If you will be taking MOTRIN for a long time, as for arthritis (rheumatism), your doctor should check your progress at regular visits. Your doctor may want to do certain tests to find out if unwanted effects are occurring, especially if you are taking phenylbutazone. The tests are very important because serious side effects, including ulcers, bleeding, or blood problems, can occur without any warning.

Stomach problems may be more likely to occur if you drink alcoholic beverages while being treated with MOTRIN. Also, alcohol may add to the depressant side effects of phenylbutazone.

If you consume 3 or more alcoholic beverages per day, check with your doctor before taking MOTRIN.

Taking two or more of the nonsteroidal anti-inflammatory drugs together on a regular basis may increase the chance of unwanted effects. Also, taking acetaminophen, aspirin or other salicylates, or ketorolac (e.g., Toradol) regularly while you are taking a nonsteroidal anti-inflammatory drug may increase the chance of unwanted effects. The risk will depend on how much of each medicine you take every day, and on how long you take the medicines together. If your health care professional directs you to take these medicines together on a regular basis, follow his or her directions carefully. However, do not take acetaminophen or aspirin or other salicylates together with MOTRIN for more than a few days, and do not take any ketorolac (e.g., Toradol) while you are taking MOTRIN, unless your doctor has directed you to do so and is following your progress.

Before having any kind of surgery (including dental surgery), tell the medical doctor or dentist in charge that you are taking MOTRIN. If possible, this should be done when your surgery is first being planned. Some of the nonsteroidal anti-inflammatory drugs can increase the chance of bleeding during and after surgery. It may be necessary for you to stop treatment for a while, or to change to a different nonsteroidal anti-inflammatory drug that is less likely to cause bleeding.

MOTRIN may cause some people to become confused, drowsy, dizzy, lightheaded, or less alert than they are normally. It may also cause blurred vision or other vision problems in some people. Make sure you know how you react to MOTRIN before you drive, use machines, or do anything else that could be dangerous if you are confused, dizzy, or drowsy, or if you are not alert and able to see well. If these reactions are especially bothersome, check with your doctor.

For patients taking the buffered form of phenylbutazone (e.g., Alka-Butazolidin):

• MOTRIN contains antacids that can keep other medicines from working properly if the 2 medicines are taken too close together. Always take MOTRIN:
  • At least 6 hours before or 2 hours after taking ciprofloxacin (e.g., Cipro) or lomefloxacin (e.g., Maxaquin).
  • At least 8 hours before or 2 hours after taking enoxacin (e.g., Penetrex).
  • At least 2 hours after taking itraconazole (e.g., Sporanox).
  • At least 3 hours before or after taking ketoconazole (e.g., Nizoral).
  • At least 2 hours before or after taking norfloxacin (e.g., Noroxin) or ofloxacin (e.g., Floxin).
  • At least 1 to 3 hours before or after taking a tetracycline antibiotic by mouth.
  • At least 1 or 2 hours before or after taking any other medicine by mouth.

For patients taking mefenamic acid:

• If diarrhea occurs while you are using MOTRIN, stop taking it and check with your doctor immediately. Do not take it again without first checking with your doctor, because severe diarrhea may occur each time you take it.

Some people who take nonsteroidal anti-inflammatory drugs may become more sensitive to sunlight than they are normally. Exposure to sunlight, even for brief periods of time, may cause severe sunburn; blisters on the skin; skin rash, redness, itching, or discoloration; or vision changes. When you begin taking MOTRIN:

• Stay out of direct sunlight, especially between the hours of 10:00 a.m. and 3:00 p.m., if possible.
• Wear protective clothing, including a hat and sunglasses.
• Apply a sun block product that has a skin protection factor (SPF) of at least 15. Some patients may require a product with a higher SPF number, especially if they have a fair complexion. If you have any questions about this, check with your health care professional.
• Do not use a sunlamp or tanning bed or booth.

If you have a severe reaction from the sun, check with your doctor.

Serious side effects, including ulcers or bleeding, can occur during treatment with MOTRIN. Sometimes serious side effects can occur without any warning. However, possible warning signs often occur, including severe abdominal or stomach cramps, pain, or burning; black, tarry stools; severe, continuing nausea, heartburn, or indigestion; and/or vomiting of blood or material that looks like coffee grounds. Stop taking MOTRIN and check with your doctor immediately if you notice any of these warning signs.

Check with your doctor immediately if chills, fever, muscle aches or pains, or other influenza-like symptoms occur, especially if they occur shortly before, or together with, a skin rash. Very rarely, these effects may be the first signs of a serious reaction to MOTRIN.

Nonsteroidal anti-inflammatory drugs may cause a serious type of allergic reaction called anaphylaxis. Although this is rare, it may occur more often in patients who are allergic to aspirin or to any of the nonsteroidal anti-inflammatory drugs. Anaphylaxis requires immediate medical attention . The most serious signs of this reaction are very fast or irregular breathing, gasping for breath, wheezing, or fainting. Other signs may include changes in color of the skin of the face; very fast but irregular heartbeat or pulse; hive-like swellings on the skin; and puffiness or swellings of the eyelids or around the eyes. If these effects occur, get emergency help at once. Ask someone to drive you to the nearest hospital emergency room. If this is not possible, do not try to drive yourself. Call an ambulance, lie down, cover yourself to keep warm, and prop your feet higher than your head. Stay in that position until help arrives.

