4.1 Therapeutic indications
Brufen is indicated for its analgesic and anti-inflammatory effects in the treatment of rheumatoid arthritis
(including juvenile rheumatoid arthritis or Still's disease), ankylosing spondylitis, osteoarthritis and other
non-rheumatoid (seronegative) arthropathies.
In the treatment of non-articular rheumatic conditions, Brufen is indicated in periarticular conditions such
as frozen shoulder (capsulitis), bursitis, tendinitis, tenosynovitis and low back pain; Brufen can also be
used in soft tissue injuries such as sprains and strains.
Brufen is also indicated for its analgesic effect in the relief of mild to moderate pain such as
dysmenorrhoea, dental and post-operative pain and for symptomatic relief of headache, including
migraine headache.
Brufen antipyretic activity is effective in reducing fever.

 

Undesirable effects may be minimised by using the lowest effective dose for the shortest duration
necessary to control symptoms (see section 4.4).
Adults and children over 12 years of age : The recommended dosage of Brufen is 1200-1800 mg daily in
divided doses. Some patients can be maintained on 600-1200 mg daily. In severe or acute conditions, it
can be advantageous to increase the dosage until the acute phase is brought under control, provided
that the total daily dose does not exceed 2400 mg in divided doses.
In Juvenile Rheumatoid Arthritis, up to 40 mg/kg of body weight daily in divided doses may be
taken. Tablets are not suitable for children under the age of 12 years.
Elderly: The elderly are at increased risk of serious consequences of adverse reactions. If an NSAID is
considered necessary, the lowest effective dose should be used and for the shortest possible duration.
The patient should be monitored regularly for GI bleeding during NSAID therapy. If renal or hepatic
function is impaired, dosage should be assessed individually.
For oral administration. It is recommended that patients with sensitive stomachs take Brufen with food. If
taken shortly after eating, the onset of action of Brufen may be delayed. To be taken preferably with or
after food, with plenty of fluid. Brufen tablets should be swallowed whole and not chewed, broken,
crushed or sucked on to avoid oral discomfort and throat irritation.

Renal impairment:

Patients with mild to moderate renal impairment, (see section 4.4 – Special warnings and precautions for use) and patients with severe renal insufficiency (see section 4.3 – Contraindications)

Hepatic impairment:

For patients with mild to moderate hepatic impairment (see section 4.4 Special warnings and precautions for use) and patients with severe hepatic dysfunction (see section 4.3 - Contraindications).

Brufen is contraindicated in patients with hypersensitivity to the active substance or to any of the excipients. Brufen should not be used in patients who have previously shown hypersensitivity reactions (e.g. asthma, urticaria, angioedema or rhinitis) after taking ibuprofen, aspirin or other NSAIDs. Brufen is also contraindicated in patients with a history of gastrointestinal bleeding or perforation, related to previous NSAID therapy. Brufen should not be used in patients with active, or history of, recurrent peptic ulcer or gastrointestinal haemorrhage (two or more distinct episodes of proven ulceration or bleeding). Brufen should not be given to patients with conditions involving an increased tendency to bleeding. Brufen is contraindicated in patients with severe heart failure (NYHA Class IV), hepatic failure and renal failure (see section 4.4). Brufen is contraindicated during the last trimester of pregnancy (see section 4.6).

Undesirable effects may be minimised by using the lowest effective dose for the shortest duration
necessary to control symptoms (see section 4.2, and GI and cardiovascular risks below).
Brufen Tablets contain lactose monohydrate. Patients with rare hereditary problems of galactose intolerance, the Lapp lactose deficiency or glucosegalactose
malabsorption should not take this medication.

As with other NSAIDs, Brufen can mask symptoms of infection, which may lead to delayed initiation of appropriate treatment and thereby worsening the outcome of the infection. This has been observed in bacterial community acquired pneumonia and bacterial complications to varicella. When Brufen is administered for fever or pain relief in relation to infection, monitoring of infection is advised. In nonhospital settings, the patient should consult a doctor if symptoms persist or worsen.
The use of Brufen with concomitant NSAIDs, including cyclooxygenase-2 selective inhibitors, should be
avoided due to the increased risk of ulceration or bleeding (see section 4.5).

