Strepsils Max Pro Special Precautions

Undesirable effects may be minimised by using the lowest effective dose for the shortest possible duration necessary to control symptoms (see texts on Gastrointestinal and Cardiovascular and Cerebrovascular Effects as follows).
The elderly have an increased frequency of adverse reactions to NSAIDs, especially gastrointestinal bleeding and perforation, which may be fatal.
Respiratory: Bronchospasm may be precipitated in patients suffering from, or with a history of, bronchial asthma or allergic disease.
Other Nonsteroidal Anti-Inflammatory Drugs: The use of Strepsils Max Pro with concomitant NSAIDS including cyclooxygenase-2 selective inhibitors should be avoided (see Interactions).
Systemic Lupus Erythematosus and Mixed Connective Tissue Disease: Systemic lupus erythematosus and mixed connective tissue disease may have increased risk of aseptic meningitis (see Adverse Reactions).
Renal: Renal impairment as renal function may further deteriorate (see Contraindication & Adverse Reactions).
Hepatic: Hepatic dysfunction (see Contraindication & Adverse Reactions).
Cardiovascular and Cerebrovascular Effects: Caution (discussion with physician 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.
Clinical trial and epidemiological data suggest that the use of NSAIDs particularly at high doses (2400 mg daily) and in long-term treatment may be associated with a small increased risk of arterial thrombotic events (eg, myocardial infarction or stroke).
All NSAIDs should be prescribed at the lowest effective dose and the duration of treatment should be periodically reviewed and kept as short as possible.
All NSAIDs should not be used perioperatively in patients who have recently undergone coronary artery bypass graft (CABG) surgery and revascularisation procedures.
Impaired Female Fertility: There is some evidence that drugs which inhibit cyclooxygenase/prostaglandin synthesis may cause impairment of female fertility by an effect on ovulation. This is reversible on withdrawal of treatment.
Gastrointestinal: Nonsteroidal anti-inflammatory drugs 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 or perforation, which can be fatal has been reported with all NSAIDs at anytime during treatment, with or without warning symptoms or a previous history of gastrointestinal 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 Contraindication), and in the elderly. These patients should commence treatment on the lowest dose available.
Patients with a history of gastrointestinal toxicity, particularly the elderly, should report any unusual abdominal symptoms (especially gastrointestinal bleeding) particularly in the initial stages of treatment.
Caution should be advised in patients receiving concomitant medications which could increase the risk of ulceration or bleeding eg, oral corticosteroids, anticoagulants eg, warfarin, selective serotonin-reuptake inhibitors (SSRIs) or antiplatelet agents eg, aspirin (see Interactions).
When gastrointestinal bleeding or ulceration occurs in patients receiving flurbiprofen, the treatment should be withdrawn.
Dermatological: Serious skin reactions, some of them fatal eg, exfoliative dermatitis, Stevens-Johnson syndrome and toxic epidermal necrolysis, have been reported very rarely in association with the use of NSAIDs (see Adverse Reactions). Patients appear to be at highest risk of these reactions early in the course of therapy, the onset of the reaction occurring in the majority of cases within the 1st month of treatment. Strepsils Max Pro should be discontinued at the 1st appearance of skin rash, mucosal lesions, or any other sign of hypersensitivity.
Use in lactation: Flurbiprofen appears in the breast milk in very low concentration and is unlikely to affect the breastfed infant adversely.