Expressed disorders of liver and kidney function, blood diseases, deficiency of glucose-6-phosphate dehydrogenase, pregnancy, lactation (breastfeeding), hypersensitivity to sulfonamides and trimethoprim.
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What is the most important information I should know about Ibuprofen (Espadiva)?
This medicine may cause life-threatening heart or circulation problems such as heart attack or stroke, especially if you use it long term. Do not use Ibuprofen (Espadiva) just before or after heart bypass surgery (coronary artery bypass graft, or CABG).
Get emergency medical help if you have chest pain, weakness, shortness of breath, slurred speech, or problems with vision or balance.
This medicine may also cause serious effects on the stomach or intestines, including bleeding or perforation (forming of a hole). These conditions can be fatal and can occur without warning while you are taking Ibuprofen (Espadiva), especially in older adults.
Call your doctor at once if you have symptoms of stomach bleeding such as black, bloody, or tarry stools, or coughing up blood or vomit that looks like coffee grounds.
Do not take more of this medication than is recommended. An overdose of Ibuprofen (Espadiva) can cause damage to your stomach or intestines. Use only the smallest amount of Ibuprofen (Espadiva) needed to get relief from your pain, swelling, or fever.
Digestive system: nausea, vomiting, diarrhea, glossitis, pseudomembranous colitis, cholestatic hepatitis.
Allergic reactions: skin rash, angioedema, Stevens-Johnson syndrome, Lyell's syndrome.
Hemopoietic system: leukopenia, neutropenia, thrombocytopenia, agranulocytosis, megaloblastic anemia.
Urinary system: crystalluria, hematuria, interstitial nephritis.
Local reactions: phlebitis (when IV injected).
Other: purpura, impaired thyroid function.
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What are the possible side effects of Ibuprofen (Espadiva)?
The following serious adverse reactions are discussed in greater detail in other sections of the labeling:
Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be compared directly to rates in the clinical trials of another drug and may not reflect the rates observed in practice.
Adult PopulationDuring clinical development, 560 patients were exposed to Ibuprofen (Espadiva), 438 in pain and 122 with fever. In the pain studies, Ibuprofen (Espadiva) was started intra-operatively and administered at a dose of 400 mg or 800 mg every six hours for up to three days. In the fever studies, Ibuprofen (Espadiva) was administered at doses of 100 mg, 200 mg, or 400 mg every four or six hours for up to 3 days. The most frequent type of adverse reaction occurring with oral Ibuprofen (Espadiva) is gastrointestinal.
Pain StudiesThe incidence rates of adverse reactions listed in the following table were derived from multi-center, controlled clinical studies in post-operative patients comparing Ibuprofen (Espadiva) to placebo in patients also receiving morphine as needed for post-operative pain.
Table 1: Post-operative Patients with Adverse Reactions Observed in ≥ 3% of Patients in any Ibuprofen (Espadiva) Treatment Group in Pain Studies*
| Event | Ibuprofen (Espadiva) | Placebo (N=287) | |
| 400 mg (N=134) | 800 mg (N=304) | ||
| Any Reaction | 118 (88%) | 260 (86%) | 258 (90%) |
| Nausea | 77 (57%) | 161 (53%) | 179 (62%) |
| Vomiting | 30 (22%) | 46 (15%) | 50 (17%) |
| Flatulence | 10 (7%) | 49 (16%) | 44 (15%) |
| Headache | 12 (9%) | 35 (12%) | 31 (11%) |
| Hemorrhage | 13 (10%) | 13 (4%) | 16 (6%) |
| Dizziness | 8 (6%) | 13 (4%) | 5 (2%) |
| Edema peripheral | 1 ( < 1%) | 9 (3%) | 4 (1%) |
| Urinary retention | 7 (5%) | 10 (3%) | 10 (3%) |
| Anemia | 5 (4%) | 7 (2%) | 6 (2%) |
| Decreased hemoglobin | 4 (3%) | 6 (2%) | 3 (1%) |
| Dyspepsia | 6 (4%) | 4 (1%) | 2 ( < 1%) |
| Wound hemorrhage | 4 (3%) | 4 (1%) | 4 (1%) |
| Abdominal discomfort | 4 (3%) | 2 ( < 1%) | 0 |
| Cough | 4 (3%) | 2 ( < 1%) | 1 ( < 1%) |
| Hypokalemia | 5 (4%) | 3 ( < 1%) | 8 (3%) |
| * All patients received concomitant morphine during these studies. |
Fever studies were conducted in febrile hospitalized patients with malaria and febrile hospitalized patients with varying causes of fever. In hospitalized febrile patients with malaria, the adverse reactions observed in at least two Ibuprofen (Espadiva)-treated patients included abdominal pain and nasal congestion.
