Package Leaflet: Information for the Patient
Espididol 400 mg Granules for Oral Solution Mint Flavor
Ibuprofen (Arginine)
Read the entire package leaflet carefully before starting to take this medication, as it contains important information for you.
Follow the administration instructions for the medication contained in this package leaflet or as indicated by your doctor or pharmacist.
Contents of the Package Leaflet
Ibuprofen, the active ingredient in this medication, acts by reducing pain and fever.
This medication is used in adults and adolescents from 12 years old (weight equal to or greater than 40 kg) for the symptomatic relief of occasional mild to moderate pain, such as headaches, dental pain, menstrual pain, muscle pain (cramps) or back pain (lumbago), as well as febrile conditions.
Do not take Espididol if:
Warnings and precautions
Anti-inflammatory/analgesic medications like ibuprofen may be associated with a small increased risk of suffering a heart attack or stroke, especially when used in high doses. Do not exceed the recommended dose or treatment duration. Do not take more than 3 sachets of granules (1200 mg of ibuprofen) per day to avoid possible circulatory or heart problems.
Consult your doctor before starting to take Espididol:
Espididol may mask the signs of an infection, such as fever and pain. Consequently, Espididol may delay the appropriate treatment of the infection, which may increase the risk of complications. This has been observed in bacterial pneumonia and bacterial skin infections related to chickenpox. If you take this medication while having an infection and the symptoms of the infection persist or worsen, consult a doctor without delay.
It is important to use the smallest dose that relieves/controls the pain and not to take this medication for longer than necessary to control your symptoms.
Avoid concomitant administration with other NSAIDs, including COX-2 inhibitors.
Be careful with Espididol:
Serious skin reactions, such as exfoliative dermatitis, erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis, drug reaction with eosinophilia and systemic symptoms (DRESS), and acute generalized exanthematous pustulosis (AGEP), have been reported in association with ibuprofen treatment. Interrupt Espididol treatment and seek medical attention immediately if you notice any of the symptoms related to these serious skin reactions described in section 4.
Precautions in elderly patients
Elderly patients have a higher frequency of adverse reactions to NSAIDs (non-steroidal anti-inflammatory drugs), especially gastrointestinal bleeding and perforation, which can be fatal.
Anti-inflammatory/analgesic medications like ibuprofen may be associated with a small increased risk of suffering a heart attack or stroke, especially when used in high doses.
Do not exceed the recommended dose or treatment duration.
You should discuss your treatment with your doctor or pharmacist before taking Espididol if:
Similarly, this type of medication may cause fluid retention, especially in patients with heart failure and/or high blood pressure (hypertension).
Ibuprofen has been associated with signs of allergic reaction to this medication, such as respiratory problems, swelling of the face and neck (angioedema), and chest pain. Stop using this medication immediately and contact your doctor or emergency medical services immediately if you observe any of these signs.
Ibuprofen should be used with caution when administered to patients who have or have a history of bronchial asthma, chronic rhinitis, or allergic diseases, as ibuprofen has been reported to cause bronchospasm, urticaria, or angioedema in these patients.
Children and adolescents
There is a risk of kidney failure in dehydrated children and adolescents.
The use of this medication is not recommended in children and adolescents weighing less than 40 kg or under 12 years old, as the dose of ibuprofen it contains is not suitable for the recommended dosage in this group of patients.
Since the administration of medications like ibuprofen has been associated with an increased risk of congenital anomalies/abortions, its administration is not recommended during the first and second trimester of pregnancy unless strictly necessary and advised by your doctor.
If you need treatment during this period or while trying to become pregnant, you should use the lowest dose for the shortest possible time.
If you take Espididol for a few days from the 20th week of gestation onwards, it may cause kidney problems in your baby, which can lead to low levels of amniotic fluid surrounding the baby (oligohydramnios) or narrowing of a blood vessel (ductus arteriosus) in the baby's heart. If you need treatment for a few more days, your doctor may recommend additional monitoring.
In the third trimester, the administration of ibuprofen is contraindicated.
For women of childbearing age, it should be noted that medications like ibuprofen have been associated with a decrease in fertility.
If you are going to undergo any diagnostic test (including blood tests, urine tests, skin tests using allergens, etc.), inform your doctor that you are taking this medication, as it may alter the results.
Inform your doctor or pharmacist if you are using, have recently used, or may need to use any other medication.
