Nurofen Plus Warnings
Who should not take Nurofen plus?
- People who are known to have a genetic variation of a liver enzyme called CYP2D6, which metabolises codeine into morphine (CYP2D6 ultra-rapid metabolisers). These people are more likely to experience side effects after taking codeine, because they convert more codeine into morphine than other people. See above.
- People with very slow, shallow breathing (respiratory depression), people having an asthma attack and people with chronic obstructive pulmonary disease (COPD).
- People with a head injury or raised pressure inside the skull (intracranial pressure).
- People who have had an allergic reaction after taking aspirin or other NSAIDs such as diclofenac in the past, for example asthma attacks, itchy rash (urticaria), nasal inflammation (rhinitis) or swelling of the lips, tongue and throat (angioedema).
- People with an active stomach or intestinal ulcer or bleeding in the gut, particularly those who have had two or more episodes of this, or who have experienced this when taking an NSAID in the past.
- People who have or who are at risk of getting a blockage in the gut (paralytic ileus).
- People with severe heart failure, liver failure or kidney failure.
- People already taking any other NSAIDs by mouth, including COX-2 inhibitors (see end of factsheet for more details).
- People who have taken the antidepressants phenelzine, tranylcypromine, isocarboxazid or moclobemide, or the anti-Parkinson’s medicine selegiline in the last 14 days.
- Women who are pregnant or breastfeeding.
- Children under 12 years of age.
- Children and adolescents under 18 years of age who have had surgery to remove their tonsils or adenoids (tonsillectomy or adenoidectomy or both) for obstructive sleep apnoea.
- Codeine is not recommended for adolescents aged 12 to 18 years whose breathing might be compromised, including those with neuromuscular disorders; severe heart or lung conditions; upper airway or lung infections; multiple trauma; or who have had extensive surgical procedures.
Nurofen plus should not be used if you are allergic to any of its ingredients. If you feel you have experienced an allergic reaction, stop using Nurofen plus and inform your doctor or pharmacist immediately.
Who should get medical advice before taking Nurofen plus?
- Elderly people.
- People with kidney or liver problems.
- People with heart failure.
- People with high blood pressure (hypertension).
- People with blood clotting problems or taking anticoagulant medicines.
- People with lung problems such as asthma or a condition called bronchiectasis, in which there is persistent widening of the airways as a result of lung disease, eg infection, inflammation, tumours or cystic fibrosis.
- People with problems affecting the stomach or intestines, such as constipation or inflammatory bowel disorders such as Crohn’s disease or ulcerative colitis.
- People who have recently had surgery on their stomach, intestines or urinary tract.
- People with biliary tract disorders, eg gallstones or recent surgery on the biliary tract.
- People who have difficulty passing urine, for example men with an enlarged prostate gland.
- People with an underactive thyroid gland (hypothyroidism).
- People with underactive adrenal glands, eg Addison’s disease.
- People with low blood pressure (hypotension) or shock.
- People with a condition involving abnormal muscle weakness called myasthenia gravis.
- People with a history of convulsions or fits, eg epilepsy.
- People with an irregular heartbeat (arrhythmia).
- People with a history of allergies.
- People with diseases affecting connective tissue, eg systemic lupus erythematosus.
- People with a history of drug abuse or dependence.
Can I take Nurofen plus while pregnant or breastfeeding?
- If you are pregnant or trying for a baby you should not use Nurofen plus without consulting your doctor first. This medicine is not recommended for use in pregnancy unless considered essential by your doctor. This is particularly important in the first and third trimesters. If codeine is used regularly in the third trimester it may cause withdrawal symptoms in the baby after birth. If used during labour it may cause breathing difficulties in the baby after birth. If ibuprofen is taken in the third trimester 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. Ask you doctor or midwife for further advice.
- Ibuprofen and codeine may pass into breast milk in amounts that are probably too small to be harmful in most people. However, because some people metabolise codeine in a slightly different way that can increase the risk of getting side effects from the medicine, it is recommended that women who are breastfeeding do not take codeine. It is impossible to predict which women and babies will metabolise codeine differently. Potential side effects in a nursing baby may include drowsiness or sedation, difficulty breastfeeding, vomiting, breathing difficulties and floppiness. If you are breastfeeding you should not take Nurofen plus.