In hospitalized febrile patients (all causes), adverse reactions observed in more than two patients in any given treatment group are presented in the table below.
Table 2: Patients with Adverse Reactions Observed in ≥ 3% of Patients in any Ibuprofen (Espadiva) Treatment Group in All-Cause Fever Study
| Event | Ibuprofen (Espadiva) | Placebo N=28 | ||
| 100 mg N=30 | 200 mg N=30 | 400 mg N=31 | ||
| Any Reaction | 27 (87%) | 25 (83%) | 23 (74%) | 25 (89%) |
| Anemia | 5 (17%) | 6 (20%) | 11 (36%) | 4 (14%) |
| Eosinophilia | 7 (23%) | 7 (23%) | 8 (26%) | 7 (25%) |
| Hypokalemia | 4 (13%) | 4 (13%) | 6 (19%) | 5 (18%) |
| Hypoproteinemia | 3 (10%) | 0 | 4 (13%) | 2 (7%) |
| Neutropenia | 2 (7%) | 2 (7%) | 4 (13%) | 2 (7%) |
| Blood urea increased | 0 | 0 | 3 (10%) | 0 |
| Hypernatremia | 2 (7%) | 0 | 3 (10%) | 0 |
| Hypertension | 0 | 0 | 3 (10%) | 0 |
| Hypoalbuminemia | 3 (10%) | 1 (3%) | 3 (10%) | 1 (4%) |
| Hypotension | 0 | 2 (7%) | 3 (10%) | 1 (4%) |
| Diarrhea | 3 (10%) | 3 (10%) | 2 (7%) | 2 (7%) |
| Pneumonia bacterial | 3 (10%) | 1 (3%) | 2 (7%) | 0 |
| Blood LDH increased | 3 (10%) | 2 (7%) | 1 (3%) | 1 (4%) |
| Thrombocythemia | 3 (10%) | 2 (7%) | 1 (3%) | 0 |
| Bacteremia | 4 (13%) | 0 | 0 | 0 |
A total of 143 pediatric patients ages 6 months and older have received Ibuprofen (Espadiva) in controlled clinical trials. The most common adverse reactions (incidence greater than or equal to 2%) in pediatric patients treated with Ibuprofen (Espadiva) were infusion site pain, vomiting, nausea, anemia and headache.
Infectious-inflammatory diseases caused by sensitive to co-trimoxazole microorganisms: respiratory tract infections (including acute and chronic bronchitis, empyema, bronchiectasis, lung abscess, pneumonia, tonsillitis, pharyngitis); urinary tract infections (including gonococcal urethritis), cystitis, pyelonephritis, prostatitis; gastrointestinal infections (including enteritis, typhoid, paratyphoid, dysentery, cholecystitis, cholangitis); infections of skin and soft tissue (including pyoderma, furunculosis, wound infection), septicemia, brucellosis.
An indication is a term used for the list of condition or symptom or illness for which the medicine is prescribed or used by the patient. For example, acetaminophen or paracetamol is used for fever by the patient, or the doctor prescribes it for a headache or body pains. Now fever, headache and body pains are the indications of paracetamol. A patient should be aware of the indications of medications used for common conditions because they can be taken over the counter in the pharmacy meaning without prescription by the Physician.Carefully consider the potential benefits and risks of Ibuprofen (Espadiva)
Oral Suspension and other treatment options before deciding to use Ibuprofen (Espadiva). Use the lowest effective dose for the shortest duration consistent with individual patient treatment goals.
