Prospect: information for the patient
Espidifen 600 mg granulated for oral solution, lemon-lime flavor
Ibuprofen (arginine)
6. Contents of the package and additional information
Ibuprofen (arginine) belongs to a group of medicines called nonsteroidal anti-inflammatory drugs (NSAIDs).
This medicine is used in adults and adolescents aged 14 years and above for the treatment of fever, the treatment of moderate to severe pain including migraine, the treatment of arthritis (inflammation of the joints, including those of hands and feet, leading to swelling and pain), juvenile rheumatoid arthritis, osteoarthritis (a chronic disorder causing cartilage damage), ankylosing spondylitis (inflammation affecting the spine joints), non-rheumatic inflammation, and primary dysmenorrhea (painful menstruation).
No take Espidifen:
Consult your doctor before starting to take Espidifen:
Espidifen may mask the signs of an infection, such as fever and pain. Consequently, Espidifen may delay the appropriate treatment of the infection, which may increase the risk of complications. This has been observed in pneumonia caused by bacteria and in bacterial skin infections related to chickenpox. If you take this medication while you have an infection and the symptoms of the infection persist or worsen, consult a doctor without delay.
It is essential to use the smallest dose that relieves or controls pain and not to take this medication for longer than necessary to control your symptoms.
Avoid concurrent administration with other NSAIDs, including COX-2 inhibitors.
Elderly patients have a higher frequency of adverse reactions to NSAIDs, especially bleeding and gastrointestinal perforation, which can be fatal.
Be especially careful with Espidifen:
Severe skin reactions, such as exfoliative dermatitis, erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis, drug reaction with eosinophilia and systemic symptoms (DRESS), generalized acute pustular psoriasis (PEGA), have been reported in association with ibuprofen treatment. Discontinue Espidifen treatment and seek medical attention immediately if you notice any of the symptoms related to these severe skin reactions described in section 4.
NSAIDs, such as ibuprofen, may be associated with a small increase in the risk of heart attack or stroke, especially when used in high doses.
Do not exceed the recommended dose or treatment duration.
Inform your doctor or pharmacist before taking Espidifen if:
NSAIDs may also cause fluid retention, especially in patients with heart failure and/or high blood pressure.
Ibuprofen has been reported to cause allergic reactions to this medication, such as respiratory problems, facial and neck swelling (angioedema), and chest pain. Discontinue use immediately and contact your doctor or emergency medical services if you observe any of these signs.
Ibuprofen should be used with caution in patients who have or have had asthma, bronchial asthma, or allergic diseases, as ibuprofen has been reported to cause bronchospasm, urticaria, or angioedema in these patients.
There is a risk of kidney insufficiency in dehydrated children and adolescents.
This medication is not recommended for use in children or adolescents under 14 years old, as the ibuprofen dose contained is not suitable for the recommended dosage in these patients.
Due to the association of ibuprofen administration with an increased risk of congenital anomalies/abortions, it is not recommended to administer this medication during the first and second trimesters of pregnancy, except in cases where it is strictly necessary and advised by your doctor.
If you need treatment during this period or while trying to become pregnant, use the lowest dose for the shortest possible time.
If you take this medication for a few days from 20 weeks of gestation onwards, Espidifen may cause kidney problems in your baby, which may lead to low amniotic fluid levels or narrowing of a blood vessel (ductus arteriosus) in your baby's heart. If you need treatment for a few more days, your doctor may recommend additional monitoring.
In the third trimester, ibuprofen administration is contraindicated.
For women of childbearing age, consider that ibuprofen-type medications have been associated with a decrease in the ability to conceive.
If you are to undergo any diagnostic test (including blood, urine, 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 used recently, or may need to use any other medication.
Espidifen may affect or be affected by other medications. For example:
The following medications may interfere and should not be taken with Espidifen without consulting your doctor:
Other medications may also affect or be affected by Espidifen treatment. Therefore, always consult your doctor or pharmacist before using Espidifen with other medications.
