Nurofen Plus

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Nurofen Plus

Medically reviewed

Laura Arias

Last updated on 22/12/2025

This page provides general, reference-level information compiled from official medical sources. It is not a substitute for professional medical advice, diagnosis, or treatment. For decisions about your health, please consult a qualified healthcare professional.

Overview of Nurofen Plus

Quick Facts

Property Description
Active ingredient Ibuprofen, Codeine phosphate
Form Film-coated tablets, Oral formulation
Pharmacological class Combination analgesic (NSAID/Opioid)
General Purpose Dual-action relief for pain
Origin Synthetic

What is Nurofen Plus?

What is Nurofen Plus and its Composition?

Nurofen Plus is a synthetic, fixed-dose combination product manufactured by Reckitt Benckiser, classified as a combination analgesic preparation. This medicine is designed for oral administration, typically manufactured as a film-coated tablet. The preparation contains two distinct active ingredients with complementary actions: Ibuprofen and Codeine phosphate (INN). The inclusion of the Codeine phosphate ingredient defines this product's identity, often leading to a strict Pharmacy-only or Prescription-only regulatory status in many markets, which differentiates it from standard over-the-counter Ibuprofen preparations.

Classification and General Purpose

The drug’s classification stems from its dual composition, which incorporates both an NSAID component and an Opioid analgesic component. The Ibuprofen component is formally categorized as a Nonsteroidal Anti-inflammatory Drug (NSAID), known to reduce the body's response to inflammation and fever. This means one component helps reduce discomfort at the source of irritation.

This structural pairing is specifically designated as a combination analgesic, a class pharmacologically supported for its ability to target two different pain pathways. Furthermore, the Codeine phosphate component is an Opioid analgesic, documented to influence pain signals by acting on receptors in the Central Nervous System. The second component changes how the brain and spinal code perceive intense pain. The overall purpose is to achieve a synergistic effect intended to provide more potent pain relief, typically reserved for discomfort that has not been adequately managed by single-agent NSAIDs.

What side effects are possible with Nurofen Plus ?

Possible Side Effects and Safety Information

The combined use of ibuprofen (a non-steroidal anti-inflammatory drug or NSAID) and codeine (an opioid analgesic) presents a dual-risk safety profile. Adverse reactions may involve multiple system-organ classes, most commonly affecting the gastrointestinal and nervous systems, as well as the immune system.

Key Adverse Reactions and Frequencies

Classification Examples of Adverse Reactions (Not Exhaustive)
Uncommon Headache, abdominal pain, nausea, dyspepsia, skin rash, hypersensitivity reactions (urticaria).
Very Rare Severe haematopoietic disorders (e.g., agranulocytosis), anaphylactic reactions, aseptic meningitis, peptic ulcer, GI perforation or haemorrhage, acute renal failure.
Not Known Drug dependence/abuse, respiratory depression, severe hypokalaemia, renal tubular acidosis.

Serious Safety Considerations

Gastrointestinal and Renal Harms: The ibuprofen component carries a risk of serious gastrointestinal events, including ulceration, bleeding, and perforation, which can be fatal. Prolonged use at higher than recommended doses, often due to dependence on codeine, has been specifically associated with serious clinical harms, including renal tubular acidosis and severe hypokalaemia, in addition to gastrointestinal haemorrhage and renal failure.

Opioid Risks: The codeine component poses a risk of respiratory depression and the development of physical and psychological dependence or abuse, even at therapeutic doses for short periods. Codeine should not be used in children under 12 years and is contraindicated in adolescents (12-18 years) with compromised respiratory function.

Restrictions and Cautions: Treatment must be limited to the lowest effective dose for the shortest possible duration (e.g., generally no more than three consecutive days). It is contraindicated in patients with severe heart, renal, or hepatic failure, and in the last trimester of pregnancy. Elderly patients face an increased risk of serious adverse reactions, particularly gastrointestinal bleeding.

Overdose and Emergency Response

Overdose and When to Seek Help

The official overdose profile for Nurofen Plus is defined by the distinct, compounding toxicities of its Ibuprofen and Codeine components. Overdose manifestations related to the opioid component (Codeine) may include profound sedation, confusion, pinpoint pupils, and cyanosis, escalating to life-threatening respiratory depression and coma.

The NSAID component (Ibuprofen) contributes risks of severe gastrointestinal pain and haemorrhage, as well as delayed complications such as renal tubular acidosis and renal failure, particularly after prolonged high-dose exposure.