The diagnosis of medication overuse headache (MOH) should be suspected in patients who have frequent or daily headaches despite (or because of) the regular use of analgesic medication. Patients with medication overuse headache should not be treated by increasing the dose of the analgesic. In such cases the use of analgesics should be discontinued.

The concomitant consumption of excessive alcohol with NSAIDs, including ibuprofen may increase the risk of adverse effects on the gastrointestinal tract, such as GI haemorrhage or the central nervous system, possibly due to an additive effect.

Elderly
The elderly have an increased frequency of adverse reactions to NSAIDs, especially gastrointestinal
bleeding and perforation, which may be fatal (see section 4.2).
Paediatric population
There is a risk of renal impairment in dehydrated children and adolescents.
Gastrointestinal bleeding, ulceration and perforation
GI bleeding, ulceration or perforation, which can be fatal, has been reported with all NSAIDs at anytime
during treatment, with or without warning symptoms or a previous history of serious GI events.
The risk of GI bleeding, ulceration or perforation is higher with increasing NSAID doses, in patients with a
history of ulcer, particularly if complicated with haemorrhage or perforation (see section 4.3), and in the
elderly. These patients should commence treatment on the lowest dose available. Combination therapy
with protective agents (e.g. misoprostol or proton pump inhibitors) should be considered for these
patients, and also for patients requiring concomitant low dose aspirin, or other drugs likely to increase
gastrointestinal risk (see below and section 4.5).
Patients with a history of gastrointestinal disease, particularly when elderly, should report any unusual
abdominal symptoms (especially gastrointestinal bleeding) particularly in the initial stages of treatment.
Caution should be advised in patients receiving concomitant medications which could increase the risk of
ulceration or bleeding, such as oral corticosteroids, anticoagulants such as warfarin, selective serotoninreuptake
inhibitors or anti- platelet agents such as aspirin (see section 4.5).
When GI bleeding or ulceration occurs in patients receiving Brufen, the treatment should be withdrawn.
NSAIDs should be given with care to patients with a history of ulcerative colitis or Crohn's disease as these
conditions may be exacerbated (see section 4.8).
Respiratory disorders and hypersensitivity reactions Caution is required if Brufen is administered to patients suffering from, or with a previous history of,
bronchial asthma, chronic rhinitis or allergic diseases since NSAIDs have been reported to precipitate
bronchospasm, urticaria or angioedema in such patients.
Cardiac, renal and hepatic impairment
The administration of an NSAID may cause a dose dependent reduction in prostaglandin formation and
precipitate renal failure. The habitual concomitant intake of various similar painkillers further increases
this risk. Patients at greatest risk of this reaction are those with impaired renal function, cardiac
impairment, liver dysfunction, those taking diuretics and the elderly. For these patients, use the lowest
effective dose, for the shortest possible duration and monitor renal function especially in long-term
treated patients (see also section 4.3).

Brufen should be given with care to patients with a history of heart failure or hypertension since oedema
has been reported in association with ibuprofen administration.
Cardiovascular and cerebrovascular effects
Appropriate monitoring and advice are required for patients with a history of hypertension and/or mild to
moderate congestive heart failure as fluid retention and oedema have been reported in association with
NSAID therapy.
Clinical studies suggest that use of ibuprofen, particularly at a high dose (2400 mg/ day) may be
associated with a small increased risk of arterial thrombotic events such as myocardial infarction or
stroke. Overall, epidemiological studies do not suggest that low dose ibuprofen (e.g. ≤ 1200mg/day) is
associated with an increased risk of arterial thrombotic events.
Patients with uncontrolled hypertension, congestive heart failure (NYHA II-III), established ischaemic
heart disease, peripheral arterial disease, and/or cerebrovascular disease should only be treated with
ibuprofen after careful consideration and high doses (2400mg/day) should be avoided. Careful
consideration should also be exercised before initiating long-term treatment of patients with risk factors
for cardiovascular events (e.g. hypertension, hyperlipidaemia, diabetes mellitus, smoking), particularly if
high doses of ibuprofen (2400mg/day) are required.

Renal effects
Caution should be used when initiating treatment with ibuprofen in patients with considerable dehydration.

