Package Leaflet: Information for the Patient
Paracetamol/Ibuprofen Nutra Essential 500 mg/200 mg Granules
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 exactly.
Contents of the Package Leaflet
Paracetamol/Ibuprofen Nutra Essential contains two active substances (that make the medication work). These are ibuprofen and paracetamol.
Ibuprofen belongs to a group of medications known as non-steroidal anti-inflammatory drugs (NSAIDs). Paracetamol works differently from ibuprofen, but both active substances work together to reduce pain.
Paracetamol/ibuprofen is used for the symptomatic occasional treatment of mild to moderate pain. This medication is especially indicated for pain that has not been relieved by ibuprofen or paracetamol alone.
Paracetamol/ibuprofen is used in adults over 18 years of age.
Do not take Paracetamol/Ibuprofen Nutra Essential if:
Warnings and Precautions
Consult your doctor or pharmacist before starting to take Paracetamol/Ibuprofeno Nutra Essential if:
? you are an elderly patient,
? you have asthmaor have suffered from asthma,
? you have kidney, heart, liver, or intestinal problems, hepatitis, or difficulty urinating,
? you are being treated concomitantly with medications that affect liver function,
? you are allergic to other substances,
? you have stomach acid, indigestion, stomach ulcers, or any other stomach problem,
? you have a tendency to bleed,
? you have Gilbert's syndrome(a rare hereditary metabolic disorder with possible signs such as yellowing of the skin or the whites of the eyes),
? you have systemic lupus erythematosus(SLE), a condition of the immune system that affects connective tissue and causes joint pain, skin changes, and disorders of other organs or other mixed connective tissue disease,
? you have gastrointestinal disorders or chronic inflammatory bowel disease(e.g., ulcerative colitis, Crohn's disease),
? you have an infection; consult the section "Infections" below,
? you have a deficiencyof a certain enzyme called glucose-6-phosphate dehydrogenase,
? you have a hereditary or acquired genetic disorder of certain enzymes that manifests with neurological complications or skin problems and occasionally both, i.e., porphyria,
? you have hemolytic anemia,
? you have hay fever, nasal polyps, or chronic obstructive respiratory disorders, as there may be a higher risk of allergic reactions,
? you suffer from chronic alcoholism,
? you have low weightor chronic malnutrition,
? you have a total body water deficiency(dehydration),
? you have recently had major surgery,
? you are in the first 6 months of pregnancyor are breastfeeding,
? you are planning to become pregnant.
? With ibuprofen, signs of allergic reaction to this medication have been reported, such as respiratory problems, swelling of the face and neck area (angioedema), and chest pain. Stop using Paracetamol/Ibuprofeno Nutra Essential immediately and contact your doctor or medical emergency service immediately if you observe any of these signs.
Consult your doctor if any of the above warnings apply to you, or if you have experienced them in the past. You may need to avoid this medication or reduce the dose.
Side effects can be minimized by using the minimum effective dose for the shortest time necessary to control symptoms. Do not take this medication for more than 3 days.
Concomitant use with NSAIDs, including specific cyclooxygenase-2 inhibitors, increases the risk of adverse reactions (see below "Other medications and Paracetamol/Ibuprofeno Nutra Essential") and should be avoided.
Warning: taking higher doses than the recommended doses does not provide greater pain relief, but causes the risk of severe liver damage. Therefore, do not exceed the maximum daily dose of paracetamol. Do not take other medications that also contain paracetamol (see also the section "Do not take Paracetamol/Ibuprofeno Nutra Essential" above). Symptoms of liver damage usually occur for the first time after a couple of days. Therefore, it is essential to consult a doctor immediatelyif you have taken more than recommended. See also section 3 "If you take more Paracetamol/Ibuprofeno Nutra Essential than you should".