Health regulators mandate that immediate medical attention must be sought for any suspected overdose, even if the patient appears well, due to the risk of delayed severe effects. Emergency management involves supportive care, monitoring for signs of sedation, and the use of the documented opioid antagonist Naloxone to reverse respiratory depression.

Population-specific warnings are provided, noting that accidental ingestion of even one dose can be fatal in children, and identifying ultra-rapid metabolizers and elderly patients as groups facing heightened risk of severe outcomes. Monitoring in a hospital setting is essential to track vital signs and assess for systemic organ damage.

Therapeutic Uses of Nurofen Plus

What Nurofen Plus Treats: Main Uses and Benefits

The primary therapeutic benefit of Nurofen Plus is to provide supportive symptomatic relief for pain that presents with heightened symptom intensity. This combination medicine is commonly used across domains where additional symptomatic support is needed, relevant in contexts involving heightened systemic burden. This medicine is typically applied in conditions such as severe headache and migraine attacks, intense dental pain, acute period pain, and discomfort from musculoskeletal sprains or arthritic flares.

Quick Fact: Relief for Heightened Symptoms

Area of Relief Type of Symptoms Managed
Analgesia Acute, severe, or episodic pain
Symptom Context Symptoms that interfere with daily functioning
Supportive Use Used when additional symptomatic support is needed

This medication helps address symptom clusters that may become intense or disruptive. It supports the patient during difficult episodes by easing distress and may help maintain a sense of stability when symptoms are more noticeable. Nurofen Plus is commonly applied in scenarios where additional management of discomfort is required for pain that is pronounced and difficult to address with simple analgesia. This supports general well-being during symptomatic phases and contributes to improved day-to-day comfort during symptomatic periods.

Eligibility and Restrictions for Use

Who Can and Cannot Use Nurofen Plus?

The population eligibility for Nurofen Plus (Ibuprofen/Codeine) is strictly limited by regulatory authorities due to the risks of its combined components. The medicine is primarily intended for short-term use by adults and adolescents aged 12 years and older who require relief from moderate pain not managed by single-agent analgesics.


Contraindicated Populations

Use is strictly contraindicated for several groups:

  • Children under 12 years of age due to the unpredictable metabolism of codeine to morphine.
  • Breastfeeding mothers and women in the last trimester of pregnancy.
  • Patients with severe heart, liver, or kidney failure.
  • Individuals with a history of peptic ulcer, gastrointestinal bleeding, or perforation related to NSAID use.
  • Patients known to be ultra-rapid metabolizers of codeine.

Restricted or Conditional Use

Use requires caution or is not recommended in other specific populations:

  • Adolescents (under 18) who have undergone tonsillectomy or adenoidectomy for sleep apnoea, or those with compromised respiratory function.
  • The elderly due to increased susceptibility to adverse reactions, particularly GI and CNS effects.
  • Patients with pre-existing conditions like uncontrolled hypertension, non-severe organ impairment, or certain gastrointestinal diseases (e.g., Crohn's Disease).

What should I know about interactions with other medicines?

Concomitant use of Nurofen Plus (ibuprofen and codeine) with certain medications can lead to increased risk of side effects, reduced effectiveness, or serious adverse events. Always consult a healthcare professional before combining this product with other drugs, including over-the-counter (OTC) medicines, supplements, or herbal remedies.

️ Medicines to Avoid or Use with Caution

Type of Medicine Examples Primary Risk
Other NSAIDs High-dose aspirin, naproxen, celecoxib Increased risk of gastrointestinal bleeding and ulcers.
Anticoagulants Warfarin Increased risk of bleeding.
SSRIs/SNRIs Fluoxetine, paroxetine, venlafaxine Increased risk of gastrointestinal bleeding.
Other Opioids Morphine, tramadol Enhanced central nervous system (CNS) depression, including sedation and respiratory depression.
CNS Depressants Alcohol, sedatives, hypnotics, certain antihistamines Enhanced CNS depression (e.g., drowsiness, respiratory issues).
MAO Inhibitors Isocarboxazid, phenelzine (or within 14 days of use) Enhanced codeine-related respiratory depression and CNS effects.
High Blood Pressure ACE inhibitors, beta-blockers, diuretics Reduced effectiveness of blood pressure medication; potential for kidney function changes.