For patients taking ibuprofen or naproxen without a prescription:

• Check with your medical doctor or dentist:
  • if your symptoms do not improve or if they get worse.
  • if you are using MOTRIN to bring down a fever and the fever lasts more than 3 days or returns.
  • if the painful area is red or swollen.

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Stop taking MOTRIN and get emergency help right away if any of the following side effects occur:

• Rare--For all nonsteroidal anti-inflammatory drugs
  • Fainting;  fast or irregular breathing ;  fast, irregular heartbeat or pulse;  hive-like swellings (large) on face, eyelids, mouth, lips, or tongue;  puffiness or swelling of the eyelids or around the eyes;  shortness of breath, troubled breathing, wheezing, or tightness in chest 
  
  

Also, stop taking MOTRIN and check with your doctor immediately if any of the following side effects occur:

• More common--for mefenamic acid only
  • Diarrhea 
  
  

• More common--for phenylbutazone only
  • Swelling of face, hands, feet, or lower legs;  weight gain (rapid) 
  
  

• Symptoms of phenylbutazone overdose
  • Bluish color of fingernails, lips, or skin;  headache (severe and continuing) 
  
  

• Rare--for all nonsteroidal anti-inflammatory drugs
  • Abdominal or stomach pain, cramping, or burning (severe);  bloody or black, tarry stools;  chest pain;  convulsions (seizures);  fever with or without chills;  nausea, heartburn, and/or indigestion (severe and continuing);  pinpoint red spots on skin;  sores, ulcers, or white spots on lips or in mouth;  spitting up blood;  unexplained nosebleeds;  unusual bleeding or bruising;  vomiting of blood or material that looks like coffee grounds 
  
  

Also, check with your doctor as soon as possible if any of the following side effects occur:

• More common
  • Bleeding from rectum (with suppositories);  headache (severe), especially in the morning (for indomethacin only);  skin rash 
  
  

• Less common or rare
  • Bladder pain;  bleeding from cuts or scratches that lasts longer than usual;  bleeding or crusting sores on lips;  bloody or cloudy urine or any problem with urination, such as difficult, burning, or painful urination ;  change in urine color or odor;  frequent urge to urinate;  sudden, large increase or decrease in the amount of urine;  or loss of bladder control;  blurred vision or any change in vision;  burning feeling in throat, chest, or stomach;  confusion, forgetfulness, mental depression, or other mood or mental changes ;  cough or hoarseness;  decreased hearing, any other change in hearing, or ringing or buzzing in ears ;  difficulty in swallowing;  eye pain, irritation, dryness, redness, and/or swelling;  hallucinations (seeing, hearing, or feeling things that are not there);  headache (severe), throbbing, or with stiff neck or back;  hives, itching of skin, or any other skin problem, such as blisters, redness or other color change, tenderness, burning, peeling, thickening, or scaliness;  increased blood pressure;  irritated tongue;  light-colored stools ;  loosening or splitting of fingernails;  muscle cramps, pain, or weakness;  numbness, tingling, pain, or weakness in hands or feet;  pain in lower back and/or side (severe);  swelling and/or tenderness in upper abdominal or stomach area;  swelling of face, feet, or lower legs (if taking phenylbutazone, stop taking it and check with your doctor immediately);  swelling of lips or tongue;  swollen and/or painful glands (especially in the neck or throat area);  thirst (continuing) ;  trouble in speaking;  unexplained runny nose or sneezing;  unexplained, unexpected, or unusually heavy vaginal bleeding;  unusual tiredness or weakness;  weight gain (rapid) (if taking phenylbutazone, stop taking it and check with your doctor immediately) ;  yellow eyes or skin 
  
  

Other side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. However, check with your doctor if any of the following side effects continue or are bothersome:

• More common
  • Abdominal or stomach cramps, pain, or discomfort (mild to moderate) ;  diarrhea (if taking mefenamic acid, stop taking it and check with your doctor immediately);  dizziness, drowsiness, or lightheadedness;  headache (mild to moderate);  heartburn, indigestion, nausea, or vomiting  
  
  

• Less common or rare
  • Bitter taste or other taste change;  bloated feeling, gas, or constipation;  decreased appetite or loss of appetite;  fast or pounding heartbeat ;  flushing or hot flashes;  general feeling of discomfort or illness;  increased sensitivity of eyes to light;  increased sensitivity of skin to sunlight;  increased sweating;  irritation, dryness, or soreness of mouth;  nervousness, anxiety, irritability, trembling, or twitching;  rectal irritation (with suppositories);  trouble in sleeping;  unexplained weight loss;  unusual tiredness or weakness without any other symptoms 
  
  

Although not all of the side effects listed above have been reported for all of these medicines, they have been reported for at least one of them. However, since all anti-inflammatory analgesics are very similar, it is possible that any of the above side effects may occur with any of these medicines.

Some side effects may occur many days or weeks after you have stopped using phenylbutazone. During this time check with your doctor immediately if you notice any of the following side effects:

• Sore throat and fever;  ulcers, sores, or white spots in mouth;  unusual bleeding or bruising ;  unusual tiredness or weakness 

Other side effects not listed above may also occur in some patients. If you notice any other effects, check with your doctor.