It is recommended to take the granulated ibuprofen (arginine) tablets with water or another liquid. You can take them alone or with food. In general, it is recommended to take it during meals or immediately after eating to reduce the possibility of stomach discomfort. Consuming alcohol during treatment may increase the risk of gastrointestinal adverse reactions.
If you are pregnant or breastfeeding, or if you think you may be pregnant, consult your doctor or pharmacist before using this medication.
Espidifen should not be taken during pregnancy, especially during the third trimester (see section Precautions during Pregnancy and in Women of Childbearing Age).Espidifen may cause kidney and heart problems in your baby. It may affect your tendency and that of your baby to bleed and make labor longer or more difficult than expected..
Minimal amounts of ibuprofen and its metabolites are excreted in breast milk. As no undesirable effects have been reported in the infant, it is usually not necessary to discontinue 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 disturbances, or other symptoms while taking this medication, you should not drive or operate hazardous machinery. If you only take a single dose of Espidifen or take it for a short period, no special precautions are necessary.
This medication contains 80 mg of aspartame in each packet.
Aspartame contains a source of phenylalanine, which may be harmful in cases of phenylketonuria (PKU), a rare genetic disorder in which phenylalanine accumulates because the body is unable to eliminate it correctly.
This medication contains saccharose. If your doctor has told you that you have an intolerance to certain sugars, consult with them before taking this medication.
This medication contains 87 mg of sodium (the main component of table salt/for cooking) in each packet. This represents 4.35% of the recommended daily maximum sodium intake for an adult.
Follow exactly the administration instructions of this medication as indicated by your doctor. In case of doubt, consult your doctor or pharmacist again.
Your doctor will indicate the duration of treatment with Espidifen. Do not discontinue treatment beforehand, as this would not yield the expected results. Similarly, do not use this medication for a longer period than indicated by your doctor.
The entire contents of the sachet should be taken after dissolving it in a sufficient amount of water.
Adults and adolescents over 14 years old
The dosage should be adjusted according to the severity of the disorder and the patient's response.
In adults and adolescents aged 14 to 18 years, the recommended dose is one sachet (600 mg of ibuprofen) every 6 to 8 hours.
In some cases, higher doses may be required, but in any case, it is recommended not to exceed the maximum daily dose of 2,400 mg in adults and 1,600 mg in adolescents aged 12 to 18 years, taking into account that the lower effective dose should be administered.
In rheumatoid arthritis, higher doses may be required, but in any case, it is recommended not to exceed the maximum daily dose of 2,400 mg (4 sachets of granulate) of ibuprofen.
In primary dysmenorrhea, a daily dose of 600 mg of ibuprofen is recommended until pain relief is achieved, with a maximum daily dose of 1,200 mg (2 sachets of granulate).
Use in children and adolescents
This medication is not recommended for use in children or adolescents under 14 years old, as the dose of ibuprofen contained is not suitable for the recommended dosage in these patients.
Use in elderly patients
In these patients, the dosage should be established by the doctor, as it may be necessary to reduce the usual dose.
Use in patients with kidney and/or liver disease
If you have kidney and/or liver disease, your doctor may prescribe a lower dose than usual. If so, take the exact dose prescribed by your doctor.
In case of overdose or accidental ingestion, consult a doctor or pharmacist immediately, go to the nearest hospital, or call the Toxicological Information Service (phone: 91.5620420), indicating the medication and the amount ingested, to inform yourself 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 eye tremors. Agitation, drowsiness, disorientation, or coma may also occur. Occasionally, patients develop seizures. At high doses, somnolence, chest pain, palpitations, loss of consciousness, seizures (mainly in children), weakness, and dizziness have been reported, as well as blood in the urine, low potassium levels in the blood, feeling cold, and respiratory problems. Additionally, 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. It is possible that asthma may worsen in asthmatics. Additionally, there may be low blood pressure and difficulty breathing.