It is crucial to avoid taking Nurofen Plus with any other product that contains ibuprofen, codeine, or any other Non-Steroidal Anti-Inflammatory Drug (NSAID) to prevent excessive dosage and potential harm. If you are taking low-dose aspirin for cardiovascular protection, discuss this with your doctor as ibuprofen may interfere with its anti-platelet effect.

Mechanism of Action

Nurofen Plus is a combination medicine containing ibuprofen (a non-steroidal anti-inflammatory drug) and codeine (an opioid analgesic). The mechanism of action is complex and involves distinct pharmacological domains that influence downstream physiological outcomes.

Modulating Prostaglandin Synthesis and Inflammatory Signaling

This domain centers on ibuprofen's action, which involves the non-selective inhibition of cyclooxygenase enzymes (COX-1 and COX-2). By blocking these enzymes, the initial molecular steps in the synthesis of prostaglandins—key mediators of physiological responses—are suppressed, modifying signaling patterns driven by prostaglandin biosynthesis.

Engaging Central Opioid Receptors

This domain covers the action of codeine, a prodrug that is metabolized into morphine. Morphine acts primarily as an agonist at mu-opioid receptors ( MOR) within the central nervous system (CNS), including the brain and spinal cord. Engaging these G-protein coupled receptors initiates inhibitory signaling sequences that modify neuronal transmission and decreases signaling through mu-opioid receptor engagement.

Influencing Descending Inhibitory Pathways

The influence of both peripheral and central components converges on the descending modulatory system. This system uses neurotransmitters to regulate efferent signaling from the spinal cord to higher centers, and this combined influence modulates the balance of excitatory and inhibitory neurotransmitter release within descending modulatory circuits.

Dosage and Administration Information

Nurofen Plus tablets contain a combination of Ibuprofen (200mg) and Codeine phosphate (12.8mg) per tablet, and are intended for the short-term treatment of acute moderate pain when single-ingredient analgesics are insufficient. Always adhere strictly to the dosage instructions provided by a healthcare professional or those detailed on the packaging. The lowest effective dose should be used for the shortest duration necessary to control symptoms.


Dosage and Administration

Age Group Starting Dose (Oral) Interval Between Doses Maximum Daily Dose
Adults and Adolescents (12 years and over) 1 or 2 tablets Every 4 to 6 hours 6 tablets (1200mg Ibuprofen/76.8mg Codeine) in 24 hours
Children under 12 years Not recommended N/A N/A
  • Swallow the tablets whole with a drink of water.
  • Taking the tablets with or immediately after food may help prevent stomach upset.
  • The minimum time to leave between doses is 4 hours.
  • Do not take Nurofen Plus for more than 3 consecutive days without medical advice. If pain persists or worsens after 3 days, consult a doctor or pharmacist.

Important Safety Information

Due to the presence of codeine, continuous use for more than three days may lead to dependency and potential withdrawal symptoms upon discontinuation. Excessive or prolonged use, especially at higher than recommended doses, has been associated with serious clinical risks. It is vital to use the medicine only as needed and to seek professional advice if you require ongoing pain relief.

Recent Clinical Evidence

Research Evidence / Overview of Studies for Nurofen Plus

Evidence for Acute Pain Models and Post-Surgical Relief

The combination of Ibuprofen and Codeine was studied in research exploring acute, short-term pain in research models. This research is derived primarily from Randomized Controlled Trials (RCTs) and is relevant in trials assessing short-term, intense discomfort, such as following minor surgical procedures like dental extractions. Studies examined how quickly and extensively patient-reported outcomes describing perceived discomfort evolved over defined time intervals.

Findings from these trials, synthesized in Systematic Reviews and Meta-analyses, reported how patient-reported outcomes evolved in the study populations. These findings describe patterns observed in the studies when research explored comparisons against an inactive control group.

However, the follow-up durations were limited in this body of evidence, often focusing on the initial three to six hours after a single dose. Consequently, there is limited information for long-term outcomes or the patterns of use extending beyond this brief period.


Evidence for Relief of Acute Episodic Pain

Research has also explored the role of the combination in conditions characterized by fluctuating or episodic manifestations, such as severe headache, migraine, and period pain. This research was evaluated in studies observing responses over defined time intervals when symptoms become more noticeable. Studies examined outcomes related to physical discomfort and daily functioning during an acute pain episode.