Espididol may affect or be affected by other medications. For example:
The following medications may interfere and should not be taken with Espididol without first consulting your doctor:
Other medications may also affect or be affected by treatment with Espididol. Therefore, you should always consult your doctor or pharmacist before using Espididol with other medications.
Take this medication with meals or with milk.
Do not administer ibuprofen with alcohol to avoid damaging the stomach. Alcohol consumption during treatment may increase the risk of adverse gastrointestinal reactions.
If you are pregnant or breastfeeding, think you may be pregnant, or plan to become pregnant, consult your doctor or pharmacist before using this medication.
Espididol should not be taken during pregnancy, especially during the third trimester (see section precautions during pregnancy and in women of childbearing age). It may cause kidney and heart problems in your baby. It may affect your and your baby's tendency to bleed and make labor longer than expected.
Minimal amounts of ibuprofen and its degradation products are excreted in breast milk. As no adverse effects are known in the infant, it is not usually necessary to interrupt breastfeeding during short-term use at recommended doses.
Therefore, if you become pregnant or are breastfeeding, consult your doctor.
If you experience dizziness, vertigo, vision changes, or other symptoms while taking this medication, you should not drive or use hazardous machinery. If you only take one dose of Espididol or take it for a short period, you do not need to take special precautions.
This medication contains 25 mg of aspartame in each sachet. Aspartame contains a source of phenylalanine that may be harmful in case of phenylketonuria (PKU), a rare genetic disease in which phenylalanine accumulates because the body is unable to eliminate it correctly.
This medication contains sucrose. If your doctor has indicated that you have an intolerance to certain sugars, consult with them before taking this medication.
This medication contains 57 mg of sodium (main component of table salt/cooking salt) in each sachet. This is equivalent to 2.85% of the maximum recommended daily sodium intake for an adult.
This medication may cause local reactions or irritation of mucous membranes because it contains butylhydroxyanisole (E 320).
Follow the administration instructions of this medication contained in this prospectus or as indicated by your doctor or pharmacist. In case of doubt, ask your doctor or pharmacist.
The effective lowest dose should be used for the shortest time necessary to relieve symptoms. If you have an infection, consult a doctor without delay if symptoms (such as fever and pain) persist or worsen (see section 2).
The recommended dose is:
Always use the lowest effective dose.
The administration of this medication is subject to the appearance of pain or fever. As these disappear, the medication should be suspended.
You should consult a doctor if it worsens or does not improve, if the fever persists for more than 3 days or the pain for more than 3 days in adolescents or 5 days in adults.
Use in children
Method of administration:
This medication is administered orally.
Dissolve the contents of one sachet completely in a glass of water and ingest it afterwards. Take this medication with meals or with milk, especially if digestive discomfort is noticed.
In case of overdose or accidental ingestion, consult a doctor or pharmacist immediately, go to the nearest hospital, or call the Toxicology Information Service (telephone: 91.5620420), indicating the medication and the amount ingested, to find out about the risk and ask for advice on the measures to be taken.
The symptoms of overdose may include nausea, stomach pain, vomiting (which may be bloody), gastrointestinal bleeding (see also section 4 below), diarrhea, headache, ringing in the ears, confusion, and tremor of the eyes. Agitation, drowsiness, disorientation, or coma may also appear. Occasionally, patients develop convulsions. At high doses, drowsiness, chest pain, palpitations, loss of consciousness, convulsions (mainly in children), weakness, and dizziness, blood in the urine, low potassium levels in the blood, feeling of cold body, and respiratory problems have been reported. Additionally, the prothrombin time/INR may be prolonged, probably due to interference with the actions of circulating coagulation factors. Acute renal failure and liver damage may occur. An exacerbation of asthma in asthmatics is possible. Additionally, there may be low blood pressure and difficulty breathing.
In case of ingestion of significant amounts, activated charcoal should be administered. Gastric lavage will be considered if significant amounts have been ingested and within 60 minutes after ingestion.
If you forget to take Espididol
Do not take a double dose to make up for forgotten doses.
If you forget to take your corresponding dose, take it as soon as you remember. However, if the time of the next dose is very close, skip the forgotten dose and take the next dose at its usual time.
If you have any other doubts about the use of this product, ask your doctor or pharmacist.
Like all medications, this medication can produce adverse effects, although not all people suffer from them.
Adverse effects of medications like Espididol are more common in people over 65 years old.
