Strepsils MaxPro Direct Special Precautions

Talk to the doctor or pharmacist before using Flurbiprofen (Strepsils MaxPro Direct).
Respiratory: Bronchospasm may be precipitated in patients suffering from or with a previous history of bronchial asthma or allergic disease. Flurbiprofen should be used with caution in these patients.
Other NSAIDs: The use of flurbiprofen with concomitant NSAIDs including cyclooxygenase-2 selective inhibitors should be avoided (see Interactions).
Systemic lupus erythematosus and mixed connective tissue disease: Patients with systemic lupus erythematosus and mixed connective tissue disease may have an increased risk of aseptic meningitis (see Adverse Reactions), however this effect is not usually seen with short term and limited use flurbiprofen products.
Cardiovascular and Cerebrovascular Effects: Caution (discussion with a doctor or pharmacist) is required prior to starting treatment in patients with a history of hypertension and/or heart failure as fluid retention, hypertension and oedema have been reported in association with NSAID therapy.
Nervous System Effects: In the event of prolonged use of analgesics or use beyond the product posology, analgesic induced headache may occur, which must not be treated with increased doses of the medicinal product.
Impaired female fertility: There is limited evidence that drugs which inhibit cyclo-oxygenase/prostaglandin synthesis may cause impairment of female fertility by an effect on ovulation. This is reversible on withdrawal of treatment.
Gastrointestinal Effects: NSAIDs should be given with care to patients with a history of gastrointestinal disease (ulcerative colitis, Crohn's disease) as these conditions may be exacerbated (see Adverse Reactions).
Gastrointestinal bleeding, ulceration and perforation which can be fatal, has been reported with all NSAIDs at any time during treatment, with or without warning symptoms or a previous history of serious GI events.
The risk of gastrointestinal bleeding, ulceration or perforation is higher with increasing NSAID doses, in patients with a history of ulcer, particularly if complicated with haemorrhage or perforation (see Contraindications) and in the elderly, however this effect is not usually seen with short term limited use flurbiprofen products. Patients with a history of gastrointestinal toxicity, particularly the elderly, should report any unusual abdominal symptoms (especially GI bleeding) to their healthcare professional.
Caution is 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 acetylsalicylic acid (see Interactions).
If gastrointestinal bleeding or ulceration occurs in patients receiving flurbiprofen, the treatment should be withdrawn.
Dermatological: Serious skin reactions, some of them fatal, including exfoliative dermatitis, Stevens Johnson syndrome, and toxic epidermal necrolysis, have been reported very rarely in association with the use of NSAIDs (see Adverse Reactions). Flurbiprofen use should be discontinued at the first appearance of skin rash, mucosal lesions, or any other sign of hypersensitivity.
Infections: Since in isolated cases an exacerbation of infective inflammations (e.g., development of necrotizing fasciitis) has been described in temporal association with the use of systemic NSAIDs as a class, the patient is advised to consult a physician immediately if signs of a bacterial infection occur or worsen during the flurbiprofen therapy. If the symptoms get worse or if new symptoms occur, the treatment should be re-evaluated by a healthcare professional. If mouth irritation occurs, treatment should be withdrawn.
Effects on ability to drive and use machines: The product has no or negligible influence on the ability to drive and use machines.
Renal and Hepatic Impairment: NSAIDs have been reported to cause nephrotoxicity in various forms including interstitial nephritis, nephrotic syndrome, and renal failure. The administration of an NSAID may cause a dose dependent reduction in prostaglandin formation and precipitate renal failure. Patients at greatest risk of this reaction are those with impaired renal function, cardiac impairment, liver dysfunction, those taking diuretics and the elderly, however, this effect is not usually seen with short term, limited use flurbiprofen products.
Use in the Elderly: The elderly have an increased frequency of adverse reactions to NSAIDs especially gastrointestinal bleeding and perforation which may be fatal.