UK Public Assessment Report

Transcription

1 IBUPROFEN 200MG TABLETS (ibuprofen) PL 31308/ UK Public Assessment Report TABLE OF CONTENTS Lay Summary Page 2 Scientific discussion Page 3 Steps taken for assessment Page 11 Summary of Product Characteristics Page 12 Product Information Leaflet Page 19 Labelling Page 25 1

2 IBUPROFEN 200MG TABLETS (ibuprofen) PL 31308/ LAY SUMMARY The Medicines and Healthcare products Regulatory Agency (MHRA) granted Max Remedies Limited Marketing Authorisations (licences) for the medicinal product Ibuprofen 200mg Tablets (PL 31308/ ) on 23 rd December The products are available in numerous pack sizes and presentations. Pack sizes of up to and including 16 tablets are available on the General Sales List (GSL), and can be purchased at pharmacies, supermarkets and other retail outlets without the supervision of a pharmacist. Pack sizes of greater than 16 tablets are P licensed medicines available only from pharmacies, under the supervision of a pharmacist. Ibuprofen belongs to a group of medicines called non-steroidal anti-inflammatory medicines, which act to relieve pain and reduce swelling. It can be used to relieve headaches, rheumatic and muscular pain, backache, migraine, period pain, dental pain and neuralgia. It can also be used to reduce fever and relieve the symptoms of colds and flu. The licences 31308/0015 and 0017 are P licensed products and can also used to treat pain of non-serious arthritic conditions. These applications are duplicates of previously granted applications for Nurofen Tablets 200mg (PL 00014/0650) and Boots Ibuprofen 200mg tablets (PL 00014/0655), held by The Boots Company plc. The test and reference products are identical. No new or unexpected safety concerns arose from these simple applications and it was therefore judged that the benefits of taking Ibuprofen 200mg Tablets outweigh the risks; hence Marketing Authorisations have been granted. 2

3 IBUPROFEN 200MG TABLETS (ibuprofen) PL 31308/ SCIENTIFIC DISCUSSION TABLE OF CONTENTS Introduction Page 4 Pharmaceutical assessment Page 5 Preclinical assessment Page 8 Clinical assessment Page 9 Overall conclusion and risk benefit assessment Page 10 3

4 INTRODUCTION Based on the review of the data on quality, safety and efficacy, the MHRA granted Max Remedies Limited Marketing Authorisations (MAs) for the medicinal product Ibuprofen 200mg Tablets (PL 31308/ ) on 23 rd December This product is indicated for the relief of pain and to reduce swelling. It can be used to relieve headaches, rheumatic and muscular pain, backache, migraine, period pain, dental pain and neuralgia. It can also be used to reduce fever and relieve the symptoms of colds and flu. The licences 31308/0015 and 0017 are P licensed products and are additionally indicated in the treatment of pain of non-serious arthritic conditions. The applications were submitted as simple abridged informed consent applications according to article 10c of Directive 2001/83/EC (as amended). PL 31308/0013 crossrefers to Nurofen Tablets 200mg (PL 00014/0650), held by The Boots Company plc, and approved on 23 rd September 2004, through a Change of Ownership application of the original product, Nurofen (Crookes Healthcare Limited, granted 06/05/1983). PLs 31308/ cross-refer to Boots Ibuprofen 200mg Tablets (PL 00014/0655), held by The Boots Company plc, and approved on 15 th November 2004, through a Change of Ownership application of the original product, Nurofen (Crookes Healthcare Limited, granted 06/05/1983). The products are available in numerous pack sizes. Pack sizes of up to and including 16 tablets are classified as GSL. Pack sizes of greater than 16 tablets are P licensed. Ibuprofen is a propionic acid derivative NSAID that has demonstrated its efficacy by inhibition of prostaglandin synthesis. In humans ibuprofen reduces inflammatory pain, swellings and fever. Furthermore, ibuprofen reversibly inhibits platelet aggregation. Ibuprofen is rapidly absorbed following administration and is rapidly distributed throughout the whole body. The excretion is rapid and complete via the kidneys. Maximum plasma concentrations are reached 45 minutes after ingestion if taken on an empty stomach. When taken with food, peak levels are observed after 1 to 2 hours. These times may vary with different dosage forms. The half-life of ibuprofen is about 2 hours. In limited studies, ibuprofen appears in the breast milk in very low concentrations. No new data were submitted nor was it necessary for these simple applications, as the data are identical to that of the previously granted cross-reference product. As the cross-reference product was granted prior to the introduction of current legislation, no PAR was generated for it. The pharmacovigilance system as described by the applicant fulfils the requirements and provides adequate evidence that the applicant has the services of a qualified person responsible for pharmacovigilance and has the necessary means for the notification of any adverse reaction suspected of occurring either in the Community or in a third country. The marketing authorisation holder has provided adequate justification for not submitting a Risk Management Plan (RMP) and Environmental Risk Assessment (ERA). 4

