Ibuprofen and codeine (Nurofen Plus)

1. About ibuprofen and codeine

You can buy ibuprofen and codeine combined as one medicine from pharmacies.

It's used to treat a range of aches and pains, including back pain, period pain, toothache, strains and sprains, and pain from arthritis.

It's usually taken when everyday painkillers, such as paracetamol, ibuprofen and aspirin alone, have not worked.

Each tablet normally contains 200mg of ibuprofen and 12.8mg of codeine.

2. Key facts

  • If you have bought combined ibuprofen and codeine from a pharmacy, do not use it for more than 3 days without talking to your doctor.
  • Always take the tablets with food or a drink of milk to reduce the chance of indigestion or stomach pain. Do not take it on an empty stomach.
  • The most common side effects are headaches, feeling dizzy and feeling sleepy.
  • It's possible to become addicted to combined ibuprofen and codeine, but this is rare if you're taking it to relieve pain and your doctor is reviewing your treatment regularly.
  • For strains and sprains, some doctors and pharmacists advise waiting 48 hours before taking combined ibuprofen and codeine, as ibuprofen may slow down healing. Speak to a pharmacist if you're unsure.
  • It's best not to drink alcohol when you're taking combined ibuprofen and codeine as you're more likely to get side effects like feeling sleepy.
  • Combined ibuprofen and codeine is also called by different brand names, including Nurofen Plus and Solpadeine Migraine.

3. Who can and can't take ibuprofen and codeine

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

Only give it to children aged 12 to 18 years old if painkillers like paracetamol and ibuprofen alone have not worked.

Important

Never give combined ibuprofen and codeine to children under 12 years old.

Combined ibuprofen and codeine is not suitable for some people.

Do not take this medicine if you:

To make sure combined ibuprofen and codeine is safe for you, speak to your pharmacist or doctor if you have:

  • had an allergic reaction to any other medicines in the past
  • asthma or another allergic illness
  • a head injury
  • adrenal gland problems
  • an illness that causes fits
  • had bleeding in your stomach, a stomach ulcer, or a hole (perforation) in your stomach
  • a health problem that means you have an increased chance of bleeding
  • liver problems, such as liver fibrosis, cirrhosis or liver failure
  • heart disease or severe heart failure
  • kidney failure
  • Crohn's disease or ulcerative colitis

Also tell your doctor or pharmacist if you:

  • are taking low dose daily aspirin (75mg)
  • regularly drink more than the maximum recommended amount of alcohol (14 units a week)

4. How and when to take it

Combined ibuprofen and codeine contains 200mg of ibuprofen and 12.8mg of codeine.

How much should I take?

Different brands have different doses, so it's important to read the instructions.

However, generally the normal dose for adults and children aged 12 years and older is 1 or 2 tablets every 4 to 6 hours.

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

How long should I take it for?

If you have bought combined ibuprofen and codeine from a pharmacy, do not use it for more than 3 days.

After 3 days talk to your pharmacist or doctor if you still have pain.

What if I forget to take it?

Take the missed dose as soon as you remember, unless it's almost time for your next dose. In this case, skip the missed dose and take your next dose as normal.

Never take a double dose to make up for a forgotten one.

What if I take too much?

Taking too much combined ibuprofen and codeine can be dangerous.

It can cause side effects, such as:

  • feeling very sleepy, sick or dizzy
  • finding it difficult to breathe or changes in your heart rate (slower or faster)
  • having black poo and blood in your vomit - a sign of bleeding in your stomach
  • becoming unconscious, if you take a lot

The amount of ibuprofen and codeine that can lead to an overdose varies from person to person.

Call your doctor straight away if you take too much ibuprofen and codeine by accident

If you need to go to the nearest hospital accident and emergency (A&E) department do not drive yourself - get someone else to drive you or call for an ambulance.

Take the box or leaflet inside the packet plus any remaining medicine with you.

5. 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 non-steroidal anti-inflammatory drugs (NSAIDs).

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.

Watch out for these painkillers in medicines you can buy from pharmacies - for example, cough and cold remedies such as Nurofen Cold & Flu or Beechams Powders.

Important

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

6. Side effects

Like all medicines, combined ibuprofen and codeine can cause side effects. But because you only take it for a very short time (up to 3 days), it's not common to get them.

Less common side effects happen in more than 1 in 1,000 people. These include:

  • headaches
  • feeling dizzy
  • feeling sleepy
  • constipation
  • feeling sick (nausea)
  • indigestion and heartburn (acid reflux)
  • diarrhoea or being sick (vomiting)
  • wind

Tell your doctor if these side effects bother you or don't go away.