The incidence of adverse effects is lower in short treatments and if the daily dose is below the maximum recommended dose.
Frequencies are established according to the following classification: very frequent (may affect more than 1 in 10 patients); frequent (may affect up to 1 in 10 patients); infrequent (may affect up to 1 in 100 patients); rare (may affect up to 1 in 1,000 patients); very rare (may affect up to 1 in 10,000 patients); unknown frequency (cannot be estimated from available data).
The following adverse effects have been observed:
Infections and infestations
Very rare: Exacerbation of inflammation-related infections (e.g., development of necrotizing fasciitis), coinciding with the use of non-steroidal anti-inflammatory drugs.
Note: If signs of infection or worsening are observed during treatment with ibuprofen, it is recommended to go to the doctor immediately, in case antibiotic/anti-infective therapy needs to be initiated.
Blood and lymphatic system disorders
Rare: Aplastic anemia (insufficiency of the bone marrow to produce different types of cells).
Very rare: Decreased platelets, decreased white blood cells (may manifest as frequent infections with fever, chills, or sore throat), decreased red blood cells (may manifest as difficulty breathing and paleness of the skin), decreased granulocytes (a type of white blood cell that may predispose to infections), pancytopenia (deficiency of red, white, and platelet cells in the blood), agranulocytosis (very large decrease in granulocytes), hemolytic anemia (premature destruction of red blood cells). The first symptoms are: fever, sore throat, superficial ulcers in the mouth, flu-like symptoms, extreme fatigue, nosebleeds, and skin bleeding. Prolongation of bleeding time.
Immune system disorders
Infrequent: Allergic reaction, hypersensitivity reactions with skin rash and itching, as well as asthma attacks (possibly along with a drop in blood pressure).
Rare: Anaphylaxis (generalized allergic reaction).
Very rare: Severe hypersensitivity reactions (these may be characterized by swelling of the face, tongue, and larynx with bronchospasm, dyspnea, tachycardia, and hypotension that may include potentially fatal shock).
Note: In the event of these symptoms, which may occur with the first use, immediate medical attention is required.
Psychiatric disorders
Infrequent: Insomnia, anxiety, restlessness.
Rare: Psychotic reaction, nervousness, irritability, depression, confusion, disorientation.
Nervous system disorders
Frequent: Fatigue or drowsiness, headache, and dizziness or feeling of instability.
Infrequent: Insomnia, excitement, irritability.
Rare: Paresthesia (sensation of numbness, tingling, prickling, etc., more frequent in hands, feet, arms, or legs).
Very rare: Aseptic meningitis. In most cases where aseptic meningitis has been reported with ibuprofen, the patient suffered from some form of autoimmune disease (such as systemic lupus erythematosus or other collagen diseases), which was a risk factor. The symptoms of aseptic meningitis observed were neck stiffness, headache, nausea, vomiting, fever, or disorientation.
Eye disorders
Infrequent: Vision disturbances.
Rare: Abnormal or blurred vision.
Unknown frequency: Papilledema (inflammation of the optic nerve).
Ear and labyrinth disorders
Frequent: Vertigo.
Infrequent: Ringing or buzzing in the ears.
Rare: Hearing difficulty.
Cardiac disorders
Medications like Espididol may be associated with a moderate increase in the risk of suffering a heart attack ("myocardial infarction") or stroke.
Very rare: Palpitations, heart failure.
Unknown frequency: Heart failure, chest pain, which may be a sign of a potentially serious allergic reaction called Kounis syndrome.
Vascular disorders
Edema (fluid retention), arterial hypertension, and heart failure have also been observed in association with treatments with ibuprofen-type medications (arginine).
Very rare: Arterial hypertension.
Unknown frequency: Arterial thrombosis.
Respiratory disorders
Infrequent: Asthma, worsening of asthma, bronchospasm, dyspnea (difficulty breathing).
Unknown frequency: Throat irritation.
Gastrointestinal disorders
The most frequent adverse effects that occur with medications like Espididol are gastrointestinal: peptic ulcers, gastrointestinal bleeding, perforations (in some cases fatal), especially in elderly patients.
Frequent: Gastrointestinal disorders such as heartburn (acidity, reflux), abdominal pain, nausea, vomiting, flatulence, diarrhea, constipation, and mild gastrointestinal bleeding that can cause anemia in exceptional cases.
