Strepsils Intensive, honey-lemon tablets 24 pcs.

Flurbiprofen is a derivative of propionic acid from the group of non-steroidal anti-inflammatory drugs (NSAIDs) and has significant analgesic, anti-inflammatory and antipyretic effect due to inhibition of cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2), with some selectivity for COX-1, resulting in reduced production of prostaglandins – mediators of pain, inflammation and hyperthermic response.

The drug has a local anesthetic and anti-inflammatory effect on the mucous membrane of the mouth and throat: it reduces swelling, difficulty in swallowing, pain and irritation in the throat.

The tablet dissolves completely in the mouth within 5-12 minutes. The soothing effect starts from the 2nd minute.

The significant reduction in the intensity of sore throat begins at 22 minutes with maximum effect after 70 minutes and lasts up to 4 hours.

Pharmacokinetics

The tablet dissolves completely in the mouth within 5-12 minutes. Absorption is high, flurbiprofen is quickly and almost completely absorbed, distributed throughout the body and largely bound to plasma proteins. Flurbiprofen is detected in blood after 5 min, maximum concentration of flurbiprofen in blood plasma (Cmax) is reached after 40-45 minutes after resorption.

Flurbiprofen can be absorbed in the oral cavity by passive diffusion. Absorption rate depends on the dosage form; maximum concentration of flurbiprofen is reached faster by resorption than by oral administration of an equivalent dose of flurbiprofen.

The elimination half-life (T1/2) is 3-6 hours. It is metabolized in liver by hydroxylation and excreted by kidneys and, to a lesser extent, with bile. Flurbiprofen is excreted with breast milk in small amounts (< 0.05 µg/ml). About 20-25 % of the oral dose of flurbiprofen is excreted unchanged.

Indications

Treatment of infectious and inflammatory diseases of the mouth and throat (sore throat, sore throat).

The drug can be used by people with diabetes (contains no sugar).

Active ingredient

Flurbiprofen

How to take, the dosage

Read the instructions carefully before using the product.

For topical use. For short-term use only.

Adults and children over 12 years of age: Slowly swallow 1 tablet every 3 to 6 hours.

The maximum daily dose: 5 tablets over 24 hours.

The duration of therapy: not more than 3 days.

If symptoms persist or worsen when taking the drug for 3 days, you should stop treatment and see a doctor.

Interaction

Simultaneous use of flurbiprofen with the following drugs should be avoided:

• Acetylsalicylic acid: except for low doses of acetylsalicylic acid (not more than 75 mg per day) prescribed by a physician, because the combined use may increase the risk of side effects.
• Other NSAIDs, including ibuprofen and selective cyclooxygenase-2 inhibitors: Concomitant use of two or more drugs from the NSAID group should be avoided due to possible increased risk of side effects.

Cautiously used concomitantly with the following drugs:

• Anticoagulants: NSAIDs may increase the effect of anticoagulants, particularly warfarin.
• Antiaggregants and selective serotonin reuptake inhibitors: increased risk of gastrointestinal bleeding.
• Hypotensive drugs (ACE inhibitors and angiotensin II antagonists) and diuretics: NSAIDs may decrease the effectiveness of these groups and may increase nephrotoxicity due to cyclooxygenase inhibition, especially in patients with impaired renal function (adequate fluid replacement in these patients must be provided).
• Heart glycosides: concomitant use of NSAIDs and cardiac glycosides may worsen heart failure, decrease glomerular filtration rate and increase plasma concentration of cardiac glycosides.
• Cyclosporine: increased risk of nephrotoxicity with concomitant use of NSAIDs and cyclosporine.
• Glucocorticosteroids: increased risk of gastrointestinal ulcers and gastrointestinal bleeding.
• Lithium preparations: There is evidence that the plasma concentration of lithium may increase with NSAIDs. NSAIDs should be taken 24 hours before or after methotrexate administration.
• Mifepristone: NSAIDs should not be started less than 8-12 days after mifepristone administration because NSAIDs may decrease the effectiveness of mifepristone.
• Quinolone antibiotics: Patients receiving combined treatment with NSAIDs and quinolone antibiotics may have increased risk of seizures.
• Tacrolimus: Concomitant use of NSAIDs and tacrolimus may increase the risk of nephrotoxicity.
• Peroral hypoglycemic drugs: changes in blood glucose levels are possible (increased frequency of blood glucose monitoring is recommended).
• Phenytoin: serum levels of phenytoin may increase (recommended serum phenytoin level monitoring and, if necessary, dose adjustment).
• Caliber diuretics: co-administration of caliber diuretics and flurbiprofen may lead to hyperkalemia.
• Probenecid and sulfinpyrazone: Drugs containing probenecid or sulfinpyrazone may delay excretion of flurbiprofen.
• Tolbutamide and antacids: To date, studies have shown no interaction between flurbiprofen and tolbutamide or antacids.
  

