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Nurofen
View on WikipediaNurofen is a brand of range of pain-relief medication containing ibuprofen made by the English-Dutch company Reckitt Benckiser.[1] Introduced in 1983, the Nurofen brand was acquired following Reckitt Benckiser's acquisition of Boots healthcare international in 2005 for £1.93 billion, which included Nurofen, Strepsils, and Clearasil.[2] The brand is primarily marketed and sold in the United Kingdom,[1] other parts of Europe, South Africa, Australia and New Zealand. In 2016, it was the biggest selling branded over-the-counter medication sold in Great Britain, with sales of £116.8 million.[3]
Key Information
Variants
[edit]
There are 11 variants of Nurofen, all of which contain ibuprofen as an active ingredient.[4] The ibuprofen is variously formulated as the free acid, or the lysine salt. For oral formulations, i.e., taken by mouth, it is available in the conventional solid round tablet, a torpedo-shaped solid caplet, or may alternatively be in the form of a soft gel cap. It is also available as a topical gel, which is applied directly to the surface of the skin.[5] In some cases these are marketed as being useful for treating specific types of pain; such as back pain or period pain. The primary difference among the various formulations is speed and duration of ibuprofen absorption. According to the UK Medicines and Healthcare products Regulatory Agency (UK MHRA), the form of ibuprofen in 'Nurofen Tension Headache' (ibuprofen lysine) is absorbed nearly twice as fast as the form in 'Nurofen Period Pain' (ibuprofen free acid), with the former reaching peak blood concentrations in 38 minutes, compared to 80 minutes for the latter.[6]
Some variants of Nurofen contain additional active ingredients; for example, 'Nurofen Cold & Flu' contains the non-sedating decongestant pseudoephedrine. Others are advertised as being targeted for specific pain types, for example period pain.[1]
Nurofen Plus
[edit]Nurofen Plus is a pain relief medication based on codeine and ibuprofen.[7] It contains 12.8 mg of codeine phosphate (a mild opioid analgesic) and 200 mg of ibuprofen,[7] which is an NSAID. Nurofen Plus is the only product in the Nurofen range that contains codeine.
The original Nurofen Plus tablet was manufactured in two equal parts, joined, and then coated. One part contained 12.8 mg of codeine phosphate, and the other part contained 200 mg of ibuprofen. The tablets could be forcefully split into their two constituent active ingredients, thus isolating the codeine for recreational use. Such drugs have a potential for misuse because they are available freely to the public.[8]
2011 product recall
[edit]On 25 August 2011, it was reported that several packs of Nurofen Plus were found to contain Seroquel XR — an anti-psychotic drug used to treat schizophrenia — in Boots stores across London.[9][10][11] The next day, a safety alert was issued by the Medicines and Healthcare products Regulatory Agency (MHRA). Pharmacists were told to check each package of Nurofen Plus to look for anti-psychotic drugs. Three batches of Nurofen Plus were affected by the alert. Reckitt Benckiser, manufacturer of Nurofen Plus, said that it did not know where the drugs had been switched. The product was re-released in October in cellophane-sealed packs.[12]
Misleading advertising
[edit]Australia
[edit]In 2010, the Australian consumer advocate Choice awarded Nurofen a "Shonky award" for charging more for "targeted" products, all of which had the same active ingredient as the base product.[13]
In 2012, the Australian Therapeutic Goods Administration upheld a complaint that Nurofen's advertising of different products for different pain was "misleading or likely to be misleading", and ordered that "any representation that refers to two or more Nurofen products that contain equivalent quantities of ibuprofen and include the same product specific indications on the Australian Register of Therapeutic Goods must clearly indicate, in the body of the advertisement, that the two products can be used for the same purposes and are interchangeable (or words to that effect)".[14]
In April 2013, the Australian consumer affairs television programme The Checkout ran a story about Nurofen's claims about targeting specific pain. Edelman, the PR company for Reckitt Benckiser provided a statement, some of which was used in the programme. Included in the information provided by Edelman were photocopies of some 'sciencey looking documents' that confirmed that Ibuprofen was 'Non-selective'.[citation needed]