Anti-inflammatory/analgesic medications like ibuprofen may be associated with a small increased risk of 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 this medication if:
? you have heart problems, such as heart failure, angina (chest pain), or if you have had a heart attack, bypass surgery, peripheral arterial disease (poor circulation in the legs and feet due to narrow or blocked arteries) or any type of stroke (including 'mini-stroke' or transient ischemic attack "TIA"),
? you have high blood pressure, diabetes, high cholesterol, family history of heart disease or stroke, or if you are a smoker.
Skin Reactions
Severe skin reactions have been reported with paracetamol/ibuprofen treatment. Stop taking this medication and go to the doctor immediately if you present any skin rash, lesions on the mucous membranes, blisters, or other signs of allergy, as these may be the first signs of a very severe skin reaction. See section 4.
Severe skin reactions, such as exfoliative dermatitis, erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis, drug reaction with eosinophilia and systemic symptoms (DRESS syndrome), and acute generalized exanthematous pustulosis (AGEP), have been reported in association with ibuprofen treatment. Interrupt treatment with Paracetamol/Ibuprofeno Nutra Essential and seek medical attention immediately if you notice any of the symptoms related to these severe skin reactions described in section 4.
Infections
Paracetamol/ibuprofen may mask the signs of an infection, such as fever and pain. Consequently, this medication may delay 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 immediately.
Gastrointestinal Symptoms
Severe gastrointestinal side effects (affecting the stomach and intestine) have been reported with the use of NSAIDs, including ibuprofen. These can occur with or without warning symptoms. The risk of these side effects is higher in patients with a history of stomach or intestinal ulcers, particularly if there was also bleeding or perforation. Elderly patients have a higher risk of gastrointestinal side effects. You should discuss any history of gastrointestinal problems with your doctor and remain alert to any unusual abdominal symptoms, such as nausea, vomiting, diarrhea, constipation, indigestion, abdominal pain, black stools, or vomiting blood.
Prolonged Use of Analgesics
Prolonged use of analgesics for headaches can worsen them. If you experience or suspect this situation, you should inform your doctor and interrupt treatment.
Regular use of analgesics, particularly in combination with several pain-relieving medications, can cause permanent kidney damage with a risk of kidney failure, a condition called analgesic nephropathy. This risk may increase under physical exertion associated with salt loss and dehydration. Therefore, it should be avoided.
Vision Problems
If you notice any vision problems after using paracetamol/ibuprofeno, stop using the medication and consult a doctor.
Other Considerations
In general, habitual intake of analgesics, particularly in combination with several analgesic active substances, can lead to permanent kidney damage with a risk of kidney failure. Therefore, it should be avoided.
Children and Adolescents
This medication is contraindicated in children and adolescents (under 18 years of age).
Other Medications and Paracetamol/Ibuprofeno Nutra Essential
Tell your doctor or pharmacist if you are taking, have recently taken, or might take any other medication.
Do not take this medication with other types of analgesics at the same time unless your doctor indicates so (see section "Warnings and Precautions"). Do not take other medications that contain paracetamol, such as some medications for colds and flu or pain.
This medication can affect other medications or be affected by them. For example:
Other medications may also affect or be affected by treatment with paracetamol/ibuprofen. Therefore, you should always seek advice from your doctor or pharmacist before taking paracetamol/ibuprofen with other medications.
Your doctor and pharmacist will have more information about these medications and how to act.
Taking Paracetamol/Ibuprofeno Nutra Essential with Food, Drinks, and Alcohol
To reduce the likelihood of side effects, take Paracetamol/Ibuprofeno with food.
Do not drink alcoholic beverages during treatment with this medication. The combination of alcohol with this medication can cause liver damage. The intoxicating effect of alcohol does not increase when taking this medication.
Pregnancy, Breastfeeding, and Fertility
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.
Pregnancy
Do not take paracetamol/ibuprofen if you are in the last 3 months of pregnancy, as it may harm the fetus or cause problems during delivery. It can cause kidney and heart problems in your baby. It may increase the risk of bleeding in you and your baby during delivery, delay delivery, or prolong it more than expected. You should not take paracetamol/ibuprofen during the first 6 months of pregnancy unless it is absolutely necessary and indicated by your doctor. If you need treatment during this period or while trying to become pregnant, the lowest dose should be used for the shortest time possible. If taken for more than a few days from 20 weeks of pregnancy, Paracetamol/Ibuprofeno Nutra Essential may cause kidney problems in the fetus that 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 more than a few days, your doctor may recommend additional monitoring.
