Ibuprofen and codeine (including Nurofen Plus)

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

It's used to treat a range of aches and pains, including:

It's usually taken when everyday painkillers, such as paracetamol, ibuprofen or aspirin, have not worked on their own.

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

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.

NHS coronavirus (COVID-19) advice

The Commission on Human Medicines has confirmed that there is no clear evidence that using ibuprofen to treat symptoms such as a high temperature can make coronavirus (COVID-19) worse.

You can take paracetamol or ibuprofen to treat the symptoms of COVID-19. We recommend that you try paracetamol first, it has fewer side effects than ibuprofen and is the safer choice for most people.

Always follow the instructions that come with your medicine.

Updated: 16 April 2020

  • If you buy combined ibuprofen and codeine from a pharmacy and your pain is not better after 3 days, it's important to ask your doctor for advice about ongoing pain relief.
  • It's possible to become addicted to the codeine in this medicine, if you take it for too long. Only take it when you need it for pain relief.
  • Do not take more than 6 combined ibuprofen and codeine tablets in 24 hours.
  • It's best to take your tablets with food or a drink of milk. You'll be less likely to get mild indigestion or stomach pain.
  • The most common side effects are indigestion, feeling sleepy and constipation.
  • It's best not to drink alcohol when you're taking combined ibuprofen and codeine. You're more likely to get side effects like feeling sleepy.

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

Only give it to a child or young person aged 12 to 17 years old if painkillers like paracetamol or ibuprofen alone have not worked.

Not suitable for young children

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

Combined ibuprofen and codeine is not suitable for some people. To make sure combined ibuprofen and codeine is safe for you, tell your pharmacist or doctor if you:

  • have ever had an allergic reaction to ibuprofen, other non-steroidal anti-inflammatories (NSAIDs), codeine or any other medicine
  • are trying to get pregnant, already pregnant, or breastfeeding
  • are 18 years old or under and have had your tonsils or adenoids taken out to treat a sleep problem called obstructive sleep apnoea
  • have asthma
  • have a head injury
  • 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 heart disease or severe heart failure
  • have kidney failure
  • have Crohn's disease or ulcerative colitis
  • regularly drink more than the maximum recommended amount of alcohol (14 units a week)

Follow the instructions that come with your medicine. This is particularly important because the codeine in combined ibuprofen and codeine can be addictive.

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

Dosage

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

However, generally the usual dose for adults and children aged 12 years and older 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.

Important

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

How long to take it for

If you have bought combined ibuprofen and codeine from a pharmacy, do not use it for more than 3 days. If you still have pain, talk to your pharmacist or doctor. It's important to ask them for advice about ongoing pain relief.

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 one 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 (it can become slower or faster)
  • becoming unconscious, if you take a lot

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

Contact 111 for advice now if:

  • you take too much ibuprofen and codeine

Call 111 or to to 111.nhs.uk.

If you need to go to A&E, 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.

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.

Many medicines you can buy from pharmacies list NSAIDs as ingredients. These include 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.

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), you're unlikely to have any side effects.

Common side effects

Talk to your pharmacist or doctor if these side effects bother you or do not go away:

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

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

Call 999 now if:

  • you have 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.

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

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 do not go away or are severe.
  • feeling sleepy – 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.
  • feeling dizzy – 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 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 increase your level of exercise. Watch a short video on how to treat constipation.
  • feeling or being sick – take ibuprofen and codeine with or just after a meal or snack. Feelings of sickness normally wear off. Talk to your doctor if it bothers you. Take small, frequent sips of water or squash if you're being sick 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.
  • 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 do not go away.
  • wind – 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 simethicone.

Ibuprofen and codeine during pregnancy

While a short course of combined ibuprofen and codeine could be taken up to 28 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 28 weeks, or for more than a few 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 risk of your baby having breathing problems. These are usually temporary, but your baby may need to stay in hospital for extra monitoring.

As a result, combined ibuprofen is not recommended during pregnancy. Other medicines are more suitable. Ask your doctor or pharmacist for advice.

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.

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

Ibuprofen and codeine do not 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. They are not tested in the same way as other medicines.