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Ibuprofen/paracetamol, sold under the brand name Combogesic among others, is a fixed-dose combination of two medications, ibuprofen, a non-steroidal anti-inflammatory drug (NSAID); and paracetamol (acetaminophen), an analgesic and antipyretic. [6] It is available as a generic medication. [9] [10] [11]
The correlation between the severity of symptoms and measured ibuprofen plasma levels is weak. Toxic effects are unlikely at doses below 100 mg/kg, but can be severe above 400 mg/kg (around 150 tablets of 200 mg units for an average adult male); [47] however, large doses do not indicate the clinical course is likely to be lethal. [48]
Paracetamol's bioavailability is dose-dependent: it increases from 63 % for 500 mg dose to 89 % for 1000 mg dose. [6] Its plasma terminal elimination half-life is 1.9–2.5 hours, [6] and volume of distribution is roughly 50 L. [132] Protein binding is negligible, except under the conditions of overdose, when it may reach 15–21 %. [6]
In the UK, sales of over-the-counter paracetamol are restricted to packs of 32 × 500 mg tablets in pharmacies, and 16 × 500 mg tablets in non-pharmacy outlets. Pharmacists may provide up to 100 tablets for those with chronic conditions at the pharmacist's discretion. [48] [49] In Ireland, the limits are 24 and 12 tablets, respectively. [50]
Panadol Extra, an S2 pharmacy-only medicine in Australia, combines 65 mg of caffeine with 500 mg of paracetamol per tablet. Caffeine may improve the analgesic effect of paracetamol. Studies have reached conflicting conclusions regarding the clinical significance of this incremental pain relief. [20] [21]
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An equianalgesic chart is a conversion chart that lists equivalent doses of analgesics (drugs used to relieve pain). Equianalgesic charts are used for calculation of an equivalent dose (a dose which would offer an equal amount of analgesia) between different analgesics. [1]
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