Paracetamol/ibuprofen may make it difficult to become pregnant. You should inform your doctor if you are planning to become pregnant or if you have problems conceiving.
Breastfeeding
Only small amounts of ibuprofen and its metabolites pass into breast milk. This medication can be taken during breastfeeding if used at the recommended dose and for the shortest time possible.
Fertility
This product belongs to a group of medications (NSAIDs) that may affect female fertility. This effect is reversible upon discontinuation of treatment.
Driving and Using Machines
This medication can cause dizziness, fatigue, drowsiness, and visual disturbances in some people. This should be taken into account in situations where a high level of alertness is required, for example, during driving. Be careful when driving or using machines until you know how this medication affects you.
Paracetamol/Ibuprofeno Nutra Essentialcontains aspartame (E-951), mannitol (E-421), isomalt (E-953), and sodium.
This medication contains 16.43 mg of aspartamein each sachet, equivalent to 14.94 mg/g. 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 isomalt(E-953). If your doctor has told you that you have an intolerance to certain sugars, consult with them before taking this medication.
This medication contains less than 23 mg of sodium(1 mmol) per sachet; this is, essentially "sodium-free".
Follow the administration instructions of this medication contained in this prospectus or as indicated by your doctor or pharmacist. In case of doubt, consult your doctor or pharmacist again.
Adults over 18 years: the recommended dose is 1 sachetup to 3 times a day. Open the sachet and pour the contents directly onto the tongue. The granulate disperses quickly in saliva and is swallowed.
Leave at least 6 hours between doses.
If one sachet does not control the symptoms, you can take up to a maximum of 2 sachets up to three times a day. Leave at least 6 hours between doses.
Do not take more than six sachets in a 24-hour period(equivalent to 1,200 mg of ibuprofen and 3,000 mg of paracetamol per day).
To reduce the likelihood of adverse effects, it is recommended to take paracetamol/ibuprofeno with food.
Use in elderly patients
No special dose modifications are required. There is a greater risk of serious adverse reactions. The lowest possible dose should be used for the shortest possible time.
Use in children and adolescents
Its use is contraindicated in children and adolescents under 18 years of age.
It may be necessary to reduce your dose to a maximum of 4 sachets per day if:
If any of the above applies to you, talk to your doctor before taking paracetamol/ibuprofeno (see also section 2 "Warnings and precautions").
Only for oral use and for short-term use.
Do not take this medication for more than 3 days.
If your symptoms worsen or persist, consult your doctor.
The effective lowest dose should be used for the shortest time necessary for symptom relief.
If you have an infection, consult a doctor immediately if symptoms (such as fever and pain) persist or worsen (see section 2).
If you take more Paracetamol/Ibuprofeno Nutra Essential than you should
If you have taken more paracetamol/ibuprofeno than you should, or if a child has ingested the medication accidentally, consult your doctor or pharmacist immediately or go to the nearest hospital to find out about the risk and ask for advice on the measures to be taken.
The symptoms may include nausea, stomach pain, vomiting (which may be streaked with blood), gastrointestinal bleeding, headache, ringing in the ears, confusion, and eye tremor (nystagmus) or, more rarely, diarrhea. Additionally, at high doses, dizziness, blurred vision, low blood pressure, excitement, disorientation, coma, hyperkalemia (high potassium levels in the blood), increased prothrombin time/INR, acute kidney failure, liver damage, respiratory depression, cyanosis, and exacerbation of asthma in asthmatics, somnolence, 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 in the body, and respiratory problems.
In case of overdose or accidental ingestion, consult your doctor or pharmacist immediately or call the Toxicology Information Service, phone: 91 562 04 20, indicating the medication and the amount ingested.
