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pain relief: is it safe to mix acetaminophen and ibuprofen?
5 minute read
“acetaminophen blocks the transmission of pain signals to the brain and it usually lasts for four to six hours,” says dr. nardine nakhla, pharmacist and a spokesperson for advil plus acetaminophen. getty
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september is pain awareness month, and it’s ushered in new conversations about how to manage pain. so when advil reached out to healthing with information about a new product that contains both acetaminophen and ibuprofen, we were naturally curious. after all, isn’t it common knowledge that no one should ever mix over-the-counter medications — including the most common painkillers?
as it turns out, some over-the-counter pain medications, like acetaminophen and ibuprofen, can be taken together and may actually have some powerful results, explains jen belcher, vice-president of strategic initiatives & member relations with the ontario pharmacists association. the key is to not take two medications that treat pain in the same way — referred to as a “mechanism of action”.
“with acetaminophen, the active ingredient in brand name products like tylenol, and ibuprofen, which is the active ingredient in advil or motrin-type products, those actually can be used together because they work differently in the body,” says belcher. “but other over-the-counter medications like advil (ibuprofen), naproxen (aleve), or acetyl salicylic acid (aspirin) shouldn’t be used together, because those three work through the same mechanism of action.”
belcher explains that it is possible to take each of the medications together or in tandem (for example, take one medication then, a few hours later, take the other.) however, it is important to take each at the appropriate interval and never go over the daily recommended limit, unless under close supervision. for example, the directions for regular strength advil caplets recommend those over the age of twelve take one caplet (200mg ibuprofen) every four hours, not exceeding six caplets in 24 hours; while tylenol regular strength recommends taking one tablet (325 mg of acetaminophen) every four to six hours, not exceeding eight tablets in 24 hours. dosage recommendations may also vary based on personal medical history.
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each medication will also have a daily limit — how many days in a row someone can take this medication before needing to speak to a health-care professional.
“acetaminophen blocks the transmission of pain signals to the brain and it usually lasts for four to six hours,” says dr. nardine nakhla, pharmacist and a spokesperson for advil plus acetaminophen. “the nsaids, which are non-steroidal anti-inflammatories — that’s kind of the umbrella term ibuprofen falls under — works differently. it reduces the production of prostaglandins, which are responsible for pain and inflammation … that usually lasts six to eight hours.
“so you’re combining two mechanisms of action with two different ingredients that have differing length … you get kind of the best of both worlds.”
with guidelines respected, some studies suggest that combining these medications may actually be safer and more effective than other prescription medications.
a 2011 study published in dermatologic surgery compared the pain reported by patients after they had undergone surgery to treat the skin cancer on their head and neck. after surgery, patients either received 1,000 mg of acetaminophen, 1,000 mg acetaminophen plus 400 mg ibuprofen, or 325 mg acetaminophen plus 30 mg codeine to help with the pain. not only did patients on the acetaminophen and ibuprofen regime report the lowest pain out of all the groups, they also reported significantly less complications than patients on the acetaminophen plus codeine prescription.
what about products with both acetaminophen and ibuprofen?
for some, keeping track of how much of one painkiller was taken and when might be a tall order — especially when you’re in pain — which is where medications that are already combined can be handy, says nakhla.
a 2020 study published in the clinical journal of pain found that a fixed-dose combination of acetaminophen and ibuprofen is tolerated and effective at pain relief. researchers prescribed 568 patients who had just undergone molar extractions a single dose of either a fixed-dose medication (250mg ibuprofen and 500mg acetaminophen), 250mg ibuprofen, 650 mg acetaminophen, or a placebo.
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(this peer-reviewed study was sponsored by pfizer consumer healthcare, the company which produces advil. “in 2019 gsk joined/acquired pfizer, bringing together their portfolio of consumer healthcare goods.” according to a source familiar with the matter. both pharmaceutical companies operate independently.)
over the course of 12 hours, those who were prescribed the combo medication reported a significantly lower pain intensity than participants who were prescribed any of the other three medications.
potential side-effects of combining painkillers
belcher warns that while the medications can complement each other, they do also carry side-effects that consumers should be aware of. anti-inflammatory medications like ibuprofen can irritate the lining of the stomach — critical for anyone who has experienced stomach ulcers or other gastrointestinal issues. severe abdominal pain or vomiting up blood is a sign that someone should seek medical attention asap.
because acetaminophen is metabolized in the liver, taking too much may result in jaundice — including yellowing of the eyes or skin. taking the medication for longer than recommended may also result in drug-induced hepatitis. those who already have liver disease or who drink three or more drinks per day are at a higher risk of developing liver damage from acetaminophen.
and dosing recommendations are serious. every year, approximately 4500 canadians are hospitalized for acetaminophen overdoses with 16 per cent (700 cases) reported as accidental.
“every person is different and we all have different backgrounds, from a medical perspective and medication perspective,” says nakhon. “and the pharmacist is equipped with the tools to really assess a patient for all that and see what makes the most sense, and help them make more informed decisions as to what they can and can’t take and what the maximum dose is.”
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other signs that someone has taken too much of these medications include heartburn, convulsions, ringing in the ears, nausea, vomiting, diarrhea, dizziness, blurred vision or developing a rash. anyone who experiences any of these symptoms should stop taking the medication and contact a health-care provider right away.
other options for pain relief
sometimes medication isn’t entirely necessary at all. pharmacists may also know other, non-medicinal options to manage pain — like applying heating pads.
“there is no one-size-fits-all approach when it comes to pain,” says nakhon. “and so the approach is really going to differ depending on the patient who presents to me, the type of pain they’re experiencing, whether it’s acute or chronic. and it’s also going to depend on other things like their specific signs and symptoms [and] what their medical conditions are.”
when trying any new medication or tactic to manage pain, it’s important to connect with health-care professionals who can tailor advice to personal medical history.
pharmacists are a great, and often underutilized, resource for canadians. in canada, pharmacists must become certified by the pharmacy examining board of canada after about 6-8 years of post-secondary education, and have a wealth of knowledge of which medications will play nice together and which ones should be absolutely avoided. in most provinces — including ontario as of january 2023 — they can also prescribe medications to help with minor ailments.
emma jones is a multimedia editor with healthing. you can reach her at emjones@postmedia.com or on instagram and twitter @jonesyjourn.
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