Study Quality and Areas of Research Uncertainty

An evaluation of the research base highlights where data remains limited. A significant gap is the limited information available to clearly isolate the incremental benefit of adding the opioid component (Codeine) versus simply using a maximal or equivalent dose of the non-opioid component (Ibuprofen) alone in all relevant conditions. The evidence quality varies across studies, and certainty remains low regarding specific comparative outcomes.

Key Studies & References

  1. Codeine for Acute Extremity Pain - NCBI Bookshelf (NIH Report)
  2. MHRA Public Assessment Report: Minimising the risk of addiction to medicines containing codeine and dihydrocodeine (UK Regulatory Document)
  3. Therapeutic Goods Administration (TGA) Consumer fact sheet: Codeine-containing medicines: Harms and changes to patient access (Australian Regulatory Document)

Frequently Asked Questions (FAQ)

Common questions about Nurofen Plus (FAQ)


Q: How long does it usually take for Nurofen Plus to start working?

A: Studies examining the combination analgesic often focus on clinically important pain relief achieved within the initial 3 to 6 hours after taking a single dose. Official research often gauges the initial effectiveness of the medicine based on pain relief achieved within this time frame.


Q: What is the typical duration of pain relief from one dose of Nurofen Plus?

A: The official product information recommends leaving a minimum of 4 to 6 hours between doses. This time frame reflects the minimum recommended period between doses in the official product information.


Q: Is Nurofen Plus suitable for menstrual pain?

A: Yes, regulatory documents list the relief of pain associated with dysmenorrhoea (period pain) as one of the product's therapeutic indications. The medicine is authorized for use in the relief of this type of pain.


Q: Is Nurofen Plus useful for migraine pain?

A: Official therapeutic indications state that Nurofen Plus is indicated for the relief of pain associated with conditions including migraine. The medicine is authorized for use in the relief of this type of pain.


Q: Does Nurofen Plus help with pain related to inflammation?

A: Yes, one of the active ingredients is ibuprofen, which is classified as a non-steroidal anti-inflammatory drug (NSAID). This component works by changing the body's response to swelling and inflammation, which is described as modifying pain linked to these processes.


Q: Is it common for people to experience stomach upset after taking Nurofen Plus?

A: Gastrointestinal side effects such as nausea, vomiting, and general stomach upset are listed among the common side effects in the official product information. The official guidance states that taking the medicine with or immediately after food may help reduce these effects.


Q: Is it true that Nurofen Plus can cause constipation?

A: Yes, regulatory information lists constipation as a less serious side effect that may occur while taking the medicine. This is a recognized potential side effect associated with the codeine component of the medicine.


Q: What are the general expectations for pain relief when using Nurofen Plus?

A: The medicine is specifically intended for acute moderate pain that has not been adequately relieved by single-ingredient painkillers alone. Studies report on patient-perceived outcomes, often focusing on clinically important pain relief achieved in the short term.


Q: How does Nurofen Plus compare to other combination analgesics described in official sources?

A: Regulatory reviews acknowledge that the combination has demonstrated effectiveness in its intended use. However, these reviews also indicate a limited research base for clearly isolating the extra benefit of the codeine component compared to simply using an equivalent dose of a single analgesic in all conditions.


Q: What kind of pain is Nurofen Plus typically used for?

A: According to official therapeutic indications, the medicine is used for the short-term treatment of acute, moderate pain. This includes relief from common types of discomfort suchs as rheumatic and muscular pain, backache, migraine, dental pain, and menstrual pain.


Q: Is Nurofen Plus different from regular Nurofen?

A: Yes, regular Nurofen typically contains only ibuprofen. Nurofen Plus is a combination product that contains two active ingredients: ibuprofen (an NSAID) and codeine (an opioid analgesic). The inclusion of codeine is what differentiates the product and determines its stricter regulatory status.


Q: Why is Nurofen Plus sometimes kept behind the pharmacy counter?

A: In many regions, regulations mandate a pharmacy-only or prescription-only status for products containing codeine. This control is implemented due to the potential risk of dependence and misuse associated with the codeine component of the medicine.


Q: Is Nurofen Plus considered a strong painkiller?

A: Officially, the product is classified as a combination analgesic for the treatment of acute, moderate pain. This classification indicates its intended use for moderate pain that has not been relieved by single-ingredient analgesics alone.


Q: Can Nurofen Plus affect sleep patterns?

A: Yes, official safety information lists potential side effects that can affect sleep, including sleeplessness or insomnia and nightmares. Additionally, the medicine can cause drowsiness.


Q: Can Nurofen Plus affect blood pressure?