There is a risk of renal impairment especially in dehydrated children, adolescents and the elderly.
As with other NSAIDs, long-term administration of ibuprofen has resulted in renal papillary necrosis and
other renal pathologic changes. Renal toxicity has also been seen in patients in whom renal
prostaglandins have a compensatory role in the maintenance of renal perfusion. In these patients,
administration of an NSAID may cause a dose- dependant reduction in prostaglandin formation and,
secondarily, in renal blood flow, which may cause renal failure. Patients at greatest risk of this reaction are
those with impaired renal function, heart failure, liver dysfunction, those taking diuretics and ACE
inhibitors and the elderly. Discontinuation of NSAID therapy is usually followed by recovery to the pretreatment
state.
SLE and mixed connective tissue disease
In patients with systemic lupus erythematosus (SLE) and mixed connective tissue disorders there may be
an increased risk of aseptic meningitis (see below and section 4.8).

Sever skin reactions

Serious skin reactions, some of them fatal, including exfoliative dermatitis, Stevens-Johnson syndrome,
and toxic epidermal necrolysis, have been reported very rarely in association with the use of NSAIDs (see
section 4.8). Patients appear to be at highest risk of these reactions early in the course of therapy, the
onset of the reaction occurring within the first month of treatment in the majority of cases. Acute

generalised exanthematous pustulosis (AGEP) has been reported in relation to ibuprofen-containing products. Brufen should
be discontinued at the first appearance of skin rash, mucosal lesions, or any other sign of hypersensitivity.

In exceptional cases, varicella can be at the origin of serious cutaneous and soft tissues infectious complications. To date, the contributing role of NSAIDs in the worsening of these infections cannot be ruled out. Thus, it is advisable to avoid use of Ibuprofen in case of varicella.

Haematological effects
Ibuprofen, like other NSAIDs, can interfere with platelet aggregation and prolong bleeding time in normal
subjects.
Aseptic meningitis
Aseptic meningitis has been observed on rare occasions in patients on ibuprofen therapy. Although it is
probably more likely to occur in patients with systemic lupus erythematosus and related connective tissue
diseases, it has been reported in patients who do not have an underlying chronic disease.
Impaired female fertility
The use of Brufen may impair female fertility and is not recommended in women attempting to conceive.
In women who have difficulties conceiving or who are undergoing investigation of infertility, withdrawal of
Brufen should be considered.

Care should be taken in patients treated with any of the following drugs as interactions have been
reported in some patients.
Antihypertensives, beta-blockers and diuretics: NSAIDs may reduce the effect of anti-hypertensives, such
as ACE inhibitors, angiotensin-II receptor antagonists, beta-blockers and diuretics.
Diuretics can also increase the risk of nephrotoxicity of NSAIDs.
Cardiac glycosides: NSAIDs may exacerbate cardiac failure, reduce GFR and increase plasma cardiac
glycoside levels.
Cholestyramine; The concomitant administration of ibuprofen and cholestyramine may reduce the
absorption of ibuprofen in the gastrointestinal tract. However, the clinical significance is unknown.
Lithium: Decreased elimination of lithium.
Methotrexate: NSAIDs may inhibit the tubular secretion of methotrexate and reduce clearance of
methotrexate. Ciclosporin: Increased risk of nephrotoxicity.

Mifepristone: A decrease in the efficacy of the medicinal product can theoretically occur due to the
antiprostaglandin properties of NSAIDs. Limited evidence suggests that coadministration of NSAIDs on
the day of prostaglandin administration does not adversely influence the effects of mifepristone or the
prostaglandin on cervical ripening or uterine contractility and does not reduce the clinical efficacy of
medicinal termination of pregnancy.
Other analgesics and cyclooxygenase-2 selective inhibitors: Avoid concomitant use of two or more
NSAIDs, including Cox-2 inhibitors, as this may increase the risk of adverse effects (see section 4.4).
Aspirin (Acetylsalicylic acid): As with other products containing NSAIDs, concomitant administration of
ibuprofen and aspirin is not generally recommended because of the potential of increased adverse
effects.
Experimental data suggest that ibuprofen may competitively inhibit the effect of low dose aspirin on
platelet aggregation when they are dosed concomitantly. Although there are uncertainties regarding
extrapolation of these data to the clinical situation, the possibility that regular, long-term use of ibuprofen
may reduce the cardioprotective effect of low-dose acetylsalicylic acid cannot be excluded. No clinically
relevant effect is considered to be likely for occasional use (see section 5.1).
Corticosteroids: Increased risk of gastrointestinal ulceration or bleeding with NSAIDs (see section 4.4).
Anticoagulants: NSAIDs may enhance the effects of anticoagulants, such as warfarin (see section 4.4).
Quinolone antibiotics: Animal data indicate that NSAIDs can increase the risk of convulsions associated

