Nurofen (Ibuprofen, Codeine Phosphate Hemihydrate)

Nurofen, a combination NSAID and opioid analgesic, is indicated for conditions that involve pain and fever.

• Mild to moderate pain: provides effective analgesia for acute pain such as injury or postoperative discomfort.
• Fever: reduces elevated body temperature associated with infection or inflammation.
• Headache: alleviates tension‑type and migraine‑related head pain.
• Dental pain: eases pain after dental procedures or toothache.
• Musculoskeletal pain: relieves pain from strains, sprains and arthritis flares.
• Menstrual pain: diminishes dysmenorrhea and associated cramps.

• Ibuprofen inhibits cyclooxygenase‑1 and cyclooxygenase‑2 enzymes, decreasing prostaglandin synthesis and thereby reducing inflammation, pain, and fever. Codeine phosphate hemihydrate acts as a mu‑opioid receptor agonist in the central nervous system, modulating pain perception and providing additional analgesic effect.

Adverse reactions may vary in frequency and severity.

Common Side Effects

• Nausea: mild to moderate stomach upset.
• Constipation: reduced bowel movements.
• Dizziness: transient light‑headedness.
• Drowsiness: increased sleepiness.
• Stomach upset: dyspepsia or heartburn.
• Headache: occasional mild headache.

Serious or Rare Side Effects

• Gastrointestinal bleeding or ulceration: potentially life‑threatening.
• Renal impairment: reduced kidney function.
• Hepatic injury: elevated liver enzymes.
• Respiratory depression: especially with high opioid exposure.
• Severe allergic reactions: rash, swelling, anaphylaxis.
• Seizures: rare neurologic events.

Before prescribing Nurofen, clinicians should consider several safety factors.

• Assess renal function: avoid in patients with severe kidney disease.
• Evaluate gastrointestinal risk: avoid in active peptic ulcer disease or history of GI bleeding.
• Use cautiously with other CNS depressants: increased sedation and respiratory risk.
• Monitor for signs of dependence: codeine may cause addiction with prolonged use.
• Do not use in children under 12 without specialist guidance: safety data limited.
• Store at room temperature: keep in the original pack, protect from moisture.

Nurofen can interact with several drug classes, requiring careful management.

Major Interactions (Avoid)

• Concurrent opioid analgesics: heightened risk of respiratory depression.
• Additional NSAIDs or aspirin: increased gastrointestinal bleeding.
• Anticoagulants (e.g., warfarin): amplified anticoagulant effect and bleeding.

Moderate Interactions (Monitor Closely)

• Alcohol: may potentiate sedation and GI irritation.
• CYP2D6 inhibitors (e.g., fluoxetine): can raise codeine plasma levels.
• Diuretics: may affect renal clearance of ibuprofen.
• ACE inhibitors or ARBs: combined use may reduce renal perfusion.