In case of significant ingestion, activated charcoal should be administered. Gastric emptying may be considered if significant amounts have been ingested and within 60 minutes of ingestion.
What if I forget to take Espidifen?
Do not take a double dose to compensate for the missed dose.
If you forget to take your dose, take it as soon as you remember. However, if the next scheduled dose is soon, skip the missed dose and take the next dose at its usual time.
If you have any other questions about the use of this medication, ask your doctor or pharmacist.
Like all medications, this medication may cause side effects, although not everyone will experience them.
The side effects of medications such as Espidifen are more common in people over 65 years old.
The incidence of side effects is lower in short-term treatments and if the daily dose is below the maximum recommended dose.
Frequencies are established according to the following classification: very common (may affect more than 1 in 10 patients); common (may affect up to 1 in 10 patients); uncommon (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); frequency not known (cannot be estimated from available data).
The following side effects have been observed:
Infections and infestations
Very rare: Exacerbation of infections-related inflammation (for example, the development of necrotizing fasciitis), coinciding with the use of nonsteroidal anti-inflammatory drugs.
Nota: If signs of infection or worsening occur during treatment with ibuprofen, it is recommended to see a doctor immediately, if necessary to initiate an anti-infective/antibiotic therapy.
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 pale 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, pseudogripal symptoms, extreme fatigue, nasal and cutaneous bleeding. Prolonged bleeding time.
Immune system disorders
Uncommon: Allergic reaction, hypersensitivity reactions with skin rash and pruritus, as well as asthma attacks (possibly accompanied by 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 a potentially fatal shock).
Nota: In the appearance of these symptoms, which may occur with the first use, immediate assistance from a doctor is required.
Mental disorders
Uncommon: Insomnia, anxiety, restlessness.
Rare: Psychotic reaction, nervousness, irritability, depression, confusion, disorientation.
Nervous system disorders
Common: Fatigue or drowsiness, headache, dizziness or sensation of instability.
Uncommon:Insomnia, excitement, irritability.
Rare: Paresthesia (numbness, tingling, burning, 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 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
Uncommon: Vision disturbances.
Rare: Abnormal or blurred vision.
Frequency not known: Papilledema (inflammation of the optic nerve).
Ear and labyrinth disorders
Common: Dizziness.
Uncommon: Ringing or buzzing in the ears.
Rare: Hearing difficulty.
Cardiac disorders
Medications such as Espidifen may be associated with a moderate increase in the risk of suffering a heart attack ("myocardial infarction") or stroke.
Very rare: Palpitations, heart failure.
Frequency not known: Cardiac arrest,chest pain, which may be a sign of a potentially severe allergic reaction called Kounis syndrome.
Vascular disorders
Edema (fluid retention), high blood pressure, and heart failure have also been observed in association with treatments with ibuprofen (arginine) type medications.
Very rare: High blood pressure.
Frequency not known: Arterial thrombosis.
Respiratory, thoracic, and mediastinal disorders
Uncommon: Asthma, worsening of asthma, bronchospasm, dyspnea (breathing difficulty)
Frequency not known: Irritation of the throat.
Gastrointestinal disorders
The most common side effects that occur with medications such as Espidifen are gastrointestinal: Peptic ulcers, gastrointestinal bleeding, perforations (in some cases fatal), especially in elderly patients.
Common: Gastrointestinal disturbances such as pyrosis (heartburn, reflux), abdominal pain, nausea, vomiting, flatulence, diarrhea, constipation, and mild gastrointestinal bleeding that may cause anemia in exceptional cases.
Uncommon: Gastrointestinal ulcers, potentially with bleeding and perforation, stomatitis ulcerosa, exacerbation of colitis and Crohn's disease, melena (blood in stool), gastritis.
Rare: Vomiting with blood.
Very rare: Inflammation of the esophagus, pancreatitis, intestinal stenosis.
