Neobrufen (Ibuprofen, Codeine Phosphate Hemihydrate)

Neobrufen combines ibuprofen and codeine to address pain‑related conditions and fever by acting on inflammatory and opioid pathways.

• Pain: Provides relief of moderate to severe acute pain.
• Fever: Reduces elevated body temperature associated with infection or inflammation.
• Headache: Alleviates tension‑type and migraine‑related headache pain.
• Musculoskeletal pain: Improves comfort in conditions such as sprains, strains and osteoarthritis.
• Dental pain: Controls postoperative or procedural dental discomfort.

• Ibuprofen inhibits cyclooxygenase‑1 and cyclooxygenase‑2 enzymes, decreasing prostaglandin synthesis and thereby reducing inflammation, pain and fever. Codeine phosphate hemihydrate is a pro‑drug metabolized by hepatic CYP2D6 to morphine, which binds µ‑opioid receptors in the central nervous system, modulating pain transmission and providing additional analgesia and cough suppression. The combined action yields synergistic analgesic effect, allowing lower doses of each component while maintaining efficacy.

Neobrufen may cause a range of adverse reactions, varying from mild to severe.

Common Side Effects

• Nausea: mild stomach upset that may be transient.
• Drowsiness: sedation or fatigue, often occurring after the first dose.
• Constipation: reduced bowel movements, sometimes requiring dietary adjustment.
• Dizziness: light‑headed sensation, particularly when standing quickly.
• Headache: mild to moderate pain that can persist for several hours.
• Dyspepsia: indigestion or heartburn, often relieved by antacids.

Serious or Rare Side Effects

• Respiratory depression: slowed or shallow breathing, especially at higher opioid doses.
• Severe allergic reaction: rash, itching, swelling of face or throat, or anaphylaxis.
• Gastrointestinal bleeding: black or tarry stools, vomiting blood, indicating ulceration.
• Hepatotoxicity: elevated liver enzymes, jaundice, or liver pain suggesting liver injury.

When prescribing Neobrufen, clinicians should consider several safety precautions to minimise risk.

• Assess renal function: avoid use in severe renal impairment without specialist advice.
• Evaluate hepatic status: caution in patients with liver disease due to metabolism of codeine.
• Monitor for opioid dependence: limit duration and assess for signs of misuse.
• Check concomitant CNS depressants: avoid combining with alcohol, benzodiazepines or other sedatives.
• Review allergy history: contraindicated in patients with known hypersensitivity to ibuprofen, other NSAIDs, or opioids.
• Store at ambient temperature: keep below 25 °C, in the original packaging, protected from moisture and direct sunlight.

Neobrufen can interact with other medicines, altering its efficacy or safety profile.

Major Interactions (Avoid)

• Other opioids: additive respiratory depression and sedation.
• CYP2D6 inhibitors (e.g., fluoxetine, paroxetine): reduce conversion of codeine to morphine, decreasing analgesic effect.
• Anticoagulants (warfarin, DOACs): increased risk of gastrointestinal bleeding.
• NSAIDs or aspirin: heightened risk of ulceration and renal impairment.
• Alcohol: potentiates central nervous system depression.

Moderate Interactions (Monitor Closely)

• Diuretics: may enhance renal effects of ibuprofen, requiring kidney function monitoring.
• Antihypertensives: ibuprofen can blunt the antihypertensive response.
• SSRIs or SNRIs: combined use may increase bleeding risk.
• Lithium: ibuprofen may raise lithium serum levels.
• Carbamazepine: may accelerate metabolism of codeine, reducing analgesia.