with quinolone antibiotics. Patients taking NSAIDs and quinolones may have an increased risk of
developing convulsions.
Sulfonylureas: NSAIDs may potentiate the effects of sulfonylurea medications. There have been rare
reports of hypoglycaemia in patients on sulfonylurea medications receiving ibuprofen.
Anti-platelet agents and selective serotonin reuptake inhibitors (SSRIs): Increased risk of gastrointestinal
bleeding with NSAIDs (see section 4.4).
Tacrolimus: Possible increased risk of nephrotoxicity when NSAIDs are given with tacrolimus.
Zidovudine: Increased risk of haematological toxicity when NSAIDs are given with zidovudine. There is
evidence of an increased risk of haemarthroses and haematoma in HIV(+) haemophiliacs receiving
concurrent treatment with zidovudine and ibuprofen.
Aminoglycosides: NSAIDs may decrease the excretion of
aminoglycosides. Herbal extracts: Ginkgo biloba may potentiate the
risk of bleeding with NSAIDs.
CYP2C9 Inhibitors: Concomitant administration of ibuprofen with CYP2C9 inhibitors may increase the
exposure to ibuprofen (CYP2C9 substrate). In a study with voriconazole and fluconazole (CYP2C9
inhibitors), an increased S(+)- ibuprofen exposure by approximately 80 to 100% has been shown.
Reduction of the ibuprofen dose should be considered when potent CYP2C9 inhibitors are administered
concomitantly, particularly when high-dose ibuprofen is administered with either voriconazole or
fluconazole.

Pregnancy
Inhibition of prostaglandin synthesis may adversely affect the pregnancy and/or embryo/foetal
development. Data from epidemiological studies suggest an increased risk of miscarriage and of cardiac
malformation and gastroschisis after the use of a prostaglandin synthesis inhibitor in early pregnancy.
The risk is believed to increase with dose and duration of therapy. In animals, the administration of a
prostaglandin synthesis inhibitor has been shown to result in 

increased pre- and post-implantation losses and embryo/foetal lethality. In addition, increased incidences
of various malformations, including cardiovascular, have been reported in animals given a prostaglandin
synthesis inhibitor during the organogenetic period.
During the first and second trimester of pregnancy, Brufen should not be given unless clearly necessary.
If Brufen is used by a woman attempting to conceive, or during the first or second trimester of
pregnancy, the dose should be kept as low and duration of treatment as short as possible.
During the third trimester of pregnancy, all prostaglandin synthesis inhibitors may expose the foetus to the
following:
• Cardiopulmonary toxicity (with premature closure of the ductus arteriosus and pulmonary hypertension)
• Renal dysfunction, which may progress to renal failure with oligohydramnios.
At the end of pregnancy, prostaglandin synthesis inhibitors may expose the mother and the neonate to the
following:
• Possible prolongation of bleeding time
• Inhibition of uterine contractions, which may result in delayed or
prolonged labour. Consequently, Brufen is contraindicated during the
third trimester of pregnancy.

Lactation
In the limited studies so far available, NSAIDs can appear in the breast milk in very low concentrations.
NSAIDs should, if possible, be avoided when breastfeeding.
See section 4.4 Special warnings and precautions for use, regarding female fertility.

Undesirable effects such as dizziness, drowsiness, fatigue and visual disturbances are possible after
taking NSAIDs. If affected, patients should not drive or operate machinery.

