Aspirin (acetylsalicylic acid) and paracetamol are used to relieve pain and fever. Can we combine them? At what dose? With what timeframe? What are the risks and contraindications?
Can we combine aspirin and paracetamol?
Yes, it is possible to combine aspirin and paracetamol either simultaneously or alternately. Moreover, the drug Actron® contains both acetylsalicylic acid and paracetamol. There no drug interaction established between these two molecules since they do not have the same mechanism of action.
What is the time between the two?
The goal of alternating aspirin with paracetamol is to cover a longer period than with simultaneous administration. The alternation must begin with paracetamol. By respecting the maximum daily doses, a delay of 4 hours between each dose drug is optimal to cover a 24-hour period.
What maximum dose?
In the context of self-medication in adults, aspirin can be administered at reason 1 g 3 times a day with a minimum delay of 4 hours, i.e. 3 g over 24 hours. In the management of certain rheumatological conditions (rheumatoid arthritis, ankylosing spondylitis), the doctor may prescribe 6 g of aspirin per day divided into 3 to 4 doses. With regard to paracetamol, the dosage in self-medication is1 g per dose 3 times a day, i.e. 3 g in total. On medical prescription, the maximum daily dose can be increased to 4 g.
These treatments should not be administered in case of severe liver disease
What are the risks of taking aspirin and paracetamol together?
Occasional use of the aspirin/paracetamol combination does not present any known risks. In effect, no interaction has been identified between acetylsalicylic acid and paracetamol. Nevertheless long-term use may be responsible for an accumulation of deleterious effects affecting the liver and kidneys. In self-medication, the duration of treatment should not exceed 3 days for fever and 5 days for pain. If symptoms persist, medical consultation is required. IThe usual recommended doses must be respected to prevent overdose.
What are the contraindications?
The contraindications of the aspirin/paracetamol combination are identical to those of the two drugs taken separately. These treatments should not be administered in case of allergy to one of the components and severe liver disease. More specifically, paracetamol should be avoided in people who regularly consume alcohol at the risk of damaging the liver. Regarding aspirin, it is contraindicated in the following cases:
- 2nd and 3rd quarters of pregnancy
- background asthma, haemorrhage, gastrointestinal perforation already caused by an anti-inflammatory
- ulcer active, history of ulcer
- haemorrhagic disease or haemorrhagic risk
- severe heart and kidney failure
As a precaution, some people should consult a doctor before using aspirin combined with paracetamol. These are the lactating or pregnant women less than 3 months old, elderly people and people with liver or kidney disease. Aspirin should not be given in children in the context of self-medication because of the rare but serious risk of occurrence of Reye’s syndrome. In adults, self-medication can be considered, but with caution because of the risk of bleeding. It’s better to ask your doctor or pharmacist for advice before taking aspirin alone or in combination with paracetamol.
Sources:
– Public drug database
-ANSM
– Drug management of pain in children: alternatives to codeine, HAS, January 2016.