PONAFEN SUSPENSION

Indications

• Mild to moderate pain relief
• Fever reduction
• Inflammatory conditions such as rheumatoid arthritis
• Osteoarthritis
• Dysmenorrhea
• Post-operative pain management

Dosage

Children: Refer to the BNF for Children for specific dosing information.

Adults: Refer to the BNF for specific dosing information.

Mechanism of action

Ibuprofen exerts its effects primarily through the inhibition of cyclooxygenase (COX) enzymes, which play a crucial role in the conversion of arachidonic acid to prostaglandins. By blocking COX-1 and COX-2, ibuprofen reduces the synthesis of prostaglandins, leading to decreased inflammation, pain sensation, and fever.

Pharmacodynamics

The pharmacological effects of ibuprofen include analgesia (pain relief), antipyresis (fever reduction), and anti-inflammatory effects. The onset of action for ibuprofen typically occurs within 30 minutes to 1 hour after oral administration, with peak plasma concentrations reached in about 1 to 2 hours. The duration of action is generally 4 to 8 hours, depending on the dose and formulation.

Pharmacokinetics

Ibuprofen is well absorbed from the gastrointestinal tract, with a bioavailability of approximately 80%. It is extensively metabolized in the liver, primarily via hydroxylation and carboxylation, and excreted in urine. The elimination half-life ranges from 1.8 to 2 hours. Ibuprofen is highly protein-bound (approximately 90-99%), which can influence its distribution and interactions with other medications.

Contra-indications

• Active or history of gastrointestinal bleeding
• Severe heart failure
• Severe renal impairment
• Hypersensitivity to ibuprofen or any excipient in the formulation
• Active peptic ulcer disease

Adverse effects

• Gastrointestinal disturbances (nausea, vomiting, diarrhea, constipation)
• Increased risk of cardiovascular events (myocardial infarction, stroke)
• Renal impairment
• Hepatotoxicity
• Skin reactions (rash, pruritus)
• Dizziness or headache
• Tinnitus

Interactions

• Increased risk of gastrointestinal bleeding with anticoagulants (e.g., warfarin)
• Potentially reduced antihypertensive effect with ACE inhibitors, diuretics, and beta-blockers
• Increased risk of nephrotoxicity with other NSAIDs or nephrotoxic medications
• May enhance the effect of other analgesics

Precautions

• Use cautiously in patients with a history of peptic ulcer disease or gastrointestinal disorders
• Monitor renal function in patients with existing renal impairment or dehydration
• Caution in patients with cardiovascular disease or at risk for cardiovascular events
• Avoid use in late pregnancy due to potential effects on fetal circulation

Pregnancy

Ibuprofen is not recommended during pregnancy, especially in the third trimester, due to risks of premature closure of the ductus arteriosus and potential for maternal and fetal complications.

Breast-feeding

Ibuprofen is excreted in breast milk in small amounts and is generally considered safe; however, caution is advised in nursing mothers, particularly at high doses.

Storage

Store in a cool, dry place, away from direct sunlight and out of reach of children.

Formulations

• Tablets
• Liquid suspension
• Topical gel
• Suppositories