Gastrointestinal disorders: The most commonly observed adverse events are gastrointestinal in nature.
Peptic ulcers, perforation or GI bleeding, sometimes fatal, particularly in the elderly, may occur (see
section 4.4). Nausea, vomiting, diarrhoea, flatulence, constipation, dyspepsia, abdominal pain, melaena,
haematemesis, ulcerative stomatitis, gastrointestinal haemorrhage and exacerbation of colitis and
Crohn's disease (see section 4.4) have been reported following ibuprofen administration. Less frequently,
gastritis, duodenal ulcer, gastric ulcer and gastrointestinal perforation have been observed.
Immune system disorders: Hypersensitivity reactions have been reported following treatment with
NSAIDs. These may consist of (a) non-specific allergic reaction and anaphylaxis, (b) respiratory tract
reactivity comprising asthma, aggravated asthma, bronchospasm or dyspnoea, or (c) assorted skin
disorders, including rashes of various types, pruritus, urticaria, purpura, angioedema and, very rarely,
erythema multiforme, bullous dermatoses (including Stevens- Johnson syndrome and toxic epidermal
necrolysis).
Cardiac disorders and vascular disorders: Oedema, hypertension and cardiac failure have been reported
in association with NSAID treatment. Clinical studies suggest that use of ibuprofen, particularly at high
dose (2400 mg/day) may be associated with a small increased risk of arterial thrombotic events such as
myocardial infarction or stroke (see section 4.4).
Infections and infestations: Rhinitis and aseptic meningitis (especially in patients with existing autoimmune
disorders, such as systemic lupus erythematosus and mixed connective tissue disease) with symptoms of
stiff neck, headache, nausea, vomiting, fever or disorientation (see section 4.4).
Exacerbation of infection-related inflammations coinciding with the use of NSAIDs has been described. If
signs of an infection occur or get worse during use of Ibuprofen the patient is therefore recommended to
go to a doctor without delay.
Skin and subcutaneous tissue disorders: In exceptional cases, severe skin infections and soft-tissue
complications may occur during a varicella infection (see also "Infections and infestations")

The following adverse reactions possibly related to ibuprofen and displayed by MedDRA frequency
convention and system organ classification. Frequency groupings are classified according to the
subsequent conventions: very common (≥1/10), Common (≥1/100 to <1/10), Uncommon (≥1/1,000 to
<1/100), Rare (≥1/10,000 to <1/1,000), Very rare (<1/10,000) and Not known (cannot be estimated from
the available data).

System organ class	Frequency	Adverse reaction
Infections and infestations	Uncommon	Rhinitis
	Rare	Meningitis aseptic
Blood and lymphatic system disorders	Rare	Leukopenia, thrombocytopenia, neutropenia, agranulocytosis, aplastic anaemia , haemolytic anaemia
Immune system disorders	Uncommon Rare	Hypersensitivity Anaphylactic reaction
Psychiatric disorders	Uncommon	Insomnia, anxiety
	Rare	Depression, confusional state
Nervous system disorders	Common	Headache, dizziness
	Uncommon	Paraesthesia, somnolence
	Rare	Optic neuritis
Eye disorders	Uncommon	Visual impairment
	Rare	Toxic optic neuropathy
Ear and labyrinth disorders	Uncommon	Hearing impaired , tinnitus, vertigo
Respiratory, thoracic and mediastinal disorders	Uncommon	Asthma, bronchospasm, dyspnoea
Gastrointestinal disorders	Common	Dyspepsia, diarrhoea, nausea, vomiting, abdominal pain, flatulence, constipation, melaena, haematemesis, gastrointestinal haemorrhage
	Uncommon	Gastritis, duodenal ulcer, gastric ulcer, mouth ulceration, gastrointestinal perforation
	Very rare	Pancreatitis
	Not known	Exacerbation of Colitis and Crohn´s disease
Hepatobiliary disorders	Uncommon	Hepatitis, jaundice, hepatic function abnormal
	Very Rare	Hepatic failure
Skin and subcutaneous tissue disorders	Common	Rash
	Uncommon	Urticaria, pruritus, purpura, angioedema, photosensitivity reaction
	Very rare	Severe forms of skin reactions ( e.g. Erythema multiforme, bullous reactions, including Stevens-Johnson syndrome,and toxic epidermal necrolysis)
	Not known	Drug reaction with eosinophilia and systemic symptoms (DRESS syndrome) Acute generalized exanthematous pustulosis (AGEP)
Renal and urinary disorders	Uncommon	Nephrotoxity in various forms e.g.Tubulointerstitial nephritis, nephrotic syndrome and renal failure
General disorders and administration site conditions	Common	Fatigue
	Rare	Oedema
Cardiac disorders	Very rare	Cardiac failure, myocardial infarction
Vascular disorders	Very rare	Hypertension

Reporting of suspected adverse reactions
Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows
continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are
asked to report any suspected adverse reactions.