5 PHARMACEUTICAL ASSESSMENT LICENCE NUMBER: PL 31308/ PROPRIETARY NAME: ACTIVE INGREDIENT/S: COMPANY NAME: E.C. ARTICLE: LEGAL STATUS: 1. INTRODUCTION Ibuprofen 200mg Tablets ibuprofen Max Remedies Limited Article 10c of Directive 2001/83/EC (as amended) GSL / P depending on pack size These are simple abridged applications, submitted under Article 10c of Directive 2001/83/EC (as amended) for Ibuprofen 200mg Tablets. The proposed MA holder is Max Remedies Ltd, Stoney Gate House, 2 Greenfield Road, Holmfirth, West Yorkshire, HD9 2JT. The reference products are Nurofen Tablets 200mg (PL 00014/0650) and Boots Ibuprofen 200mg tablets (PL 00014/0655), held by The Boots Company plc. The test and reference products are identical. 2. MARKETING AUTHORISATION APPLICATION FORM 2.1 Name(s) The proposed name of the product is Ibuprofen 200mg Tablets. The product has been named in line with current requirements. 2.2 Strength, pharmaceutical form, route of administration, container and pack sizes The tablets are marketed in different pack sizes and presentations for the different licences. For PL 31308/0013, 0014, and 0016, the tablets are marketed in PVCaluminium foil blister strips, which are packaged with the Patient Information Leaflet (PIL) into cardboard outer cartons in pack sizes of 2, 4, 6, 8, 12, and 16 tablets. For PL 31308/0015 and 0017, the tablets are marketed in PVC-aluminium foil blister strips, which are packaged with the Patient Information Leaflet (PIL) into cardboard outer cartons in pack sizes of 2, 4, 6, 8, 12, 16, 24, and 48 tablets; the tablets are also presented in white High Density Polyethylene (HDPE) bottles fitted with child resistant caps in pack sizes of 96 tablets. The proposed shelf-life (36 months) and storage conditions (PVC/aluminium blisters - Do not store above 25 C ; HDPE bottle This medicinal product does not require any special storage conditions ) are consistent with the details registered for the crossreference product. 5

6 2.3 Legal status Pack sizes of up to and including 16 tablets are available on the General Sales List (GSL), and can be purchased at pharmacies, supermarkets and other retail outlets without the supervision of a pharmacist. PLs 31308/0013, 0014 and 0016 are GSL medicines. Pack sizes of greater than 16 tablets are P licensed medicines available only from pharmacies, under the supervision of a pharmacist. PLs 31308/0015 and 0017 are P medicines. 2.4 Marketing authorisation holder / Contact Persons / Company The proposed Marketing Authorisation holder is Max Remedies Ltd, Stoney Gate House, 2 Greenfield Road, Holmfirth, West Yorkshire, HD9 2JT. The QP responsible for pharmacovigilance is stated and their CV is included. 2.5 Manufacturers The proposed manufacturing site is consistent with that registered for the crossreference product and evidence of GMP compliance has been provided. 2.6 Qualitative and quantitative composition The proposed composition is consistent with the details registered for the crossreference product. 2.7 Manufacturing process The proposed manufacturing process is consistent with the details registered for the cross-reference product and the maximum batch size is stated. 2.8 Finished product / shelf-life specification The proposed finished product specification is in line with the details registered for the cross-reference product. 2.9 Drug substance specification The proposed drug substance specification is consistent with the details registered for the cross-reference product TSE Compliance The only excipient used that contains material of animal or human origin is stearic acid. Appropriate assurances have been provided confirming the acceptability of this excipient. 6