In March 2015, the Australian Competition & Consumer Commission (ACCC) launched proceedings against Reckitt Benckiser; for misleading advertising for its targeted pain range. In December 2015, the Federal Court of Australia found that Reckitt Benckiser, which makes Nurofen, had misled consumers with its "Nurofen Specific pain range", and ordered that all Nurofen specific pain products be removed from retail sale within three months.[15] A spokeswoman for Reckitt Benckiser argued that, "[This] specific-pain range" was intended "to help consumers navigate their pain relief options, particularly within the grocery environment where there is no healthcare professional to assist decision making".[16] The ACCC said that the products were found to be "no more effective at treating the type of pain described on its packaging than any of the other Nurofen specific pain products", and sold for almost twice the price.[17] Specific pain range painkillers include Nurofen Back Pain, Nurofen Period Pain, Nurofen Migraine Pain and Nurofen Tension; and all contain the "same active ingredient, 342 milligrams of ibuprofen lysine".[16]
In April 2016, the Federal Court imposed a $1.7 million fine on Reckitt Benckiser.[18] The ACCC appealed the decision in May arguing that $1.7 million in penalties did not act as an adequate deterrent for a company the size of Reckitt Benckiser.[19] In December 2016, the Federal Court increased the fine to $6 million, the highest corporate penalty ever awarded for misleading conduct under the Australian Consumer Law.[20]
United Kingdom
[edit]Following the 2015 Australian decision, the UK Advertising Standards Authority (ASA) said that it was investigating earlier complaints about a television advertisement for Nurofen Express, which was alleged to be misleading, as it implied that the medicine targeted muscles in the head.[21]
References
[edit]- ^ a b c "Chemistry in your cupboard - Nurofen, Introduction". RSC.org. Royal Society of Chemistry (RSC), Learning Science Ltd, Reckitt Benckiser and Presenting Science. Archived from the original on 27 August 2016. Retrieved 25 August 2016.
- ^ "Reckitt Benckiser buys Boots unit". 2005-10-07. Retrieved 2024-01-04.
- ^ "A breakdown of the over-the-counter medicines market in Britain in 2016". Pharmaceutical Journal. 28 April 2017. Retrieved 29 May 2017.
- ^ "Nurofen website". Nurofen.com. Retrieved 17 November 2011.
- ^ "Chemistry in your cupboard - Nurofen, Nurofen Gel - a topical formulation". RSC.org. Royal Society of Chemistry (RSC), Learning Science Ltd, Reckitt Benckiser and Presenting Science. Archived from the original on 27 August 2016. Retrieved 25 August 2016.
- ^ "MHRA Approval Summary" (PDF). Retrieved 5 August 2014.
- ^ a b The Medical Journal of Australia. Nurofen Plus misuse: an emerging cause of perforated gastric ulcer. Accessed 2 July 2009.
- ^ Chetty, R; Baoku, Y; Mildner, R; Banerjee, A; Vallance, D; Haddon, A; Labib, M (2003). "Severe hypokalaemia and weakness due to Nurofen misuse". Annals of Clinical Biochemistry. 40 (Pt 4): 422–3. doi:10.1258/000456303766477101. PMID 12880547. S2CID 22948582.
- ^ "Nurofen "sabotaged" across London". Bellenews.com. 26 August 2011. Retrieved 17 November 2011.
- ^ Adetunji, Jo (27 August 2011). "Nurofen Plus recalled as drug manufacturer suspects sabotage". The Guardian. London: Guardian.co.uk. Retrieved 17 November 2011.
- ^ "Nurofen Plus recalled amid sabotage fears". London: The Daily Telegraph. 26 August 2011. Archived from the original on 27 August 2011. Retrieved 17 November 2011.
- ^ "Nurofen Plus goes back on sale in tamper-proof packs". BBC News. BBC.co.uk. 29 September 2011. Retrieved 17 November 2011.
- ^ "Nurofen - Shonkys 2010 - CHOICE". 29 June 2016.
- ^ "Nurofen - Reckitt Benckiser (Australia)". tga.gov.au. 9 May 2014.
- ^ "Nurofen made misleading pain relief claims: Federal Court". abc.net.au. 14 December 2015.
- ^ a b Moore, Susan (14 December 2015). "Targeted painkillers zero in on one vital organ – the wallet". The Guardian. London. Retrieved 14 December 2015.
- ^ "Nurofen maker Reckitt Benckiser defends Australia packaging". BBC News. 14 December 2015. Retrieved 14 December 2015.
- ^ "Nurofen maker fined $1.7m for misleading customers on 'specific pain' relief range". ABC News. 29 April 2016. Archived from the original on 16 December 2016. Retrieved 16 December 2016.
