Ibuprofen and paracetamol are indicated in the management of pain and fever. Can we take them at the same time? Alternating? At what dose? What are the risks and contraindications?
What is the difference between ibuprofen and paracetamol?
Ibuprofen is a nonsteroidal anti-inflammatory drugs (NSAIDs), it has anti-inflammatory, analgesic, antipyretic (against fever) and short-lived platelet antiaggregation (thinning the blood) properties. Paracetamol is a pain medication which has only analgesic and antipyretic properties.
Can I take both drugs?
Yes, it is quite possible to take paracetamol and ibuprofen concomitantly since these molecules do not have the same mechanism of action. According to some scientific studies, the effectiveness of paracetamol is increased when combined with an anti-inflammatory compared to taking paracetamol alone. However, this combination must remain occasional due to a possible accumulation of side effects affecting the kidneys and the liver.
Is it dangerous to alternate ibuprofen and paracetamol?
No, provided you respect the daily doses maximum and the recommended times between two doses of paracetamol (4 to 6 hours minimum depending on the dosage in relation to the weight) or two doses of ibuprofen (6 hours minimum). This alternation is recommended in case of persistent pain or fever.
What is the time between the two?
The advantage of alternating ibuprofen and paracetamol is to cover a longer period than with concomitant doses. Indeed, if the administrations are too close together, it will be necessary wait several hours after the last authorized dose to be able to take an analgesic. The alternation begins with taking paracetamol. By respecting the maximum daily dosages, a delay of 3 hours between each intake of paracetamol and ibuprofen will be considered to cover a period of 18 hours and 4 hours to cover a 24 hour period.
What maximum dose?
In self-medication, paracetamol can be taken at a rate of‘1 g 3 times a day, i.e. 3 g in total over 24 hours. The dosage can be increased to 4 g per day on medical prescription. In self-medication, the dosage of ibuprofen is 400 mg 3 times a day, i.e. 1200 mg per day. On medical prescription, the usual dose of ibuprofen is identical except for rheumatological conditions (rheumatoid arthritis, ankylosing spondylitis). In this case, the drug Antarène® 400 mg can be prescribed as an attack treatment at 800 mg taken 3 times a day, i.e. 2400 mg over 24 hours. Vigilance is required when medicinal combinations based on paracetamol (e.g. Fervex®, Actifed®) or ibuprofen (e.g. Antarene codeine®) are administered on the same day since they must be taken into account in the calculation of the daily dose.
What are the dangers of alternating ibuprofen and paracetamol?
The risk of alternating ibuprofen and paracetamol is exposing oneself to an overdose in the event of non-compliance with the daily doses maximum and the time between two doses of ibuprofen or two doses of paracetamol. To prevent this risk, it is advisable to note the times of administration of the two drugs. An overdose of paracetamol or ibuprofen can cause severe, sometimes irreversible, liver and kidney damage, gastrointestinal bleeding, and acidosis (pathological decrease in blood pH). In the most severe cases, paracetamol taken alone can cause impaired brain function (encephalopathy) and coma sometimes leading to death. With regard to ibuprofen, too large a dose can cause dizziness, difficulty breathing and seizures.
Contraindications: who cannot alternate ibuprofen and paracetamol?
People who cannot alternate these drugs are those who have a contraindication to ibuprofen or paracetamol. Their common contraindications are allergy to any of the components and severe liver disease. More specifically, taking paracetamol should be avoided in alcohol dependent people at the risk of inducing impaired liver function. Regarding ibuprofen, administration should be excluded in the following cases:
- during the 2nd and 3rd quarters of pregnancy
- heart or kidney failure severe
- history of asthma, bleeding or digestive perforation already induced by an anti-inflammatory
- active hemorrhage
- ulcer, history of ulcer or gastrointestinal bleeding
- lupus (chronic autoimmune disease)
Moreover, in case of suspected bacterial infection, ibuprofen should not be administered at the risk of causing serious cutaneous complications. The use of ibuprofen requires increased vigilance in the 1st trimester of pregnancy, in breastfeeding women, renal or hepatic insufficiency and the elderly (subject to digestive bleeding). These people must consult a doctor who will decide whether or not to establish an ibuprofen/paracetamol alternation after an assessment of the benefit/risk balance. In addition, in the management of persistent pain in children, the High Authority for Health (HAS) recommends taking ibuprofen and paracetamol concomitantly and not alternately.
Sources:
– Public drug database
-ANSM
– French Observatory of Analgesic Medicines (OFMA)
– Single dose of ibuprofen combined with oral paracetamol for the treatment of acute postoperative pain. – June 2013 – Cochrane Review, Derry CJ, Derry S, Moore RA.
– Drug management of pain in children: alternatives to codeine, HAS, January 2016.