7 3. EXPERT REPORTS Satisfactory expert reports and curriculum vitae of experts are provided. 4. PRODUCT NAME & APPEARANCE See 2.1 for details of the proposed product name. The appearance of the product (white, circular sugar-coated tablets marked B200 on one side) is consistent with that of the cross-reference product. 5. SUMMARY OF PRODUCT CHARACTERISTICS (SmPC) The approved SmPCs are consistent with the details registered for the cross-reference product. 6. PATIENT INFORMATION LEAFLET (PIL) / CARTON PIL The patient information leaflets have been prepared in the user tested format and in line with the details registered for the cross-reference product. The approved PILs are satisfactory. Carton and bottle label Colour mock-ups of the labelling have been provided and are satisfactory. The approved artwork is comparable to the artwork registered for the cross-reference product and complies with statutory requirements. The applicant has included the name of the product in Braille on the outer packaging. 7. CONCLUSIONS The grounds for these applications are considered adequate. Marketing Authorisations were, therefore, granted. 7

8 PRECLINICAL ASSESSMENT The applications were submitted as simple abridged applications according to article 10c of Directive 2001/83/EC (as amended). No new preclinical data have been supplied with these applications and none are required for applications of this type. A preclinical expert report has been written by a suitably qualified person and is satisfactory. 8

9 CLINICAL ASSESSMENT The applications were submitted as simple abridged applications according to article 10c of Directive 2001/83/EC (as amended). As these are duplicate applications for PL 00014/0650 and 0655, no new clinical data have been supplied with the applications and none are required. A clinical expert report has been written by a suitably qualified person and is satisfactory. 9

10 OVERALL CONCLUSION AND RISK BENEFIT ASSESSMENT QUALITY The data for these applications are consistent with that previously assessed for the cross-reference product and as such has been judged to be satisfactory. PRECLINICAL No new preclinical data were submitted and none are required for applications of this type. EFFICACY These applications are identical to the previously granted application for Nurofen Tablets 200mg and Boots Ibuprofen 200mg Tablets (PL 00014/0650 and 0655, The Boots Company plc). No new or unexpected safety concerns arise from these applications. PRODUCT LITERATURE The approved SmPCs, PILs and labelling are satisfactory and consistent with those of the cross-reference product. Package leaflets have been submitted to the MHRA along with results of consultations with target patient groups ("user testing"), in accordance with Article 59 of Council Directive 2001/83/EC. The results indicate that the package leaflets are well-structured and organised, easy to understand and written in a comprehensive manner. The testing shows that patients/users are able to act upon the information that the leaflets contain. Colour mock-ups of the labelling have been provided and are satisfactory. The approved labelling artwork complies with statutory requirements. The name of the product in Braille appears on the outer packaging. RISK BENEFIT ASSESSMENT The quality of the product is acceptable and no new preclinical or clinical safety concerns have been identified. The applicant s product is identical to the crossreference product. The risk: benefit is considered to be positive. 10

11 IBUPROFEN 200MG TABLETS (ibuprofen) PL 31308/ STEPS TAKEN FOR ASSESSMENT 1 The MHRA received the marketing authorisation applications on 11 th July Following standard checks and communication with the applicant the MHRA considered the applications valid on 17 th July Following assessment of the applications the MHRA requested further information relating to the quality dossier on 9 th September 2008 and 11 th October The applicant responded to the MHRA s requests, providing further information for the quality sections on 7 th November 2008 and 17 th November 2009 respectively 5 The applications were determined on 21 st December 2009 and granted on 23 rd December