- ^ Kozaki, Danuta (23 May 2016). "ACCC seeks $6m fine against Nurofen maker for misleading consumers". ABC News. Archived from the original on 16 December 2016. Retrieved 16 December 2016.
- ^ Cormack, Lucy (16 December 2016). "Nurofen fine for misleading consumers increased to $6 million". Sydney Morning Herald. Fairfax Media. Archived from the original on 16 December 2016. Retrieved 16 December 2016.
- ^ "Nurofen makers under investigation after court rules on misleading adverts". The Guardian. 15 December 2015. Retrieved 15 December 2015.
Nurofen
View on GrokipediaHistory and Development
Origins of Ibuprofen
Ibuprofen, chemically known as 2-(4-(2-methylpropyl)phenyl)propanoic acid, was synthesized in 1961 by a research team at the Boots Pure Drug Company Limited in Nottingham, England, led by pharmacologist Stewart Adams and chemist John Nicholson.[4][8] The effort stemmed from Boots' post-World War II initiatives to develop non-steroidal anti-inflammatory drugs (NSAIDs) as safer alternatives to aspirin and corticosteroids for treating rheumatoid arthritis, addressing limitations such as gastrointestinal irritation and steroid-related side effects.[9][10] Over the preceding decade, starting around 1953, Adams and Nicholson screened hundreds of arylpropionic acid derivatives, synthesizing more than 600 compounds in pursuit of efficacy comparable to phenylbutazone but with improved safety profiles.[4] The breakthrough compound emerged from systematic modifications to earlier arylacetic acids, with ibuprofen demonstrating potent anti-inflammatory activity in animal models, including carrageenan-induced rat paw edema tests, where it outperformed aspirin at equivalent doses.[8] Adams personally validated its tolerability by self-administering doses to alleviate a hangover prior to a 1960s conference presentation, confirming rapid absorption and absence of acute adverse effects, which bolstered confidence in proceeding to human trials.[9][11] A British patent application for the molecule was filed in 1961, granted in 1962, securing Boots' intellectual property for the synthesis process and therapeutic claims.[9] Initial clinical evaluations in the mid-1960s, including trials on rheumatoid arthritis patients in Edinburgh, affirmed ibuprofen's efficacy in reducing inflammation and pain, leading to its approval as a prescription medication in the United Kingdom in 1969 under the brand name Brufen.[4][12] A U.S. patent followed in 1966, enabling eventual global marketing, though widespread over-the-counter availability awaited patent expiration in 1985.[11][4] This development marked a pivotal advancement in NSAID pharmacology, grounded in empirical screening rather than theoretical modeling, and has since contributed to ibuprofen's status as one of the most prescribed analgesics worldwide.[8]Brand Launch and Ownership Changes
Nurofen, an over-the-counter ibuprofen-based analgesic, was first launched in 1983 by the British pharmaceutical company Boots as a consumer-accessible pain relief product following the deregulation of ibuprofen for non-prescription use.[3] This introduction marked a significant expansion of ibuprofen's availability beyond prescription-only status, with initial marketing emphasizing its efficacy for everyday pain management in markets including the United Kingdom and Australia.[13] Boots, which had originally developed ibuprofen in the 1960s under the prescription brand Brufen, positioned Nurofen to capitalize on growing demand for targeted relief from conditions like headaches and menstrual pain.[4] Ownership of the Nurofen brand transferred in 2005 when Reckitt Benckiser acquired Boots Healthcare International, the division encompassing Nurofen and other over-the-counter products, for £1.926 billion.[14] This deal, completed to bolster Reckitt Benckiser's portfolio in pain relief and consumer health, integrated Nurofen as a flagship brand alongside acquisitions like Strepsils, enhancing global distribution capabilities.[6] The acquisition reflected strategic consolidation in the consumer healthcare sector, with Nurofen contributing to Reckitt's emphasis on high-growth OTC analgesics. No subsequent major ownership changes have occurred, and the brand continues under Reckitt's management as of 2024.[15]Product Overview
Composition and Mechanism of Action