To report any side effect(s):
-National Pharmacovigilance Center (NPC)
o Fax: +966-1-205-7662
o Call NPC at +966-11-2038222, Exts: 2317-2356-2353-2354-2334-2340.
o Toll free phone: 8002490000
o E-mail: npc.drug@sfda.gov.sa
o Website: www.sfda.gov.sa/npc

 

Toxicity
Signs and symptoms of toxicity have generally not been observed at doses below 100 mg/kg in children
or adults. However, supportive care may be needed in some cases. Children have been observed to
manifest signs and symptoms of toxicity after ingestion of 400 mg/kg or greater.
Symptoms
Most patients who have ingested significant amounts of ibuprofen will manifest symptoms within 4 to 6 hours.
The most frequently reported symptoms of overdose include nausea, vomiting, abdominal pain, lethargy
and drowsiness. Central nervous system (CNS) effects include headache, tinnitus, dizziness,
convulsion, and loss of consciousness. Nystagmus, metabolic acidosis, hypothermia, renal effects,
gastrointestinal bleeding, coma, apnoea, diarrhoea and depression of the CNS and respiratory system
have also been rarely reported. Disorientation, excitation, fainting and cardiovascular toxicity, including
hypotension, bradycardia and tachycardia have been reported. In cases of significant overdose, renal
failure and liver damage are possible. Large overdoses are generally well tolerated when no other drugs
are being taken.
Therapeutic measures
Patients should be treated symptomatically as required. Within one hour of ingestion of a potentially toxic
amount, activated charcoal should be considered. Alternatively, in adults, gastric lavage should be
considered within one hour of ingestion of a potentially life-threatening overdose.
Good urine output should be ensured.
Renal and liver function should be closely monitored.
Patients should be observed for at least four hours after ingestion of potentially toxic amounts.
Frequent or prolonged convulsions should be treated with intravenous diazepam. Other measures may
be indicated by the patient's clinical condition.

Pharmacotherapeutic classification: Anti-inflammatory and antirheumatic products, nonsteroidal;
propionic acid derivatives.
ATC code: M01AE01
Ibuprofen is a propionic acid derivative with analgesic, anti-inflammatory and anti-pyretic activity. The
drug's therapeutic effects as an NSAID is thought to result from its inhibitory effect on the enzyme cyclooxygenase,
which results in a marked reduction in prostaglandin synthesis.
Experimental data suggest that ibuprofen may competitively inhibit the effect of low dose aspirin on
platelet aggregation when they are dosed concomitantly. Some pharmacodynamic studies show that
when single doses of ibuprofen 400mg were taken within 8 hours before or within 30 minutes after
immediate release aspirin dosing (81mg), a decreased effect of aspirin on the formation of thromboxane
or platelet aggregation occurred. Although there are uncertainties regarding extrapolation of these data to the clinical situation, the possibility that
regular, long- term use of ibuprofen may reduce the cardioprotective effect of low-dose acetylsalicylic acid
cannot be excluded. No clinically relevant effect is considered to be likely for occasional ibuprofen use.
(see section 4.5)

Ibuprofen is rapidly absorbed from the gastrointestinal tract, peak serum concentrations occurring 1-2
hours after administration. The elimination half-life is approximately 2 hours.
Ibuprofen is metabolised in the liver to two inactive metabolites and these, together with unchanged
ibuprofen, are excreted by the kidney either as such or as conjugates. Excretion by the kidney is both
rapid and complete.
Ibuprofen is extensively bound to plasma proteins.

Not applicable.

6.1 List of excipients
Tablet core: Ibuprofen, Stearic acid, Maize starch, Aerosil 200, Maize starch dried, Pregelled maize starch, Core
Tablet Weight
Coating: Opaspray white M-1-7111B, Hydroxypropylmethylcellulose, Talc, Printing Ink: Opacode S-1-277001
Black

None.

36 months

Store below 25°C, store in the original package.

HDPE bottle – pack size 30 tablets.

None.