12 SUMMARY OF PRODUCT CHARACTERISTICS The UK Summary of Product Characteristics (SmPC) for Ibuprofen 200mg Tablets is as follows. Differences between the individual SmPCs are highlighted. 1 NAME OF THE MEDICINAL PRODUCT Ibuprofen 200mg Tablets 2 QUALITATIVE AND QUANTITATIVE COMPOSITION Ibuprofen 200mg 3 PHARMACEUTICAL FORM Tablet White, circular, sugar-coated tablets marked B200 on one side. For a full list of excipients, see section CLINICAL PARTICULARS 4.1 Therapeutic indications For PL 31308/0013, 0014, 0016 Adults, elderly and children over 12 years Rheumatic or muscular pain, backache, neuralgia, migraine, headache, dental pain, dysmenorrhoea, feverishness, symptoms of colds and influenza. For PL 31308/0015, 0017 Rheumatic or muscular pain, pain of non-serious arthritic conditions, backache, neuralgia, migraine, headache, dental pain, dysmenorrhoea, feverishness, symptoms of colds and influenza. 4.2 Posology and method of administration For oral administration and short-term use only. Adults, elderly and children over 12 years The lowest effective dose should be used for the shortest duration necessary to relieve symptoms. The patient should consult a doctor if symptoms persist or worsen, or if the product is required for more than 10 days. Initial dose two tablets (400mg) taken with water, then if necessary, one or two tablets ( mg) every 4 hours. Leave at least four hours between doses and do not take more than six tablets (1200mg) in any 24 hour period. Children under 12 years Not suitable for children under 12 years. 4.3 Contraindications Hypersensitivity to ibuprofen or any of the excipients in the product. Patients who have previously shown hypersensitivity reactions (e.g. asthma, rhinitis, angioedema, or urticaria), in response to aspirin or other non-steroidal anti-inflammatory drugs. 12

13 Active or history of recurrent peptic ulcer/haemorrhage (two or more distinct episodes of proven ulceration or bleeding). History of gastrointestinal bleeding or perforation, related to previous NSAIDs therapy. Severe heart failure, renal failure or hepatic failure (see section 4.4). Last trimester of pregnancy (see section 4.6). Contains sucrose: patients with rare hereditary problems of fructose intolerance, glucosegalactose malabsorption or sucrase-isomaltase insufficiency should not take this medicine. 4.4 Special warnings and precautions for use Undesirable effects may be minimised by using the lowest effective dose for the shortest duration necessary to control symptoms (see GI and cardiovascular risks below). The elderly have an increased frequency of adverse reactions to NSAIDs especially gastrointestinal bleeding and perforation which may be fatal. Respiratory: Bronchospasm may be precipitated in patients suffering from or with a previous history of bronchial asthma or allergic disease. Other NSAIDs: The use of ibuprofen with concomitant NSAIDs including cyclo-oxygenase-2 selective inhibitors should be avoided (see section 4.5). SLE and mixed connective tissue disease: Systemic lupus erythematosus and mixed connective tissue disease - increased risk of aseptic meningitis (see section 4.8). Renal: Renal impairment as renal function may further deteriorate (see sections 4.3 and 4.8). Hepatic: Hepatic dysfunction (see sections 4.3 and 4.8). Cardiovascular and cerebrovascular effects: Caution (discussion with doctor or pharmacist) is required prior to starting treatment in patients with a history of hypertension and/or heart failure as fluid retention, hypertension and oedema have been reported in association with NSAID therapy. Clinical trial and epidemiological data suggest that use of ibuprofen, particularly at high doses (2400mg daily) and in long-term treatment may be associated with a small increased risk of arterial thrombotic events (for example myocardial infarction or stroke). Overall, epidemiological studies do not suggest that low dose ibuprofen (e.g. 1200mg daily) is associated with an increased risk of myocardial infarction. Impaired female fertility: There is limited evidence that drugs which inhibit cyclo-oxygenase/prostaglandin synthesis may cause impairment of female fertility by an effect on ovulation. This is reversible upon withdrawal of treatment. Gastrointestinal: NSAIDs should be given with care to patients with a history of gastrointestinal disease (ulcerative colitis, Crohn s disease) as these conditions may be exacerbated (see section 4.8). GI bleeding, ulceration or perforation, which can be fatal, has been reported with all NSAIDs at anytime during treatment, with or without warning symptoms or a previous history of serious GI events. The risk of GI bleeding, ulceration or perforation is higher with increasing NSAID doses, in patients with a history of ulcer, particularly if complicated with haemorrhage or perforation (see section 4.3), and in the elderly. These patients should commence treatment on the lowest dose available. 13

