Next Uno Express capsules 200mg, No. 20

• Used for headache, migraine, toothache, painful menstruation, neuralgia, back pain, muscle and rheumatic pain; for fever with flu and colds.

• Designed for symptomatic therapy, reducing pain and inflammation at the time of use, does not affect the progression of the disease.

Next Uno Express is prescribed for adults and children over 12 years of age inside after meals, 200 mg (1 capsule) 3-4 times a day. The capsules should be taken with a glass of water.
To achieve a quick therapeutic effect, the dose can be increased to 400 mg (2 capsules) 3 times a day. When the therapeutic effect is achieved, the daily dose of the drug is reduced to 600-800 mg.
The maximum daily dose for adults is 1200 mg (do not exceed 6 capsules in 24 hours).
The maximum daily dose for children 12-18 years old is 800 mg.
A repeated dose should be taken no earlier than 4 hours later.
If, when using the drug for 5 days, the pain syndrome or within 3 days the fever persists or intensifies, you should stop taking it and consult your doctor.

1 capsule contains:
Active ingredient: ibuprofen - 200,000 mg.
Excipients: ?-tocopherol acetate - 0.372 mg, povidone 17 PF - 30,000 mg, macrogol 600 - 414.628 mg.
Composition of the shell of a gelatin capsule: gelatin, sorbitol non-crystallizing solution, glycerol, methyl parahydroxybenzoate, purified water, charming red dye E-129.

• Hypersensitivity to ibuprofen and other components of the drug;

• erosive and ulcerative diseases of the gastrointestinal tract (including peptic ulcer of the stomach and duodenum in the acute stage, ulcerative colitis, peptic ulcer, Crohn's disease);

• complete or incomplete combination of bronchial asthma, recurrent polyposis of the nose and paranasal sinuses and intolerance to acetylsalicylic acid or other NSAIDs (including a history);

• blood clotting disorders (including hemophilia, prolonged bleeding time, bleeding tendency, hemorrhagic diathesis);

• children under 12 years of age;

• pregnancy III trimester, breastfeeding period;

• active gastrointestinal bleeding;

• intracranial hemorrhage;

• a history of bleeding or perforation of a gastrointestinal ulcer, provoked by the use of NSAIDs;

• severe heart failure;

• severe renal failure (CC less than 30 ml / min);

• progressive kidney disease;

• severe liver failure or active liver disease;

• condition after coronary artery bypass grafting;

• confirmed hyperkalemia;

• intolerance to fructose.

Carefully:
The drug is used with caution in liver cirrhosis with portal hypertension, hyperbilirubinemia, gastric ulcer and duodenal ulcer (in history), gastritis, enteritis, colitis; hepatic and / or renal failure, nephrotic syndrome; chronic heart failure, arterial hypertension; blood diseases of unknown etiology (leukopenia and anemia), old age, pregnancy (I-II trimester), ischemic heart disease, cerebrovascular diseases, dyslipidemia / hyperlipidemia, diabetes mellitus, peripheral arterial diseases, smoking, chronic renal failure (CC 30-60 ml / min ), the presence of Helicobacter pylory infection, prolonged use of NSAIDs, frequent alcohol consumption, severe somatic diseases,systemic lupus erythematosus or other autoimmune diseases of the connective tissue (increased risk of aseptic meningitis), concomitant use of oral corticosteroids (including prednisolone), anticoagulants (including warfarin), antiplatelet agents (including clopidogrel), selective serotonin reuptake inhibitors (including citalopram, fluoxetine, paroxetine, sertraline).

Pharmacotherapeutic group:
Non-steroidal anti-inflammatory drugs.
ATC code: ћ01ј?01
Pharmacological properties:
Pharmacodynamics:
The mechanism of action of ibuprofen, a propionic acid derivative from the group of non-steroidal anti-inflammatory drugs (NSAIDs), is due to inhibition of the synthesis of prostaglandins - mediators of pain, inflammation and hyperthermic reaction. Indiscriminately blocks cyclooxygenase 1 (COX-1) and cyclooxygenase 2 (COX-2), as a result of which it inhibits the synthesis of prostaglandins. Has a fast directed action against pain (analgesic), antipyretic and anti-inflammatory action. Ibuprofen inhibits platelet aggregation inversely.