In Pediatric Patients, Ibuprofen (Espadiva)
Oral Suspension is indicated:In Adults, Ibuprofen (Espadiva)
Oral Suspension is indicated:Since there have been no controlled trials to demonstrate whether there is any beneficial effect or harmful interaction with the use of Ibuprofen (Espadiva) in conjunction with aspirin, the combination cannot be recommended.
Ibuprofen (Espadiva) is a nonsteroidal anti-inflammatory drug (NSAID) used to treat mild to moderate pain, and helps to relieve symptoms of arthritis (osteoarthritis, rheumatoid arthritis, or juvenile arthritis), such as inflammation, swelling, stiffness, and joint pain. Ibuprofen (Espadiva) does not cure arthritis and will help you only as long as you continue to take it.
In addition, Ibuprofen (Espadiva) can be used to treat fever, menstrual cramps, and other conditions as determined by your doctor.
Ibuprofen (Espadiva) is available both over-the-counter (OTC) and with your doctor's prescription.
Ibuprofen (Espadiva) is a member of the propionic acid group of nonsteroidal anti-inflammatory drugs (NSAIDs). It is a racemic mixture of [+]S- and [-]R-enantiomers.
The chemical name for Ibuprofen (Espadiva) is (±)-2-(4-isobutylphenyl) propionic acid. It has a molecular weight of 206.28 and a molecular formula of C13H18O2.
Ibuprofen (Espadiva) is a colorless, crystalline stable solid, with a melting point of 75-77°C. It is relatively insoluble in water but readily soluble in most organic solvents. Ibuprofen (Espadiva) has a pKa of 4.43±0.03 and an n-octanol/water partition coefficient of 11.7 at pH 7.4.
Ibuprofen (Espadiva) has shown analgesic, anti-inflammatory and antipyretic activity in both animal and human studies. These properties provide symptomatic relief of inflammation and pain.
Use Ibuprofen (Espadiva) capsules as directed by your doctor. Check the label on the medicine for exact dosing instructions.
Ask your health care provider any questions you may have about the proper use of Ibuprofen (Espadiva) capsules.
There are specific as well as general uses of a drug or medicine. A medicine can be used to prevent a disease, treat a disease over a period or cure a disease. It can also be used to treat the particular symptom of the disease. The drug use depends on the form the patient takes it. It may be more useful in injection form or sometimes in tablet form. The drug can be used for a single troubling symptom or a life-threatening condition. While some medications can be stopped after few days, some drugs need to be continued for prolonged period to get the benefit from it.Ibuprofen (Espadiva) is used to relieve pain from various conditions such as headache, dental pain, menstrual cramps, muscle aches, or arthritis. It is also used to reduce fever and to relieve minor aches and pain due to the common cold or flu. Ibuprofen (Espadiva) is a nonsteroidal anti-inflammatory drug (NSAID). It works by blocking your body's production of certain natural substances that cause inflammation. This effect helps to decrease swelling, pain, or fever.
If you are treating a chronic condition such as arthritis, ask your doctor about non-drug treatments and/or using other medications to treat your pain. See also Warning section.
This form of Ibuprofen (Espadiva) is intended for use by children. Do not give this medication to a child younger than 6 months unless directed by the doctor.
Check the ingredients on the label even if you have used the product before. The manufacturer may have changed the ingredients. Also, products with similar names may contain different ingredients meant for different purposes. Taking the wrong product could harm you.
How to use Ibuprofen (Espadiva)Read and follow all directions on the product package before using this medication. If you have any questions, ask your doctor or pharmacist.
Take this medication by mouth as directed by your doctor or the package label, usually every 6 to 8 hours as needed. Shake the bottle well before each dose. Carefully measure the dose using the provided dropper/syringe. Do not use a household spoon because you may not get the correct dose. If you have stomach upset while taking this medication, take it with food or milk.
The dosage is based on your medical condition and response to treatment. To reduce your risk of stomach bleeding and other side effects, take this medication at the lowest effective dose for the shortest possible time. Do not increase your dose or take this drug more often than directed by your doctor or the package label.
When Ibuprofen (Espadiva) is used by children, the dose is based on the child's weight. Read the package directions to find the proper dose for your child's weight. Consult the pharmacist or doctor if you have questions or if you need help choosing a nonprescription product.