Nurofen formulations contain ibuprofen as the primary active ingredient, a non-steroidal anti-inflammatory drug (NSAID) chemically designated as 2-(4-(2-methylpropyl)phenyl)propanoic acid.[16] Standard tablet variants typically provide 200 mg or 400 mg of ibuprofen per dose, with excipients such as croscarmellose sodium, sodium lauryl sulphate, sodium citrate, and stearic acid aiding tablet integrity and dissolution.[1][17] Certain variants, such as Nurofen Express available in markets like the United Kingdom, use ibuprofen lysine (e.g., 684 mg equivalent to 400 mg ibuprofen) for faster absorption. Following oral administration, ibuprofen lysine dissociates to ibuprofen acid and lysine, with lysine having no recognized pharmacological activity.[18][19] Ibuprofen in Nurofen is the racemic mixture, consisting of equal parts of the active S-enantiomer and the less active R-enantiomer, which undergoes chiral inversion in vivo to contribute to therapeutic effects.[16] The mechanism of action of ibuprofen, and thus Nurofen, involves non-selective, reversible inhibition of the cyclooxygenase enzymes COX-1 and COX-2.[20] These enzymes catalyze the conversion of arachidonic acid to prostaglandin H2, a precursor to prostaglandins and thromboxanes that mediate pain signaling, inflammatory responses, and fever induction.[21] By reducing prostaglandin synthesis peripherally at sites of tissue injury and centrally in the hypothalamus, ibuprofen exerts analgesic, antipyretic, and anti-inflammatory effects; however, COX-1 inhibition also underlies gastrointestinal risks due to decreased protective mucosal prostaglandins.[22] This dual inhibition distinguishes ibuprofen from selective COX-2 inhibitors, contributing to its broad efficacy but also its side effect profile.[20]Approved Uses and Clinical Efficacy
Nurofen, a branded formulation of ibuprofen, is approved for the temporary relief of mild to moderate pain associated with conditions such as headache, migraine, tension headache, toothache, sore throat, dental pain, backache, period pain, muscular aches, rheumatic pain, and symptoms of colds or influenza, as well as for the reduction of fever in adults and children above specified age or weight thresholds depending on the jurisdiction and formulation.[23] [24] Specific pediatric formulations, such as Nurofen for Children Strawberry Baby (ibuprofen 100 mg/5 ml oral suspension), are approved in the United Kingdom for infants from 3 months of age weighing over 5 kg for the relief of pain and fever, including post-immunisation fever, teething, cold and flu symptoms, and minor aches.[25] Certain variants are indicated for reducing inflammation and swelling in mild arthritis.[23] In over-the-counter settings, such as under U.S. FDA labeling for ibuprofen products, it is authorized for minor aches and pains from arthritis, menstrual cramps, the common cold, muscular strains, and toothache, alongside fever reduction, with recommended doses of 200-400 mg every 4-6 hours not exceeding 1200 mg daily for adults.[26] Prescription-strength formulations address osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis.[20] Clinical trials and systematic reviews establish ibuprofen's efficacy as a nonsteroidal anti-inflammatory drug (NSAID) for symptomatic relief in acute pain, with 400 mg doses achieving at least 50% pain reduction in approximately 40-50% of patients, yielding a number needed to treat of about 2.7 compared to placebo in postoperative dental pain models.[27] Efficacy is dose-dependent up to 400 mg for acute nociceptive pain, with limited additional benefit from 600-800 mg, and it outperforms placebo in reducing pain intensity by 1-2 points on a 10-point visual analog scale within 1-2 hours post-administration.[27] In comparisons, 400 mg ibuprofen provides analgesia comparable to diclofenac 50 mg or acetaminophen 1000 mg plus codeine 60 mg for postoperative pain, though higher doses offer marginal gains.[28][29] For fever, ibuprofen 5-10 mg/kg reduces temperature more effectively than acetaminophen in children within 4-24 hours, with sustained antipyretic effects.[30] In dysmenorrhea and musculoskeletal injuries, randomized controlled trials confirm significant symptom reduction versus placebo, supporting its role in short-term management without altering underlying pathology.[31] Fast-dissolving formulations enhance onset speed, achieving peak analgesia faster than standard tablets while maintaining equivalent overall efficacy.[32]Safety and Side Effects