14 Patients with a history of GI toxicity, particularly when elderly, should report any unusual abdominal symptoms (especially GI bleeding) particularly in the initial stages of treatment. Caution should be advised in patients receiving concomitant medications which could increase the risk of ulceration or bleeding, such as oral corticosteroids, anticoagulants such as warfarin, selective serotonin-reuptake inhibitors or anti-platelet agents such as aspirin (see section 4.5). When GI bleeding or ulceration occurs in patients receiving ibuprofen, the treatment should be withdrawn. Dermatological: Serious skin reactions, some of them fatal, including exfoliative dermatitis, Stevens-Johnson syndrome, and Toxic Epidermal Necrolysis, have been reported very rarely in association with the use of NSAIDs (see section 4.8). Patients appear to be at highest risk for these reactions early in the course of therapy: the onset of the reaction occurring in the majority of cases within the first month of treatment. Ibuprofen should be discontinued at the first appearance of skin rash, mucosal lesions, or any other sign of hypersensitivity. The label will include: Read the enclosed leaflet before taking this product. Do not take: If you have (or have had two or more episodes of) a stomach ulcer, perforation or bleeding If you are allergic to ibuprofen or any other ingredients of the product, aspirin or other related painkillers If you are taking other NSAID painkillers, or aspirin with a daily dose above 75 mg Speak to a pharmacist or your doctor before taking: If you have or have had asthma, diabetes, high cholesterol, high blood pressure, a stroke, heart, liver, kidney or bowel problems If you are a smoker If you are pregnant If your symptoms persist or worsen, consult your doctor. 4.5 Interaction with other medicinal products and other forms of interaction Ibuprofen should be avoided in combination with: Aspirin: Unless low-dose aspirin (not above 75mg daily) has been advised by a doctor, as this may increase the risk of adverse reactions (see section 4.4). Other NSAIDs including cyclo-oxygenase-2 selective inhibitors: Avoid concomitant use of two or more NSAIDs as this may increase the risk of adverse effects (see section 4.4). Ibuprofen should be used with caution in combination with: Anticoagulants: NSAIDS may enhance the effects of anti-coagulants, such as warfarin (see section 4.4). Antihypertensives and diuretics: NSAIDs may diminish the effect of these drugs. Diuretics can increase the risk of nephrotoxicity of NSAIDs. Corticosteroids: Increased risk of gastrointestinal ulceration or bleeding (see section 4.4). Anti-platelet agents and selective serotonin-reuptake inhibitors (SSRIs): Increased risk of gastrointestinal bleeding (see section 4.4). Cardiac glycosides: NSAIDs may exacerbate cardiac failure, reduce GFR and increase plasma glycoside levels. Lithium: There is evidence for potential increases in plasma levels of lithium. 14

15 Methotrexate: There is a potential for an increase in plasma methotrexate. Ciclosporin: Increased risk of nephrotoxicity. Mifepristone: NSAIDs should not be used for 8-12 days after mifepristone administration as NSAIDs can reduce the effect of mifepristone. Tacrolimus: Possible increased risk of nephrotoxicity when NSAIDs are given with tacrolimus. Zidovudine: Increased risk of haematological toxicity when NSAIDs are given with zidovudine. There is evidence of an increased risk of haemarthroses and haematoma in HIV(+) haemophiliacs receiving concurrent treatment with zidovudine and ibuprofen. Quinolone antibiotics: Animal data indicate that NSAIDs can increase the risk of convulsions associated with quinolone antibiotics. Patients taking NSAIDs and quinolones may have an increased risk of developing convulsions. Experimental data suggest that ibuprofen may inhibit the effect of low dose aspirin on platelet aggregation when they are dosed concomitantly. However, the limitations of these data and the uncertainties regarding extrapolation of ex vivo data to the clinical situation imply that no firm conclusions can be made for regular ibuprofen use, and no clinically relevant effect is considered to be likely for occasional ibuprofen use (see section 5.1). 4.6 Pregnancy and lactation Whilst no teratogenic effects have been demonstrated in animal experiments, the use of ibuprofen should, if possible, be avoided during the first 6 months of pregnancy. During the 3rd trimester, ibuprofen is contraindicated as there is a risk of premature closure of the foetal ductus arteriosus with possible persistent pulmonary hypertension. The onset of labour may be delayed and the duration increased with an increased bleeding tendency in both mother and child (see section 4.3). In limited studies, ibuprofen appears in the breast milk in very low concentration and is unlikely to affect the breast-fed infant adversely. See section 4.4 regarding female fertility. 4.7 Effects on ability to drive and use machines None expected at recommended doses and duration of therapy. 4.8 Undesirable effects Hypersensitivity reactions have been reported and these may consist of: (a) non-specific allergic reactions and anaphylaxis (b) respiratory tract reactivity, e.g. asthma, aggravated asthma, bronchospasm, dyspnoea (c) various skin reactions, e.g. pruritus, urticaria, angioedema and more rarely exfoliative and bullous dermatoses (including epidermal necrolysis and erythema multiforme) The following list of adverse effects relates to those experienced with ibuprofen at OTC doses, for short-term use. In the treatment of chronic conditions, under long-term treatment, additional adverse effects may occur. Hypersensitivity reactions: Uncommon: Hypersensitivity reactions with urticaria and pruritus. Very rare: Severe hypersensitivity reactions. Symptoms could be: facial, tongue and laryngeal swelling, dyspnoea, tachycardia, hypotension, (anaphylaxis, angioedema or severe shock). Exacerbation of asthma and bronchospasm. Gastrointestinal: The most commonly-observed adverse events are gastrointestinal in nature. Uncommon: Abdominal pain, nausea, dyspepsia. 15