Pharmacokinetics:
Ibuprofen is absorbed from the digestive tract by about 80%. Absorption decreases slightly when the drug is taken after meals. The time to reach the maximum concentration (TCmax) when taken on an empty stomach is 45 minutes, when taken after meals - 1.5Ц2 hours, in synovial fluid - 2-3 hours.
Ibuprofen is 90% bound to blood proteins, mainly albumin.
Undergoes presystemic and post-systemic metabolism in the liver. After absorption, about 60% of the pharmacologically inactive R-form of ibuprofen is slowly transformed into the active S-form. The isoenzyme CYP2C9 is involved in the metabolism of the drug. It has a two-phase elimination kinetics with a half-life (T1 / 2) of 2Ц2.5 hours. It is excreted by the kidneys (not more than 1% unchanged) and, to a lesser extent, with bile.

Application during pregnancy and during breastfeeding:
In animal studies, no adverse effects of ibuprofen on the fetus were found. Due to the lack of a sufficient number of well-controlled observations in humans, the drug should be used in the first and second trimesters of pregnancy only in cases of urgent need, if the potential benefit to the mother outweighs the potential risk to the fetus and child.
Ibuprofen inhibits uterine muscle contraction. The action of ibuprofen on the fetus can cause premature closure of the duct botalus, which can lead to the development of pulmonary hypertension in the newborn. Ibuprofen should not be used at the end (third trimester) of pregnancy.
No excretion of ibuprofen in breast milk was detected. However, due to the limited volume of these studies and the possible adverse effect of inhibition of prostaglandin synthesis in a newborn, it is not recommended to use the drug during breastfeeding.

Side effects:
When using the drug Next Uno Express for 2-3 days, there are practically no side effects.
In case of prolonged use, the following side effects may occur:

• from the gastrointestinal tract (GIT): NSAID gastropathy (abdominal pain, heartburn, diarrhea, flatulence, pain and discomfort in the epigastric region), ulceration of the mucous membrane of the gastrointestinal tract (in some cases complicated by perforation and bleeding); irritation, dryness of the oral mucosa or pain in the mouth, ulceration of the gum mucosa, aphthous stomatitis, pancreatitis, constipation, indigestion, nausea, loss of appetite, vomiting, hepatitis;

• from the respiratory system: shortness of breath, bronchospasm, exacerbation of bronchial asthma;

• hearing impairment: hearing loss, ringing or tinnitus;

• from the central and peripheral nervous system: insomnia, anxiety, nervousness and irritability, psychomotor agitation, depression, confusion, hallucinations, rarely - aseptic meningitis (more often in patients with autoimmune diseases), headache, dizziness, drowsiness;

• on the part of the cardiovascular system: development or worsening of heart failure, tachycardia, increased blood pressure;

• from the urinary system: acute renal failure, allergic nephritis, nephrotic syndrome (edema), polyuria, cystitis;

• on the part of the hematopoietic organs: hemolytic anemia, aplastic anemia, thrombocytopenia and thrombocytopenic purpura, agranulocytosis, leukopenia, pancytopenia;

• on the part of the visual organs: reversible toxic amblyopia, blurred vision or double vision, dryness and irritation of the eyes, edema of the conjunctiva and eyelids (allergic genesis), scotoma, color vision disorders;

• allergic reactions: skin rash (usually erythematous, urticaria), pruritus, Quincke's edema, anaphylactoid reactions, anaphylactic shock, bronchospasm, fever, erythema multiforme (including Stevens-Johnson syndrome), toxic epidermal necrosis), erythematosus syndrome (syndrome) , allergic rhinitis;

• others: increased sweating.

The risk of ulceration of the mucous membrane of the gastrointestinal tract, bleeding (gastrointestinal, gingival, uterine, hemorrhoidal), visual impairment (color vision disorders, scotoma, amblyopia) increases with prolonged use in large doses.
If side effects appear, you should stop taking the drug and consult a doctor.
Laboratory indicators.

• bleeding time (may increase);

• serum glucose concentration (may decrease);

• creatinine clearance (may decrease);

• hematocrit or hemoglobin (may decrease);

• serum creatinine concentration (may increase);

• the activity of 'hepatic' transaminases (may increase).

Overdose:
Symptoms: abdominal pain, nausea, vomiting, lethargy, drowsiness, depression, headache, tinnitus, metabolic acidosis, coma, acute renal failure, decreased blood pressure, bradycardia, tachycardia, atrial fibrillation, respiratory arrest.
Treatment: gastric lavage (only within an hour after ingestion), activated charcoal, alkaline drink, forced diuresis, symptomatic therapy.