Nurofen, containing ibuprofen as its active ingredient, is generally well-tolerated at recommended doses for short-term use, with common side effects primarily involving the gastrointestinal tract, including dyspepsia, nausea, abdominal pain, and diarrhea.[20] These effects occur in approximately 5-15% of users and are often mild and self-limiting, though they can be mitigated by taking the medication with food.[33] Serious adverse effects, though less frequent, include gastrointestinal complications such as ulceration, bleeding, or perforation, with ibuprofen associated with a relative risk of approximately 2.7 for upper gastrointestinal events compared to non-use.[34] This risk increases with higher doses (e.g., above 1200 mg/day), prolonged duration exceeding 7 days, concurrent use of other NSAIDs or corticosteroids, and in patients with prior ulcer history or advanced age.[35] Cardiovascular risks, including myocardial infarction and stroke, are elevated particularly at high doses (e.g., 2400 mg/day), with meta-analyses indicating a dose-dependent increase in major vascular events similar to other traditional NSAIDs.[36] [37] Renal effects, such as acute kidney injury, are more pronounced in dehydrated individuals, those with pre-existing renal impairment, or the elderly, stemming from ibuprofen's inhibition of prostaglandin synthesis that impairs renal blood flow.[38] Rare hypersensitivity reactions, including asthma exacerbation in aspirin-sensitive patients and severe cutaneous adverse reactions like Stevens-Johnson syndrome, have been reported.[39] Contraindications include active peptic ulceration, severe heart failure, and known hypersensitivity to ibuprofen or other NSAIDs, while caution is advised in patients with uncontrolled hypertension, ischemic heart disease, or during the third trimester of pregnancy due to potential fetal renal and cardiovascular harm.[40] Overdose typically presents with gastrointestinal symptoms and central nervous system effects like drowsiness, but ibuprofen's therapeutic index allows for relatively safe management with supportive care, unlike more toxic analgesics.[20] In pediatric populations, ibuprofen demonstrates a favorable safety profile for fever and pain relief, with meta-analyses showing a 41% lower incidence of adverse events compared to alternatives like ketorolac in some contexts.[41] Overall, while effective, long-term use should be minimized, with monitoring for at-risk patients to balance benefits against these documented hazards.[42]Product Variants
Standard Ibuprofen Formulations
Nurofen's standard ibuprofen formulations are immediate-release oral products containing ibuprofen or its sodium salt as the sole active ingredient, without added analgesics or other therapeutic agents. These include film-coated tablets and liquid capsules, typically dosed at 200 mg ibuprofen equivalents for short-term symptomatic relief of mild to moderate pain and fever. In regions like France, standard Nurofen uses the regular ibuprofen acid form, similar to most standard ibuprofen products available in the USA.[43][44][1][45] The primary product, Nurofen 200 mg Tablets, contains 200 mg of ibuprofen per tablet, along with excipients such as 116.1 mg sucrose and 13.71 mg sodium. It is indicated for relief of migraines, backache, dental pain, neuralgia, period pain, rheumatic and muscular pain, and associated inflammation; it also reduces fever in cold and flu symptoms. For adults and adolescents aged 12-18 years, the recommended dosage is 1-2 tablets swallowed whole with water, up to three times daily with at least 4 hours between doses, not exceeding 6 tablets in 24 hours; use is limited to short-term treatment, with medical consultation advised if symptoms persist beyond 10 days in adults or 3 days in adolescents.[1] Nurofen Express formulations employ ibuprofen sodium dihydrate or ibuprofen lysine for enhanced solubility and faster gastrointestinal absorption compared to standard ibuprofen free acid forms, leading to quicker pain relief onset in clinical studies. Examples include Nurofen Express 256 mg Tablets, containing 256 mg ibuprofen sodium dihydrate (equivalent to 200 mg ibuprofen), Nurofen Express 684 mg Caplets containing 684 mg ibuprofen lysine (equivalent to 400 mg ibuprofen), and Nurofen Express 400 mg Liquid Capsules with 400 mg ibuprofen. These are suitable for similar indications as standard tablets, such as headache, period pain, and muscular aches, with comparable dosing guidelines adjusted for strength—typically 1 capsule or tablet up to three times daily for the 200 mg equivalent.[18][46][47][48]| Formulation | Active Ingredient Equivalent | Form | Absorption Profile |
|---|---|---|---|
| Nurofen 200 mg Tablets | 200 mg ibuprofen | Film-coated tablet | Standard immediate release |
| Nurofen Express 256 mg | 200 mg ibuprofen | Tablet or liquid capsule | Faster due to sodium salt |
| Nurofen Express 684 mg | 400 mg ibuprofen | Caplet | Faster due to lysine salt |
| Nurofen Express 400 mg | 400 mg ibuprofen | Liquid capsule | Faster due to sodium salt and liquid form[49][46] |
