Drug Interaction:
Ibuprofen antogonises the effect of furosemide and thiazides Pethidine and propathelene reduce absorption of paracetamol Asprin displaces ibuprofen from binding sites NSAIDs blunt the effect of antihypertensives Increased risk of GI ulceration and bleeding Paracetamol increases risk of liver damage in chronic alcoholics Ibuprofen increases risk of methotrexate and lithium toxicity
Indication:
Pain and inflammation
INFORMATION UP DATE
NO BENEFIT OF PARACETAMOL WITH IBUPRUFEN FDC
The Fixed Dose Combination (FDC) of paracetamol with ibuprofen (sold as COMBIFLAM,
FLEXON, IBUCLIN etc.) is no better than either paracetamol or ibuprofen taken alone in
relief of muculo-skeletal pain according to double blind, randomised controlled trial
undertaken at the Department of Emergency medicine, Stony Brook University, New York
A total of 90 patients were administered either ibuprofen 800mg or paracetamol 1g or
FDC or both.
There were no difference in the relief of pain among three groups. Side effects of FDC
are more consuming two drugs together than individual ingredients. (MIMS FEB 2014)
Adverse Reaction:
Dyspesia, heart burn , GI bleeding Rash, asthmatic attacks, Thrombocytopenia, Drug induced ulcer Drowsiness, hepatic necrosis. Visual disturbances and disorientation Rarel nausea and vomiting occur
Contra-Indications:
Active peptic ulcer, history of hypersensitivity to either components Recent GI bleeding Neonates
Special precautions- Bronchial asthma, Renal or hepatic disorders Bleding disorders CV Diseases Patients on anticoagulants Aspirin/ NSAIDs Pregnancy and lactation
Dosages/ Overdosage Etc:
Indication-
Pain and inflammation
Dosage-
1 tab 3 to 4 times a day
Child- ibuprofen 100mg + paracetamol 125mg i dose tid or as required
Other Information:
EVIDENCE BASED MEDICINE (April 2003) Pain of Osteoarthiritis Comparitive effectiveness of various interventions
Beneficial
1. Systemic simple analgesics (eg paracetamol for short term pain relief, and improvement in function)
2. Systemic NSAIDs (short term pain relief and improvement in function) 3. Topical agents (short term pain relief)
Likely to be beneficial
1. Education, dietary advice,empowerment and support ( improved knowledge of disease and pain relief)
2. Physical support (pain relief and improvement in function)
KEY POINTS
1. There is no good evidence that NSAIDs were superior to simple analgesics such as paracetamol or to suggest that any one of the many available NSAIDs had greater efficacy in relieving pain of osteoarthritis.
2. One systematic review of randomised controlled trials has found that topical agents provide pain relief in patients with osteoarthritis and offer a non-toxic alternative to systemic drug treatment. However there is no evidence to indicate whether the prescribed agents were superior to less expensive, non-prescribtion drugs over the counter (OTC) alternatives, or to other local treatments such as hot or cold packs.
Pregnancy and lactation:
Contraindicated for use during pregnancy and lactation Observe caution if reqd to be used