration is 3-4 times a day; for children - 20-40 mg/kg/day in several doses.

Apply externally for 2-3 weeks.

Maximum daily dose for adults when taken orally or rectally is 2.4 g.

Side effects

From the digestive system: often - nausea, anorexia, vomiting, epigastric discomfort, diarrhea; the development of erosive and ulcerative lesions of the gastrointestinal tract is possible; rarely - bleeding from the gastrointestinal tract; With long-term use, liver function disorders are possible.

From the central nervous system and peripheral nervous system: often - headache, dizziness, sleep disturbances, agitation, visual disturbances.

From the hematopoietic system: with long-term use, anemia, thrombocytopenia, and agranulocytosis are possible.

From the urinary system: With long-term use, renal dysfunction is possible.

Allergic reactions: often - skin rash, Quincke's edema; rarely - aseptic meningitis (more often in patients with autoimmune diseases), bronchospastic syndrome.

Local reactions: When used externally, skin hyperemia, burning or tingling sensations are possible.

Drug interactions

With simultaneous use, ibuprofen reduces the effect of antihypertensive drugs (ACE inhibitors), diuretics (furosemide, hydrochlorothiazide).

When used simultaneously with anticoagulants, their effect may be enhanced.

When used simultaneously with GCS, the risk of developing side effect from the gastrointestinal tract.

When used concomitantly, ibuprofen may displace compounds with blood proteins indirect anticoagulants(acenocoumarol), hydantoin derivatives (phenytoin), oral hypoglycemic drugs, sulfonylurea derivatives.

When used simultaneously with amlodipine, a slight decrease in the antihypertensive effect of amlodipine is possible; c - the concentration of ibuprofen in the blood plasma decreases; with baclofen - a case of enhancement is described toxic effect baclofen.

When used simultaneously with warfarin, an increase in bleeding time is possible; microhematuria and hematomas were also observed; with captopril - a decrease in the antihypertensive effect is possible; with cholestyramine - a moderately pronounced decrease in the absorption of ibuprofen.

When used simultaneously with lithium carbonate, the concentration of lithium in the blood plasma increases.

When used simultaneously with magnesium hydroxide, the initial absorption of ibuprofen increases; c - the toxicity of methotrexate increases.

special instructions

Use with caution in case of concomitant diseases of the liver and kidneys, chronic heart failure, with dyspeptic symptoms before starting treatment, immediately after treatment. surgical interventions, with indications in the anamnesis of bleeding from the gastrointestinal tract and gastrointestinal diseases, allergic reactions associated with taking NSAIDs.

During treatment, systematic monitoring of liver and kidney functions and peripheral blood patterns is necessary.

Should not be used externally on damaged skin areas.

Pregnancy and lactation

Use in the third trimester of pregnancy is contraindicated. Use in the first and second trimesters of pregnancy is justified only in cases where the expected benefit to the mother outweighs the possible risk to the fetus.

Ibuprofen is excreted in breast milk in small quantities. Use during lactation for pain and fever is possible. If long-term use or use is necessary high doses(more than 800 mg/day), the issue of stopping breastfeeding should be decided.

For impaired renal function

Contraindicated in cases of severe renal impairment. Use with caution in case of concomitant kidney diseases.

For liver dysfunction

Contraindicated in cases of severe liver dysfunction. Use with caution in case of concomitant liver diseases.