A: The label information cautions that patients with high blood pressure (hypertension) should speak to a healthcare professional before use.


Q: Are there certain foods or drinks that should be avoided when taking Nurofen Plus?

A: The primary official warning is to strictly avoid drinking alcohol while taking this medicine, as it can enhance central nervous system effects like drowsiness. General advice is to speak with a healthcare professional regarding any supplements or remedies being taken.


Q: Is Nurofen Plus ever used for fever?

A: Yes, although the primary purpose is pain relief, the therapeutic indications for the product also include the management of feverishness and symptoms related to colds and flu.


Q: What are the signs that someone might be reacting poorly to Nurofen Plus?

A: Official warnings describe signs of a serious adverse reaction, which include swelling of the face, lips, or tongue, difficulty swallowing or breathing, hives or a skin rash, and fainting. If any of these signs occur, immediate medical attention is required.


Q: What are some common reasons people look for alternatives to Nurofen Plus?

A: Reasons for seeking alternatives are generally linked to the product's official limitations, such as the 3-day limit on use, various contraindications (like severe organ failure), and warnings about the risk of dependency associated with the codeine component.


Q: Is Nurofen Plus suitable for arthritis pain?

A: The official therapeutic indications for the product include relief of pain associated with rheumatic and muscular pain. However, due to the mandatory short-term use limit of three days, it is typically not recommended for chronic, long-term conditions.


Q: Are there any common over-the-counter medicines that interact with Nurofen Plus?

A: Official guidance warns specifically against combining Nurofen Plus with other products that contain ibuprofen, aspirin, or naproxen, which are common over-the-counter anti-inflammatory medicines. Combining these could increase the risk of serious side effects.


Q: Is the ibuprofen in Nurofen Plus the same as the ibuprofen in standard pain relievers?

A: Yes, Nurofen Plus contains Ibuprofen (200mg), which is the same type of non-steroidal anti-inflammatory drug (NSAID) found in standard single-ingredient relievers. The key difference is the addition of the second active ingredient, codeine.


Q: Can Nurofen Plus be used for tension headaches?

A: The therapeutic indications for the product include the relief of pain associated with headache, which covers tension headaches. However, its use is limited to acute, moderate pain when standard pain relievers have not worked.


Q: Does taking Nurofen Plus affect the ability to drive or operate machinery?

A: Official warnings state that the medicine may cause dizziness or drowsiness in some individuals. The label advises that if you experience these effects, driving or operating machinery should be avoided.


Q: How does the codeine component contribute to pain relief?

A: Codeine is classified as a prodrug, meaning it is converted by the body into morphine. The morphine then acts on opioid receptors in the central nervous system (the brain and spinal cord) to reduce the communication of intense pain messages.


Q: What is the difference between Ibuprofen and Codeine in Nurofen Plus?

A: The two active ingredients target pain differently: Ibuprofen is an NSAID that works mainly at the source of the discomfort to help reduce inflammation, while codeine is an opioid analgesic that changes how intense pain signals are perceived by the central nervous system.


Q: Is Nurofen Plus known to cause drowsiness?

A: Drowsiness is listed as a potential side effect in the official product information. This effect is why official warnings are issued regarding driving or operating machinery while taking the medicine.


Q: Is Nurofen Plus known to interact with herbal supplements?

A: General official guidance advises patients that there is not enough information to confirm that complementary or herbal remedies are safe to take with Nurofen Plus. General advice is to speak with a healthcare professional regarding any supplements or remedies being taken.

How should Nurofen Plus be stored and disposed of?

Storage and Disposal Requirements for Nurofen Plus

Nurofen Plus (Ibuprofen/Codeine) must be handled according to specific regulatory requirements to maintain its stability and ensure safety.


Official Storage Conditions

Requirement Constraint
Temperature Store below 25°C (77°F).
Container Keep in the original pack in a dry place.
Stability Do not use after the expiry date.

The medicine is mandatory to be kept out of the sight and reach of children due to its Codeine component. Tablets must also be protected from moisture and temperatures above the stated maximum.


Disposal Instructions

Unused or expired Nurofen Plus must be disposed of promptly and safely. Regulatory documents prohibit disposing of the medicine in the household trash or down the drain/wastewater. The required procedure is to return the unused product to a pharmacist or an official take-back program for proper disposal according to local regulations.

Attention! Always consult to a doctor or pharmacist before using pills or medicines.

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