Serious side effects

Stop taking the medicine and call a doctor straight away if you have:

  • black poo or blood in your vomit - these can be signs of bleeding in your stomach
  • swollen ankles, blood in your pee, or not peeing at all - these can be signs of a kidney problem
  • severe chest or stomach pain - these can be signs of a hole in your stomach or gut

Serious allergic reaction

In rare cases, it's possible to have a serious allergic reaction (anaphylaxis) to ibuprofen and codeine.

Contact a doctor straight away if:

  • you get a skin rash that may include itchy, red, swollen, blistered or peeling skin
  • you're wheezing
  • you get tightness in the chest or throat
  • you have trouble breathing or talking
  • your mouth, face, lips, tongue or throat start swelling

These are warning signs of a serious allergic reaction. A serious allergic reaction is an emergency.

These are not all the side effects of combined ibuprofen and codeine. For a full list, see the leaflet inside your medicines packet.

Information:

You can report any suspected side effect to the UK safety scheme.

7. How to cope with side effects

What to do about:

  • headaches - 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 don't go away or are severe.
  • feeling sleepy - do not drive or use tools or machinery if you're feeling drowsy. Do not drink any alcohol as this will make you feel more tired.
  • feeling dizzy - if you begin to feel dizzy, lie down so you don't 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 or use tools or machinery while you feel like this.
  • constipation - eat more high-fibre foods, 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 do some gentle exercise. Watch a short video on how to treat constipation.
  • feeling sick (nausea) - take ibuprofen and codeine with or just after a meal or snack. Feelings of sickness normally wear off after a few days. Talk to your doctor about taking an anti-sickness medicine if it carries on for longer.
  • indigestion and heartburn (acid reflux) - stop taking the medicine and speak to your pharmacist or doctor if it does not go away. 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 don't go away.
  • diarrhoea or being sick (vomiting) - drink plenty of water or other liquids if you have diarrhoea or you're being sick. Speak to a pharmacist if you have signs of dehydration, such as peeing less than usual or having dark, strong-smelling pee. Do not take any other medicines to treat diarrhoea or vomiting without speaking to a pharmacist or doctor.
  • wind - try not to eat foods that cause wind (like lentils, beans and onions). Eat smaller meals, eat and drink slowly, and exercise regularly. There are pharmacy medicines that can also help, such as simethicone.

8. Pregnancy and breastfeeding

Combined ibuprofen and codeine is not recommended during pregnancy and while breastfeeding. There are safer medicines you can take. Ask your doctor or pharmacist for advice.

In early pregnancy, codeine has been linked to some problems in unborn babies. If you take codeine at the end of pregnancy, there's a risk that your baby may get withdrawal symptoms when it's born. Your baby may also get breathing problems.

Ibuprofen may cause birth defects that could affect your baby's heart or blood vessels. There may also be a link between taking ibuprofen in early pregnancy and miscarriage.

For more information about how ibuprofen and codeine can affect you and your baby during pregnancy, read the Best Use of Medicines in Pregnancy (BUMP) leaflets on ibuprofen and codeine.

Ibuprofen and codeine while breastfeeding

It is not recommended that women take combined ibuprofen and codeine while breastfeeding.

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

However, ibuprofen alone is safe to take while breastfeeding.

Tell your doctor if you're:

  • trying to get pregnant
  • pregnant
  • breastfeeding

9. Cautions with other medicines

Ibuprofen and codeine don't mix well with some medicines.

Tell your doctor if you're taking these medicines before you start taking combined ibuprofen and codeine:

Mixing ibuprofen and codeine with herbal remedies and supplements

There's not enough research to know whether complementary medicines and herbal remedies are safe to take with combined ibuprofen and codeine.

Important

For safety, tell your doctor or pharmacist if you're taking any other medicines, including herbal remedies, vitamins or supplements.

10. Common questions

How do ibuprofen and codeine work?

Ibuprofen belongs to a group of medicines called non-steroidal anti-inflammatory drugs (NSAIDs). It works by reducing hormones that cause pain and swelling in the body.

Codeine is from a group of medicines called opiates, or narcotics. It works in the central nervous system and the brain to block pain signals to the rest of the body. It also reduces the anxiety and stress caused by pain.

When codeine blocks the pain, there are other unwanted effects - for example, slow or shallow breathing. It also slows down digestion, which is why codeine can cause constipation.

How long does combined ibuprofen and codeine take to work?