Frequency not known: Anorexia.
Hepatobiliary disorders
Rare: Liver damage, hepatitis (inflammation of the liver), abnormalities of liver function, and jaundice (yellowing of the skin and eyes).
Skin and subcutaneous tissue disorders
Common: Skin rash.
Uncommon: Redness of the skin, itching or swelling of the skin (angioedema, urticaria), purpura (purple spots on the skin).
Rare: Anaphylactic reaction.
Very rare: Medications such as Espidifen 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 lesions of purple color, preferably on the trunk) and toxic epidermal necrolysis (erosions in mucous membranes and painful lesions with necrosis and detachment of the epidermis).
Loss of hair, erythema multiforme (skin lesion). Exceptionally, severe skin infections and complications in soft tissue may occur during chickenpox.
Frequency not known: Photosensitivity reactions, 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 and scaly rash, with bumps under the skin and blisters, located mainly on skin folds, trunk, and upper limbs, accompanied by fever. Symptoms usually appear at the beginning of treatment (generalized acute pustular exanthema).
Renal and urinary disorders
Rare: Hematuria (blood in urine).
Very rare: Edema (signs that may indicate kidney disease, which sometimes may include renal insufficiency); renal tissue damage (papillary necrosis), increased serum uric acid concentration.
Based on the experience with nonsteroidal anti-inflammatory drugs in general, cases of interstitial nephritis, nephrotic syndrome, and renal insufficiency cannot be ruled out.
General disorders and administration site conditions
Very rare: Exacerbation of inflammation during infectious processes.
Frequency not known: Edema.
Investigations
Rare: Alteration of liver function tests.
Frequency not known: Alteration of renal function tests.
Until now, severe allergic reactions have not been reported with Espidifen, although they cannot be ruled out. The manifestations of this type of effect may be fever, skin rash, abdominal pain, severe headache, nausea, vomiting, swelling of the face, tongue, and throat, breathing difficulty, asthma, palpitations, hypotension (lower than usual blood pressure) or shock.
If any of the following side effects appear, discontinue treatment and seek immediate medical attention:
Discontinue treatment with Espidifen 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 or pharmacist, even if it is a possible adverse reaction that does not appear in this leaflet. You can also report them directly through the Spanish System for the Pharmacovigilance of Medicinal Products for Human Use: https://www.notificaram.es.
By reporting adverse reactions, you can contribute to providing more information on the safety of this medication.
Keep this medication out of the sight and reach of children.
No special storage conditions are required.
Do not use this medication after the expiration date that appears on the packaging after the abbreviation CAD. The expiration date is the last day of the month indicated.
Medications should not be disposed of through drains or trash. Dispose of the packaging and medications you no longer need at your local SIGRE collection point at your usual pharmacy. Ask your pharmacist how to dispose of the packaging and medications you no longer need. This will help protect the environment.
Composition of Espidifen
The active ingredient is Ibuprofen. Each blister pack contains 600 mg of ibuprofen (as 1.155 mg of ibuprofen (arginine)).
The other components (excipients) are: L-arginine, potassium acesulfame (E950), aspartame (E951), sucrose, anhydrous sodium carbonate, lemon-lime flavor
White-yellowish granulated powder for oral solution. Each package contains 20 or 40 blister packs with granulated powder.
Only some package sizes may be commercially available.
Zambon, S.A.U.
Maresme, 5.Polígono Can Bernades-Subirà
08130 Sta.Perpètua de Mogoda (Barcelona)
Spain
Zambon, S.p.A.
Via della Chimica, 9
36100 Vicenza
Italy
or
Zambon, S.A.U.
Maresme, 5. Polígono Can Bernades-Subirà
08130 Sta. Perpètua de Mogoda (Barcelona)
Spain
The detailed and updated information on this medication is available on the website of the Spanish Agency for Medicines and Medical Devices (AEMPS)http://www.aemps.gob.es/
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