Last Saturday in the lecture I attended on pharmacology we spent at least half of our time discussing commonly prescribed pain medications. I was surprised to learn that Vicodin ES is the most frequently prescribed medication in the US. Despite the frequency with which prescriptions are written for narcotic medications they come with a host of negatives. Many of our patients will experience side effects ranging from nausea and vomiting to drowsiness and disorientation. In addition to the other side effects, these medications can be addictive and pose challenges to the prescribing doctor.
Ibuprofen is a non-narcotic medication that works both to provide pain relief and manage inflammation locally as a cox (cyclooxygenase) inhibitor. Acetaminophen is also a non-narcotic analgesic, but it’s mechanism of action is completely different. It’s effect is mediated centrally we believe by action on a variety of neurotransmitter receptors which alter pain perception and threshold. When we combine the mechanisms of Ibuprofen and Acetaminophen the analgesic effect is equal to that of many narcotic medications like Vicodin ES, with the addition of anti-inflammatory effect and the absence of the side effects associated with opiates.
For maximum pain relief the recommended dosage is 800mg of Ibuprofen three to four times per twenty-four hours in combination with 325mg of Acetaminophen 3-4 times per day. I have had the opportunity to try this out several times this week with great results reported by the patients.
Rex Menke says
I thought there was a serious side effect to??? kidney? liver? when the two were used simultaneously.
“tell me it ain’t so!!”
Lee Ann Brady says
I did not hear about any special issues associated with the combination of Ibuprofen and Acetaminophen in the lecture I attended, and I just did some research and can not find anything on that. Now with that said Acetaminophen is known to be very hard on the liver, especially in high doses over extended usage or abuse. The Max daily amount of Acetaminophen was just dropped to 3000mg, and for patients with liver disease or any form of hepatitis the max per day is 1500mg. Ibuprofen can be associated with Kidney issues, again in high doses taken over a long time or in patients who take it chronically.
I recently missed a dentist appt & was in excruciating pain. The dental assistant recommended I take this combination & it worked wonders until my next appointment.
Kevin Izard, MD says
Unfortunately there is no universally safe pain medication. The combination of acetaminophen and NSAIDs (like ibuprofen) significantly increase the risk for gastrointestinal bleeding.