Ibuprofen and codeine

Combined ibuprofen and codeine is suitable for most adults, and children aged 12 years and over. Always check before taking it.

Combined ibuprofen and codeine is not suitable for some people. For example, check with your doctor if you have asthma or any other lung condition.

Combined ibuprofen and codeine comes as tablets that you take every 4 to 6 hours. Follow the instructions that come with your medicine.

Common side effects of ibuprofen and codeine include constipation and indigestion. More serious side effects can happen in rare cases.

It can cause problems to take ibuprofen and codeine with some other medicines, such as medicines used to treat nausea and vomiting.

Most adults and children aged 12 years and over can take combined ibuprofen and codeine.

However, it should only be taken if painkillers like paracetamol, ibuprofen or aspirin have not worked on their own. Do not give aspirin to anyone under 16 years old.

Combined ibuprofen and codeine is not suitable for some people.

Never give combined ibuprofen and codeine to children aged 11 years or under.

To make sure combined ibuprofen and codeine is safe for you, tell your pharmacist or doctor if you or your child:

• have ever had an allergic reaction to ibuprofen, aspirin or other NSAIDs (non-steroidal anti-inflammatory drugs), codeine or any other medicine
• are trying to get pregnant, already pregnant, or breastfeeding
• are 18 years old or under and have recently had your tonsils or adenoids taken out to treat a sleep problem called obstructive sleep apnoea
• have asthma, breathing problems or any other lung condition
• have a head injury or a condition where there is raised pressure in your head
• have adrenal gland problems
• have a condition that causes seizures or fits
• have ever had bleeding in your stomach, a stomach ulcer, or a hole (perforation) in your stomach
• have a health problem that means you have an increased chance of bleeding, such as haemophilia or thrombocytopenia
• have liver problems such as liver fibrosis, cirrhosis or liver failure
• have high blood pressure, heart disease or severe heart failure, or have ever had a stroke
• have kidney failure
• have Crohn's disease or ulcerative colitis
• regularly drink more than the maximum recommended amount of alcohol (14 units a week)
• often have constipation
• have a connective tissue disorder such as lupus (systemic lupus erythematosus)
• have low blood pressure (hypotension) or an underactive thyroid (hypothyroidism)
• have chickenpox

Combined ibuprofen and codeine contains 200mg of ibuprofen and 12.8mg of codeine in each tablet.

Different brands have different doses, so it's important to read the instructions that come with your medicine.

However, the usual dose for adults and children aged 12 years and over is 1 or 2 tablets, taken every 4 to 6 hours.

If you're not sure how much to take, talk to your pharmacist or doctor.

Do not take more than 6 combined ibuprofen and codeine tablets in 24 hours.

Swallow the tablets whole with a drink of water.

It's best to take it with, or just after, food or a drink of milk so it does not upset your stomach. Do not take it on an empty stomach.

These side effects of ibuprofen and codeine happen to more than 1 in 100 people. There are things you can do to help cope with them:

If you get headaches after taking combined ibuprofen and codeine, do not take any more and see if the headache goes away.

It might be better to try another painkiller, like paracetamol.

Talk to your doctor if the headaches do not go away or are severe.

If you begin to feel dizzy, lie down so you do not faint. If you feel dizzy when you stand up, try getting up very slowly or stay sitting down until you feel better. Do not drive, cycle or use tools or machinery while you feel like this.

Do not drive, cycle or use tools or machinery if you're feeling drowsy. Do not drink any alcohol as this will make you feel more tired.

Get more fibre into your diet, such as fresh fruit and vegetables and cereals. Try to drink several glasses of water or another non-alcoholic liquid each day. If you can, it may also help to increase your level of exercise.

Stick to simple meals and do not eat rich or spicy food. It might help to take your ibuprofen and codeine with or just after a meal or snack. Feelings of sickness normally wear off.

If you're being sick, try small, frequent sips of water to avoid dehydration. Signs of dehydration include peeing less than usual or having dark, strong-smelling pee.