Special instructions:
During treatment, it is necessary to control the picture of peripheral blood and the functional state of the liver and kidneys.
When symptoms of gastropathy appear, careful monitoring is shown, including esophagogastroduodenoscopy, blood test with determination of hemoglobin, hematocrit, and fecal occult blood test.
To prevent the development of NSAID gastropathy, it is recommended to combine it with prostaglandin E (misoprostol).
If it is necessary to determine 17-ketosteroids, the drug should be discontinued 48 hours before the study.
Before starting therapy, patients with a history of arterial hypertension and / or heart failure should be careful and consult a specialist, since these patients have been noted: fluid retention, arterial hypertension and edema associated with taking NSAIDs.
Long-term use can increase the risk of acute coronary disease or stroke.
In patients with bronchial asthma or a history of allergic diseases, the drug may cause an attack or bronchospasm.
It is not recommended to take ethanol during the treatment period.
Ibuprofen has an antiplatelet effect (weaker than acetylsalicylic acid), which requires caution in the case of administration to patients with bleeding disorders, as well as taking anticoagulants.
It is recommended to take the drug in the shortest possible course and in the minimum effective dose necessary to eliminate symptoms. Drugs that inhibit cyclooxygenase and prostaglandin synthesis can affect ovulation, disrupting female reproductive function (reversible after discontinuation of treatment).

Interaction with other drugs:
Inducers of microsomal oxidation (phenytoin, ethanol, barbiturates, rifampicin, phenylbutazone, tricyclic antidepressants) increase the production of hydroxylated active metabolites of ibuprofen, increasing the risk of developing severe hepatotoxic reactions.
Inhibitors of microsomal oxidation reduce the risk of hepatotoxic effects of ibuprofen.
Ibuprofen reduces the antihypertensive effect of antihypertensive drugs (ACE inhibitors, blockers of 'slow' calcium channels, etc.), the natriuretic and diuretic efficacy of furosemide and hydrochlorothiazide; reduces the effectiveness of uricosuric drugs, enhances the ulcerogenic effect of glucocorticosteroids, colchicine, ethanol; enhances the effect of oral hypoglycemic agents and insulin; increases the concentration in the blood of digoxin, lithium and methotrexate preparations.
Ibuprofen enhances the undesirable effects of estrogens when used together.
Antacids and cholestyramine reduce the absorption of ibuprofen.
Caffeine enhances the analgesic effect of ibuprofen.
With the simultaneous appointment of ibuprofen reduces the anti-inflammatory and antiplatelet effect of acetylsalicylic acid (it is possible to increase the incidence of acute coronary insufficiency in patients receiving small doses of acetylsalicylic acid as an antiplatelet agent after starting ibuprofen).
When administered with anticoagulant and thrombolytic drugs (alteplase, streptokinase, urokinase), the risk of bleeding increases at the same time.
With the combined use of ibuprofen and cefamandol, cefoperazone, cefotetan, valproic acid, the incidence of hypoprothrombinemia increases.
Myelotoxic drugs increase the manifestations of the drug's hematotoxicity.
Cyclosporine and gold preparations increase the effect of ibuprofen on the synthesis of prostaglandins in the kidneys, which is manifested by an increase in nephrotoxicity. Ibuprofen increases the plasma concentration of cyclosporine and the likelihood of developing its hepatotoxic effects.
Drugs that block tubular secretion reduce excretion and increase the plasma concentration of ibuprofen.
Ibuprofen can reduce the effectiveness of mifepristone, so ibuprofen should be started no earlier than 8-12 days after taking mifepristone.
With the simultaneous administration of ibuprofen and tacrolimus, an increase in the risk of nephrotoxicity is possible.
The simultaneous use of ibuprofen and zidovudine can lead to an increase in hematological toxicity. There is evidence of an increased risk of hemarthrosis and hematomas in HIV-positive patients with hemophilia who received co-treatment with zidovudine and ibuprofen.
In patients receiving combined treatment with ibuprofen and quinolone antibiotics, there may be an increased risk of seizures.

Influence on the ability to drive vehicles, mechanisms:
During the period of treatment, it is necessary to refrain from those activities that require increased attention and speed of mental and motor reactions.