16 Rare: Diarrhoea, flatulence, constipation and vomiting. Very rare: Peptic ulcer, perforation or gastrointestinal haemorrhage, melaena, haematemesis, sometimes fatal, particularly in the elderly. Ulcerative stomatitis, gastritis. Exacerbation of colitis and Crohn s disease (see section 4.4). Nervous System: Uncommon: Headache. Very rare: Aseptic meningitis single cases have been reported very rarely. Renal: Very rare: Acute renal failure, papillary necrosis, especially in long-term use, associated with increased serum urea and oedema. Hepatic: Very rare: Liver disorders. Haematological: Very rare: Haematopoietic disorders (anaemia, leucopenia, thrombocytopenia, pancytopenia, agranulocytosis). First signs are: fever, sore throat, superficial mouth ulcers, flu-like symptoms, severe exhaustion, unexplained bleeding and bruising. Dermatological: Uncommon: Various skin rashes Very rare: Severe forms of skin reactions such as bullous reactions, including Stevens- Johnson syndrome, erythema multiforme and Toxic Epidermal Necrolysis can occur. Immune System: In patients with existing auto-immune disorders (such as systemic lupus erythematosus, mixed connective tissue disease) during treatment with ibuprofen, single cases of symptoms of aseptic meningitis, such as stiff neck, headache, nausea, vomiting, fever or disorientation have been observed (see section 4.4). Cardiovascular and cerebrovascular: Oedema, hypertension, and cardiac failure have been reported in association with NSAID treatment. Clinical trial and epidemiological data suggest that the use of ibuprofen (particularly at high doses 2400mg daily) and in long-term treatment may be associated with a small increased risk of arterial thrombotic events (for example myocardial infarction or stroke) (see section 4.4). 4.9 Overdose In children ingestion of more than 400 mg/kg may cause symptoms. In adults the dose response effect is less clear cut. The half-life in overdose is hours. Symptoms Most patients who have ingested clinically important amounts of NSAIDs will develop no more than nausea, vomiting, epigastric pain, or more rarely diarrhoea. Tinnitus, headache and gastrointestinal bleeding are also possible. In more serious poisoning, toxicity is seen in the central nervous system, manifesting as drowsiness, occasionally excitation and disorientation or coma. Occasionally patients develop convulsions. In serious poisoning metabolic acidosis may occur and the prothrombin time/inr may be prolonged, probably due to interference with the actions of circulating clotting factors. Acute renal failure and liver damage may occur. Exacerbation of asthma is possible in asthmatics. Management Management should be symptomatic and supportive and include the maintenance of a clear airway and monitoring of cardiac and vital signs until stable. Consider oral administration of activated charcoal if the patient presents within 1 hour of ingestion of a potentially toxic amount. If frequent or prolonged, convulsions should be treated with intravenous diazepam or lorazepam. Give bronchodilators for asthma. 16