If you are using this drug "as needed" (not on a regular schedule), remember that pain medications work best if they are used as the first signs of pain occur. If you wait until the pain has worsened, the medication may not work as well.
If your condition persists or worsens, or if you think you may have a serious medical problem, get medical help right away. If you are using the nonprescription product to treat yourself or a child for fever or pain, consult the doctor right away if fever worsens or lasts more than 3 days, or if pain worsens or lasts more than 10 days.
Individual. Doses of BS Xepa-Soul Pattinson are given on the basis of sulfamethoxazole. For oral administration for adults and children older than 12 years the average dose is 0.4-2 g every 12 hours (2 times / day), course of treatment - 5-14 days.
Orally for children aged 2-5 months - 100 mg 2 times / day; 1-2 years - 100 mg 2 times / day; 3-6 years - 200 mg 2 times / day; 6-12 years at 200-400 mg 2 times / day.
Parenterally administered only in the absence of the possibility of oral administration. IM for adults and children over 12 years - 800 mg every 12 hours; for children aged 6-12 years - 30 mg / kg / day, interval between each dose - 12 hours.
If necessary prescribed IV as drops at 0.8-1.6 g every 12 hours (2 times / day) within 5 days. For children aged 6-12 years are prescribed at 15 mg / kg every 12 hours. Average duration of BS Xepa-Soul Pattinson injection - 30-60 minutes but no more than 1.5 hours. The course of treatment is average 5 days, then if necessary go to oral administration. The maximum oral daily dose for adults is 3.6 g.
Recommended DoseA course of therapy is three doses of Ibuprofen (Espadiva) administered intravenously (administration via an umbilical arterial line has not been evaluated). An initial dose of 10 mg per kilogram is followed by two doses of 5 mg per kilogram each, after 24 and 48 hours. All doses should be based on birth weight. If anuria or marked oliguria (urinary output < 0.6 mL/kg/hr) is evident at the scheduled time of the second or third dose of Ibuprofen (Espadiva), no additional dosage should be given until laboratory studies indicate that renal function has returned to normal. If the ductus arteriosus closes or is significantly reduced in size after completion of the first course of Ibuprofen (Espadiva), no further doses are necessary. If during continued medical management the ductus arteriosus fails to close or reopens, then a second course of Ibuprofen (Espadiva), alternative pharmacological therapy, or surgery may be necessary.
Directions For UseFor intravenous administration only.
Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration whenever solution and container permit. Do not use Ibuprofen (Espadiva) if particulate matter is observed.
After the first withdrawal from the vial, any solution remaining must be discarded because Ibuprofen (Espadiva) contains no preservative.
For administration, Ibuprofen (Espadiva) should be diluted to an appropriate volume with dextrose or saline. Ibuprofen (Espadiva) should be prepared for infusion and administered within 30 minutes of preparation and infused continuously over a period of 15 minutes. The drug should be administered via the IV port that is nearest the insertion site. After the first withdrawal from the vial, any solution remaining must be discarded because Ibuprofen (Espadiva) contains no preservative.
Since Ibuprofen (Espadiva) is potentially irritating to tissues, it should be administered carefully to avoid extravasation.
Ibuprofen (Espadiva) should not be simultaneously administered in the same intravenous line with Total
Parenteral Nutrition (TPN). If necessary, TPN should be interrupted for a 15-minute period prior to and after drug administration. Line patency should be maintained by using dextrose or saline.
How suppliedDosage Forms And Strengths10 mg/mL as a clear sterile preservative-free solution of the L-lysine salt of Ibuprofen (Espadiva) in a 2 mL single-use vial.
Ibuprofen (Espadiva) (Ibuprofen (Espadiva) lysine) Injection is dispensed in clear glass single-use vials, each containing 2 mL of sterile solution (NDC 55292-122-52). The solution is not buffered and contains no preservatives. Each milliliter contains 17.1 mg/mL (±)-Ibuprofen (Espadiva) L-lysine [equivalent to 10 mg/mL (±)-Ibuprofen (Espadiva)] dissolved in Water for Injection, USP. Ibuprofen (Espadiva) is supplied in a carton containing 3 single-use vials.