Special Instructions

It is recommended that the drug be taken in as short a course as possible and in the lowest effective dose necessary to relieve symptoms.

Persons with diabetes should be aware that each honey lemon sippy tablet contains about 2.5 grams of sugar (0.21 CFU) (orange sippy tablets contain no sugar).

The orange sippers contain maltitol liquid and isomalt (the maximum daily dose of which is more than 2 g), so they may have a laxative effect.

In case of symptoms of gastropathy, close monitoring is indicated, including esophagogastroduodenoscopy, complete blood count (hemoglobin determination), fecal occult blood test.

If it is necessary to determine 17-ketosteroids, the drug should be discontinued 48 hours before the study.

Ethanol intake is not recommended during treatment.

Patients with renal or hepatic impairment, as well as elderly patients and patients taking diuretics should consult a physician before using the drug, since there is a risk of impairment of renal function. In short-term use of the drug the risk is insignificant.

Patients with arterial hypertension, including a history of and/or chronic heart failure, should consult a physician before using the drug, as the drug may cause fluid retention, increased blood pressure, and edema.

Information for women planning pregnancy: The drug suppresses cyclooxygenase and prostaglandin synthesis and may affect ovulation, impairing female fertility (reversible after discontinuation of treatment).

In case of irritation in the oral cavity, skin rash, mucosal lesions and other manifestations of allergic reaction, the drug should be stopped and a physician should be consulted.

If there is a worsening of symptoms or if new symptoms develop, including evidence of bacterial infection, you should see a physician immediately so that the therapy can be revised.

Contraindications

• High sensitivity to flurbiprofen or any of the ingredients in the drug.
• A history of hypersensitivity reactions (bronchial asthma, bronchospasm, rhinitis, Quincke’s edema, urticaria, recurrent nasal or paranasal sinus polyposis) in response to use of acetylsalicylic acid or other NSAIDs.
• Erotic ulcerative diseases of the gastrointestinal tract (including gastric and duodenal ulcer, Crohn’s disease, ulcerative colitis) or ulcer bleeding in the acute phase or in the history (two or more confirmed episodes of peptic ulcer or ulcer bleeding).
• Bleeding or gastrointestinal ulcer perforation in history triggered by use of NSAIDs.
• Deficiency of glucose-6-phosphate dehydrogenase, hemophilia and other clotting disorders (including hypocoagulation), hemorrhagic diathesis.
• Severe hepatic insufficiency or active liver disease.
• Severe renal insufficiency (creatinine clearance < 30 ml/min), confirmed hyperkalemia.
• Decompensated heart failure; period after coronary artery bypass.
• Sugar/isomaltase deficiency, fructose intolerance, glucose-galactose malabsorption.
• Pregnancy (3rd trimester).
• Children under 12 years of age.

Cautions

With the conditions listed in this section, consult a physician before using the drug.

Concomitant use of other NSAIDs; history of a single episode of peptic ulcer disease or peptic ulcer bleeding; history of gastrointestinal diseases (ulcerative colitis, Crohn’s disease), gastritis, enteritis, colitis, the presence of Helicobacter pylori infection; bronchial asthma or allergic diseases in the acute stage or in the history – bronchospasm may develop; systemic lupus erythematosus or mixed connective tissue disease (Sharp’s syndrome) – increased risk of aseptic meningitis (with short-term use of flurbiprofen the risk is negligible); renal failure including dehydration (creatinine clearance less than 30-60 ml/min), nephrotic syndrome; liver failure, cirrhosis with portal hypertension, hyperbilirubinemia; arterial hypertension and/or heart failure, edema; concomitant use of drugs that may increase the risk of ulceration or bleeding, in particular oral glucocorticosteroids (including prednisolone), anticoagulants (including warfarin), antiaggregants (including acetylsalicylic acid, clopidogrel), selective serotonin reuptake inhibitors (including citalopram, fluoxetine, paroxetine, sertraline) I-II trimester pregnancy, breastfeeding, old age, and alcohol use.