Talk to a doctor immediately if you have taken too much medication, even if you feel well.The reason is that an excessive amount of paracetamol can cause severe late liver damage, which can be fatal. Even if there are no signs of discomfort or poisoning, you may need urgent medical attention. Liver damage can become irreversible in case of late intervention. To avoid liver damage, it is essential to obtain medical treatment as soon as possible.
If you forgot to take Paracetamol/Ibuprofeno Nutra Essential
Do not take a double dose to make up for forgotten doses. If you forget to take a dose, take it as soon as you remember and then take the next dose at least 6 hours later.
If you have any other doubts about the use of this medication, ask your doctor or pharmacist.
Like all medications, this medication can produce adverse effects, although not all people suffer from them.
Regarding the following adverse effects, it should be noted that they depend largely on the dose and vary from patient to patient.
The most frequently observed adverse effects are of a gastrointestinal nature. Peptic ulcers, perforation, or gastrointestinal bleeding may occur, sometimes fatal, especially in elderly patients. After administration, nausea, vomiting, diarrhea, flatulence, constipation, indigestion, abdominal pain, tarry stools, vomiting blood, stomatitis, ulcerative exacerbation of colitis, and Crohn's disease have been reported. Less frequently, gastritis has been observed. In particular, the risk of gastrointestinal bleeding depends on the dose range and duration of use.
Cases of edema, high blood pressure, and heart failure have been reported in association with AINE treatment.
STOP TAKING the medication and inform your doctor if you experience:
Uncommon (may affect up to 1 in 100 people):
Rare (may affect up to 1 in 10,000 people):
Frequency not known (cannot be estimated from the available data):
Other possible adverse effects
Common(may affect up to 1 in 10 people):
Uncommon(may affect up to 1 in 100 people):
Rare(may affect up to 1 in 1,000 people):
Very rare(may affect up to 1 in 10,000 people):
Not known(cannot be estimated from the available data):
Medications like paracetamol/ibuprofeno may be associated with a small increased risk of heart attack ("myocardial infarction") or stroke (see section 2).
Reporting of adverse effects
If you experience adverse effects, consult your doctor or pharmacist, even if it is possible adverse effects that do not appear in this prospectus. You can also report them directly through the Spanish Pharmacovigilance System for Human Use Medicines: www.notificaram.es. By reporting adverse effects, you can contribute to providing more information on the safety of this medication.
Keep this medication out of sight and reach of children.
Do not use this medication after the expiration date that appears on the packaging, after CAD. The expiration date is the last day of the month indicated.
Do not store at a temperature above 25°C.
Keep in the original packaging to protect it from light.
Medications should not be thrown down the drain or into the trash. Deposit the packaging and medications you no longer need at the SIGRE point in the pharmacy. In case of doubt, 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 Paracetamol/Ibuprofeno Nutra Essential
The other components (excipients) are: calcium carbonate, sodium hydrogen carbonate, anhydrous citric acid, anhydrous sodium citrate, aspartame (E-951), glycerol distearate (Type I), mannitol (E-421), isomalt (E-953), sodium croscarmellose, sodium starch glycolate type A (from potato), silicon dioxide, ethylcellulose, hypromellose, macrogol, lemon flavor, strawberry flavor, flavoring (contains aspartame).
Product appearance and package contents
Sachets
Each package contains 10 or 20 single-dose polyester/aluminum/polyethylene sachets.
Marketing authorization holder and manufacturer
Marketing authorization holder
Nutra Essential OTC, S.L.
C/ La Granja, 1, 3rd floor
28108, Alcobendas (Madrid)
Spain
Manufacturer
Farmalider, S.A.
C/ Aragoneses, 2
28108, Alcobendas (Madrid)
Spain
or
Edefarm, S.L.
Enchilagar del Rullo Industrial Estate, 117
46191, Valencia
Spain
Date of the last revision of this prospectus: April 2025
Other sources of information:
Detailed information on this medication is available on the website of the Spanish Agency for Medicines and Health Products (AEMPS)
http://www.aemps.gob.es/