17 5 PHARMACOLOGICAL PROPERTIES 5.1 Pharmacodynamic properties Pharmacotherapeutic group: Anti-inflammatory and Anti-rheumatic products, Non-Steroids Propionic acid derivatives ATC Code M01AE01 Ibuprofen is a propionic acid derivative NSAID that has demonstrated its efficacy by inhibition of prostaglandin synthesis. In humans ibuprofen reduces inflammatory pain, swellings and fever. Furthermore, ibuprofen reversibly inhibits platelet aggregation. Experimental data suggest that ibuprofen may inhibit the effect of low dose aspirin on platelet aggregation when they are dosed concomitantly. In one study, when a single dose of ibuprofen 400mg was taken within 8 h before or within 30 min after immediate release aspirin dosing (81mg), a decreased effect of ASA on the formation of thromboxane or platelet aggregation occurred. However, the limitations of these data and the uncertainties regarding extrapolation of ex vivo data to the clinical situation imply that no firm conclusions can be made for regular ibuprofen use, and no clinically relevant effect is considered to be likely for occasional ibuprofen use. 5.2 Pharmacokinetic properties Ibuprofen is rapidly absorbed following administration and is rapidly distributed throughout the whole body. The excretion is rapid and complete via the kidneys. Maximum plasma concentrations are reached 45 minutes after ingestion if taken on an empty stomach. When taken with food, peak levels are observed after 1 to 2 hours. These times may vary with different dosage forms. The half-life of ibuprofen is about 2 hours. In limited studies, ibuprofen appears in the breast milk in very low concentrations. 5.3 Preclinical safety data There are no pre-clinical data of relevance to the prescriber which are additional to that already included in other sections of the SPC. 6 PHARMACEUTICAL PARTICULARS 6.1 List of excipients Tablet core Maize starch Stearic acid Tablet coating Calcium sulphate dihydrate Sodium carboxymethycellulose Acacia powdered sieved or Acacia manufacturing Refined sugar Opalux White AS 7000B (solids) Carnauba wax powder Opaglos regular (solids) Printing ink Opacode S black (solids) (containing black iron oxide E172, shellac, propylene glycol) 6.2 Incompatibilities Not applicable. 17

18 6.3 Shelf life 36 months 6.4 Special precautions for storage Do not store above 25 C. 6.5 Nature and contents of container For PL 31308/0013, 0014, 0016 Blisters of 250μm PVC/ 20μm Aluminium foil. Pack sizes of 2, 4, 6, 8, 12, 16 tablets. For PL 31308/0015, 0017 Blisters of 250μm PVC/ 20μm Aluminium foil. Pack sizes of 2, 4, 6, 8, 12, 16, 24, 48 tablets. White High Density Polyethylene bottle with a Child-Resistant cap fitted with either a waxed aluminium-faced wad or a lectraseal liner. Pack size of 96 tablets. 6.6 Special precautions for disposal No special requirements. 7 MARKETING AUTHORISATION HOLDER Max Remedies Ltd Stoney Gate House 2 Greenfield Road Holmfirth West Yorkshire HD9 2JT 8 MARKETING AUTHORISATION NUMBER(S) PL 31308/0013 PL 31308/0014 PL 31308/0015 PL 31308/0016 PL 31308/ DATE OF FIRST AUTHORISATION/RENEWAL OF THE AUTHORISATION 21/12/ DATE OF REVISION OF THE TEXT 21/12/

19 PATIENT INFORMATION LEAFLET PL 31308/0013, 0014, and 0016 GSL licensed 19

20 20

21 PL 31308/0015 P licensed 21

22 22

23 PL 31308/0017 P licensed 23

24 24

25 LABELLING PL 31308/0013, 0014, 0016 GSL licensed (labelling is identical apart from the PL number) Carton 25

26 Braille Blister foil 26

27 PL 31308/0015 and 0017 P licensed (labelling is identical apart from the PL number) 27

28 Braille Blister foil 28

29 HDPE Bottle label 29

30 30

31 Braille for HDPE bottle for PL 31308/0015 and