Infrequent: Gastrointestinal ulcers, potentially with bleeding and perforation, ulcerative stomatitis, exacerbation of colitis and Crohn's disease, melena (blood in stool), gastritis.
Rare: Vomiting blood.
Very rare: Esophageal inflammation, pancreatitis, intestinal stenosis.
Unknown frequency: Anorexia.
Hepatobiliary disorders
Rare: Liver damage, hepatitis (inflammation of the liver), liver function abnormalities, and jaundice (yellowing of the skin and eyes).
Skin and subcutaneous tissue disorders
Frequent: Skin rash.
Infrequent: Redness of the skin, itching or swelling of the skin (angioedema, urticaria), purpura (purple spots on the skin).
Rare: Anaphylactic reaction.
Very rare: Medications like Espididol may be associated, in very rare cases, with severe blistering reactions such as Stevens-Johnson syndrome (widespread erosions affecting the skin and two or more mucous membranes and purple-colored lesions, preferably on the trunk) and toxic epidermal necrolysis (erosions on mucous membranes and painful lesions with necrosis and shedding of the epidermis). Hair loss, erythema multiforme (skin lesion). Exceptionally, severe skin infections and soft tissue complications may occur during chickenpox.
Unknown frequency: Photosensitivity (skin reactions due to light influence), worsening of skin reactions. A severe skin reaction known as DRESS syndrome may occur. The symptoms of DRESS syndrome include: skin rash, lymph node inflammation, and elevated eosinophils (a type of white blood cell).
Generalized red scaly rash, with bumps under the skin and blisters, mainly located in skin folds, trunk, and upper limbs, accompanied by fever at the start of treatment (acute generalized exanthematous pustulosis). Stop taking Espididol if you present these symptoms and seek immediate medical attention. See also section 2.
Renal and urinary disorders
Rare: Hematuria (presence of blood in the urine).
Very rare: Edema (signs that may indicate kidney disease, which may include kidney failure); kidney tissue damage (papillary necrosis), increased serum uric acid concentration.
Based on experience with non-steroidal anti-inflammatory drugs in general, cases of interstitial nephritis, nephrotic syndrome, and kidney failure cannot be excluded.
General disorders
Very rare: Worsening of inflammation during infectious processes.
Unknown frequency: Edema.
Investigations
Rare: Alteration of liver function tests.
Unknown frequency: Alteration of renal function tests.
To date, no serious allergic reactions have been reported with Espididol, although they cannot be ruled out. The manifestations of this type of effect could be fever, skin rash, abdominal pain, severe and persistent headache, nausea, vomiting, angioedema, swelling of the face, tongue, and throat, difficulty breathing, asthma, palpitations, hypotension (lower than usual blood pressure), or shock.
If any of the following adverse effects occur, discontinue treatment and go to your doctor immediately:
Discontinue treatment with Espididol and seek immediate medical attention if you notice any of the following symptoms:
Reporting of adverse reactions
If you experience any type of adverse reaction, consult your doctor, pharmacist, or nurse, even if it is a possible adverse reaction that does not appear in this prospectus. You can also report them directly through the Spanish Pharmacovigilance System for Human Use Medicines: https://www.notificaram.es. By reporting adverse reactions, you can contribute to providing more information on the safety of this medication.
Keep out of sight and reach of children.
No special storage conditions are required.
Medications should not be thrown down the drain or into the trash. Deposit the packaging and medications you no longer need in the SIGRE Point of the pharmacy. Ask your pharmacist how to dispose of the packaging and medications you no longer need. This way, you will help protect the environment.
Composition of Espididol
The active ingredient is ibuprofen-arginine. Each sachet contains 400 mg of ibuprofen (as 770 mg of ibuprofen arginine).
It is presented in packages containing 12 or 20 sachets.
Only some package sizes may be marketed.
Zambon, S.A.U.
Maresme, 5. Can Bernades-Subirà Industrial Park
08130 Sta. Perpètua de Mogoda (Barcelona)
Spain
Zambon, S.p.A.
Via della Chimica, 9
36100 Vicenza
Italy
Zambon, S.A.U.
Maresme, 5. Can Bernades-Subirà Industrial Park
08130 Sta. Perpètua de Mogoda (Barcelona)
Spain
Detailed and updated information on this medication is available on the website of the Spanish Agency for Medicines and Health Products (AEMPS) http://www.aemps.gob.es/.