Combined codeine and ibuprofen works in 30 to 60 minutes and keeps on working for about 4 to 6 hours.

How long should I take ibuprofen and codeine tablets for?

If you have bought combined ibuprofen and codeine from a pharmacy, do not use it for more than 3 days. If your pain has not gone away, talk to your pharmacist or doctor.

Is it safe to take long term?

It's not recommended to take combined ibuprofen and codeine you have bought from a pharmacy for longer than 3 days.

If you take combined ibuprofen and codeine for a long time, your body can become tolerant to it. That means you need higher doses to control your pain.

For long-term conditions, this combination may not be the most appropriate medicine for you and you should speak to your doctor.

Can it cause stomach ulcers?

The ibuprofen in this medicine can cause ulcers in your stomach or gut, especially if you take it for a long time or in big doses. If you take it correctly and for short periods of time, the risk is very low.

Is it addictive?

Yes, taking combined ibuprofen and codeine regularly for a long time could make you addicted to the codeine in it.

But in reality, if you're taking it as a painkiller for short periods of time or under medical supervision, it's very unlikely you will get addicted to it.

People who take it as a recreational drug to get "high" are more likely to become addicted.

How will I know if I'm addicted?

If you're addicted to combined ibuprofen and codeine, you may find it difficult to stop taking it or feel you need to take it more often than necessary.

And if you stop taking ibuprofen and codeine suddenly, you may suffer from withdrawal symptoms. These include:

  • feeling agitated
  • feeling anxious
  • shaking
  • sweating

Talk to your doctor if you're worried about addiction.

How does combined ibuprofen and codeine compare with other painkillers?

Some painkillers work better than others for certain pains. For example, the best painkiller to ease your headache may not be the best one for your backache.

The ibuprofen in combined ibuprofen and codeine means it can be particularly effective for period pain, back pain, strains and sprains. However, sometimes doctors and pharmacists advise people to wait 48 hours after a strain or sprain before taking combined ibuprofen and codeine.

This is because ibuprofen may slow down healing. If you're unsure about taking it, speak to a pharmacist.

Combined ibuprofen and codeine should only be taken for short periods of no more than 3 days.

This means it may not be appropriate to use for longer term conditions unless your doctor prescribes it.

For these types of conditions, there are likely to be other more suitable alternatives.

Before taking combined ibuprofen and codeine, try taking paracetamol to see if that helps your pain. Paracetamol can relieve most types of pain.

Will recreational drugs affect it?

If you take recreational drugs, such as cannabis, cocaine and heroin, while you're taking combined ibuprofen and codeine, you're more likely to get the serious side effects of the codeine.

These include breathing difficulties, heart problems, fits, and even going into a coma.

Some recreational drugs, such as cannabis, also increase common codeine side effects such as sleepiness and dizziness.

Taking heroin while you're taking ibuprofen and codeine is especially dangerous. You're more likely to get all the side effects of the codeine, including addiction.

Speak to your doctor if you think you might take recreational drugs while taking ibuprofen and codeine.

Can I drink alcohol with it?

Drinking alcohol while you're taking combined ibuprofen and codeine can make you feel more sleepy or increase the risk of serious side effects.

It's best to stop drinking alcohol while taking combined ibuprofen and codeine.

If you do choose to drink and you feel sleepy, stop drinking alcohol until you finish taking this medicine.

Is there any food or drink I need to avoid?

You can eat and drink normally while taking combined ibuprofen and codeine.

In fact it's best to take ibuprofen and codeine with, or just after, a meal so it does not upset your stomach. Do not take it on an empty stomach.

Will combined ibuprofen and codeine affect my contraception?

Combined ibuprofen and codeine does not affect any contraceptives, including the contraceptive pill and the morning after pill.

Will it affect my fertility?

Ibuprofen tablets, in large doses or for a long time, can affect ovulation in women. That might make it more difficult for you to get pregnant. This is usually reversible when you stop taking ibuprofen.

Taking codeine can temporarily reduce fertility in men and women. If you take high doses of codeine for a long time, it can cause a health problem called hypogonadism.

Hypogonadism is where the body does not make enough sex hormones. This can make it more difficult for you to conceive.

If you're worried about combined ibuprofen and codeine and your fertility, talk to your doctor.

Can I drive or ride a bike?

Combined ibuprofen and codeine can make you feel sleepy or dizzy. If this happens to you, do not drive or ride a bike until you feel better.

Page last reviewed: 03/05/2018
Next review due: 03/05/2021