Storage And HandlingStore at 20-25°C (68-77°F); excursions permitted 15-30°C (59-86°F). Protect from light. Store vials in carton until contents have been used.
Manufactured by: AAIPharma Services, Charleston, SC 29405, U.S.A. For: Recordati Rare Diseases Inc. Lebanon, NJ 08833, U.S.A. Revised: October 2015
With the simultaneous application of co-trimoxazole effect of anticoagulants of indirect action is greatly enhanced due to slow inactivation of the latter, as well as their release from binding with plasma proteins.
In an application with some sulfonylureas may increase hypoglycemic effect which is associated with an increased concentration of free fraction of co-trimoxazole.
The simultaneous use of co-trimoxazole and methotrexate may increase the toxicity of the latter (in particular to the appearance of pancytopenia) due to its release from binding to plasma proteins.
Influenced butadion, indomethacin, naproxen, salicylates and other NSAIDs may increase the action co-trimoxazole with the development of undesirable effects, since there release of active substances from binding with blood proteins and increase their concentration.
Simultaneous treatment with diuretics and co-trimoxazole increases the risk of thrombocytopenia caused by the latter especially in elderly patients.
In the case of co-administration chloridine with BS Xepa-Soul Pattinson antimicrobial effect is enhanced because chloridine inhibits the formation of tetrahydrofolic acid required for the synthesis of nucleic acids and proteins. In turn sulfonamides inhibit the formation of dihydrofolic acid, a precursor of tetrahydrofolic acid. This combination is widely used in the treatment of toxoplasmosis.
Absorption of sulfamethoxazole and trimethoprim at their joint reception with cholestyramine decreases the formation of insoluble complexes, which leads to a decrease in their concentration in the blood.
See also:
What other drugs will affect Ibuprofen (Espadiva)?
Coumarin-Type Anticoagulants: Several short-term controlled studies failed to wshow that Ibuprofen (Espadiva) significantly affected prothrombin times or a variety of other clotting factors when administered to individuals on coumarin-type anticoagulants. However, because bleeding has been reported when Ibuprofen (Espadiva) and other nonsteroidal anti-inflammatory agents have been administered to patients on coumarin-type anticoagulants, the physician should be cautious when administering Ibuprofen (Espadiva) to patients on anticoagulants.
Aspirin: Animal studies wshow that aspirin given with nonsteroidal anti-inflammatory agents, including Ibuprofen (Espadiva), yields a net decrease in anti-inflammatory activity with lowered blood levels of the non-aspirin drug. Single dose bioavailability studies in normal volunteers have failed to wshow an effect of aspirin on Ibuprofen (Espadiva) blood levels. Correlative clinical studies have not been performed.
Methotrexate: Ibuprofen (Espadiva), as well as other nonsteroidal anti-inflammatory drugs, probably reduces the tubular secretion of methotrexate based on in vitro studies in rabbit kidney slices. This may indicate that Ibuprofen (Espadiva) could enhance the toxicity of methotrexate. Caution should be used if Ibuprofen (Espadiva) is administered concomitantly with methotrexate.
H-2 Antagonists: In studies with human volunteers, co-administration of cimetidine or ranitidine with Ibuprofen (Espadiva) had no substantive effect on Ibuprofen (Espadiva) serum concentrations.
Furosemide: Clinical studies, as well as random observations, have shown that Ibuprofen (Espadiva) can reduce the natriuretic effect of furosemide and thiazides in some patients. This response has been attributed to inhibition of renal prostaglandin synthesis. During concomitant therapy with Ibuprofen (Espadiva), the patient should be observed closely for signs of renal failure, as well as to assure diuretic efficacy.
Lithium: Ibuprofen (Espadiva) produced an elevation of plasma lithium levels and a reduction in renal lithium clearance in a study of eleven normal volunteers. The mean minimum lithium concentration increased 15% and the renal clearance of lithium was decreased by 19% during this period of concomitant drug administration.
This effect has been attributed to inhibition of renal prostaglandin synthesis by Ibuprofen (Espadiva). Thus, when Ibuprofen (Espadiva) and lithium are administered concurrently, subjects should be observed carefully for signs of lithium toxicity. (Read circulars for lithium preparation before use of such concurrent therapy).
