Severe hepatic failure, renal failure or heart failure (See section 4.4, Special warnings and precautions for use).

The elderly are at increased frequency of adverse reactions to NSAIDS, especially gastrointestinal bleeding and perforation which may be fatal (see section 4.2). Monoamine Oxidase Inhibitors (MAOIs): CNS depression or excitation may occur if Codeine is given to patients receiving monoamine oxidase inhibitors, or within two weeks of stopping treatment with them.

Neuropen

While a short course of combined ibuprofen and codeine could be taken up to 28 weeks of pregnancy, other painkillers are likely to be more suitable.

From the 20th week of pregnancy onward, Nurofen Plus use may cause oligohydramnios resulting from foetal renal dysfunction. This may occur shortly after treatment initiation and is usually reversible upon discontinuation. In addition, there have been reports of ductus arteriosus constriction following treatment in the second trimester, most of which resolved after treatment cessation. Therefore, during the first and second trimester of pregnancy, Nurofen Plus should not be given unless clearly necessary. If Nurofen Plus is used by a woman attempting to conceive, or during the first and second trimester of pregnancy, the dose should be kept as low and duration of treatment as short as possible. Antenatal monitoring for oligohydramnios and ductus arteriosus constriction should be considered after exposure to Nurofen Plus for several days from gestational week 20 onward. Nurofen Plus should be discontinued if oligohydramnios or ductus arteriosus constriction are found. Nuromol Dual Action Pain Relief 200/500mg tablets. Contains ibuprofen & paracetamol. For pain relief not relieved by ibuprofen or paracetamol individually.

Precaution

Relatively traditional tests such as ankle reflex, 10 g monofilament test and 128 Hz tuning fork have been recommended as screening tests for DPN. They can be used solely or jointly as triage tests in clinical practice for physical examination to assess the signs of DPN, which may also contribute to clinical diagnosis of DPN. Their results require confirmation by more objective measures such as electrodiagnostic, quantitative sensory and autonomic function tests, which can help establish the confirmed diagnosis and classification of DPN ( American Diabetes Association 1992; Boulton 2005a). However, in some population‐based epidemiological studies, these tests have been used jointly in the replacement of NCS to identify DPN. Prolonged regular use of Codeine, except under medical supervision, may lead to physical and psychological dependence (addiction) and result in withdrawal symptoms, such as restlessness and irritability once the drug is stopped.

Renal impairment as renal function may further deteriorate (See section 4.3 and Section 4.8). There is a risk of renal impairment in dehydrated children and adolescents.VPT is one type of quantitative sensory test which is an extension of the sensory portion of the neurological evaluation with the ability to determine the absolute threshold in thermal perception, light touch perception, pain perception, cutaneous current perception, as well as vibration perception ( American Diabetes Association 1992). 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). Results of NCS are vulnerable to many factors including filter setting, type of electrodes, the location of recording, limb temperature, qualification of examiner and other aspects. All these factors require meticulous attention to detail for reliable NCS ( American Diabetes Association 1992). Applicable variables such as skin temperature, age, height, sex, and weight should be measured and accounted for when reporting a NCS as normal or abnormal ( AAEM 1999).

Acetylsalicylic Acid (Aspirin): Unless low-dose acetylsalicylic acid (aspirin) (not above 75mg daily) has been advised by a doctor, as this may increase the risk of adverse reactions (See section 4.4). Diabetic peripheral neuropathy is one of the most common complications of diabetes, potentially leading to loss of If you are pregnant or are being prescribed medicines by your doctor, seek this advice before taking this product. Care is advised in the administration of this product in patients with severe renal or severe hepatic impairment (hepatic disease).Combined ibuprofen and codeine is not suitable for some people. To make sure combined ibuprofen and codeine is safe for you, tell your pharmacist or doctor if you: TheIpswichTouchTest: a simple and novel method to identify inpatients with diabetes at risk of foot ulceration. Sucrose - Patients with rare hereditary problems of fructose intolerance, glucose-galactose malabsorption or sucrase-isomaltase insufficiency should not take this medicine. Renal tubular acidosis and hypokalaemia have been reported in the post-marketing setting typically following prolonged use of the ibuprofen component at higher than recommended doses. Anticoagulants: NSAIDs may enhance the effects of anti-coagulants, such as warfarin (See section 4.4).