Do not take any other medicines to treat vomiting without speaking to a pharmacist or doctor.

If you take the combined contraceptive pill or progestogen-only pill and you're being sick, your contraception may not protect you from pregnancy. Check the pill packet for advice.

Stop taking the medicine and see your doctor as soon as possible. If you need something to ease the discomfort, try taking an antacid, but do not put off speaking to your pharmacist or doctor if the symptoms do not go away.

Try not to eat foods that cause wind (like lentils, beans and onions). Eat smaller meals, eat and drink slowly, and exercise regularly if you can.

There are pharmacy medicines that can also help, such as charcoal tablets or simeticone.

Speak to a doctor or pharmacist if the advice on how to cope does not help and a side effect is still bothering you or does not go away.

While a short course of combined ibuprofen and codeine could be taken up to 20 weeks of pregnancy, other painkillers are likely to be more suitable.

Ibuprofen can affect your baby's circulation and amniotic fluid if you take it after 20 weeks, or for more than 2 to 3 days at a time.

Codeine can affect your baby, especially towards the end of pregnancy. Your baby may get used to having codeine and may have withdrawal symptoms when they're born. There is a slightly higher chance of your baby having breathing problems. These are usually temporary, but your baby may need to stay in hospital for extra monitoring.

Combined ibuprofen and codeine is not recommended during pregnancy. Other medicines are more suitable. Ask your doctor or pharmacist for advice.

Do not take combined ibuprofen and codeine if you're breastfeeding. Talk to your doctor or pharmacist, as they will be able to recommend a more suitable painkiller.

Small amounts of the codeine may get into breast milk and can cause breathing problems in your baby and make them feel sleepy.

However, it's OK to take ibuprofen on its own while breastfeeding.

There are some medicines that do not mix well with combined ibuprofen and codeine and can affect how well it works.

Check with your pharmacist or doctor if you're taking, or have recently had, any other medicines, including:

• anticoagulants, such as warfarin
• other anti-inflammatory painkillers, such as aspirin (including a daily low dose of 75mg), diclofenac, mefenamic acid or naproxen
• medicines for high blood pressure
• diuretic medicines, such as furosemide or spironolactone
• steroid medicines such as prednisolone
• antibiotics such as ciprofloxacin, levofloxacin, moxifloxacin, norfloxacin or ofloxacin
• antidepressants, such as citalopram, fluoxetine, fluvoxamine, paroxetine, sertraline or venlafaxine
• other antidepressants called monoamine oxidase inhibitors (MAOIs)
• methotrexate (a medicine for psoriasis and rheumatoid arthritis)
• lithium (a medicine for mental health problems)
• ciclosporin or tacrolimus, medicines used after a transplant and for the treatment of psoriasis
• zidovudine, a medicine to treat HIV
• other medicines that can make you sleepy, such as sleeping pills, tranquillisers, or medicines for anxiety
• medicines used to treat nausea and vomiting, such as domperidone or metoclopramide
• medicines for diarrhoea, such as loperamide (Imodium)
• cimetidine, a medicine used to treat stomach ulcers
• mifepristone, a medicine used for abortion

These are not all the medicines that may cause problems if you take them with combined ibuprofen and codeine. For a full list, see the leaflet inside your medicine packet.

Taking ibuprofen and codeine with other painkillers

It's safe to take combined ibuprofen and codeine with paracetamol.

Do not take combined ibuprofen and codeine with ibuprofen, aspirin or naproxen.

Ibuprofen, aspirin and naproxen belong to the same group of medicines called NSAIDs (non-steroidal anti-inflammatory drugs). If you take them together, the ibuprofen plus aspirin or naproxen may increase the chance of you getting side effects, like stomach ache, or serious issues such as stomach bleeds.

Many medicines you can buy from pharmacies have NSAIDs as ingredients. These include cough and cold remedies such as Nurofen Cold & Flu or Beechams Powders.

Before taking any other medicines, check the label to see if they contain codeine, ibuprofen, aspirin or other NSAIDs.