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    Combining ibuprofen and acetaminophen for acute pain management after third

    The results of the quantitative systematic reviews indicated that the ibuprofen-APAP combination may be a more effective analgesic, with fewer untoward effects, than are many of the currently available opioid-containing formulations. In addition, the authors found several randomized controlled trial …

    Review

    . 2013 Aug;144(8):898-908.

    doi: 10.14219/jada.archive.2013.0207.

    Combining ibuprofen and acetaminophen for acute pain management after third-molar extractions: translating clinical research to dental practice

    Paul A Moore  1 , Elliot V Hersh

    Affiliations

    Affiliation

    1 Department of Oral Surgery and Pharmacology, School of Dental Medicine, University of Pennsylvania, Philadelphia, USA. [email protected]

    PMID: 23904576

    DOI: 10.14219/jada.archive.2013.0207

    Review

    Combining ibuprofen and acetaminophen for acute pain management after third-molar extractions: translating clinical research to dental practice

    Paul A Moore et al. J Am Dent Assoc. 2013 Aug.

    . 2013 Aug;144(8):898-908.

    doi: 10.14219/jada.archive.2013.0207.

    Authors

    Paul A Moore  1 , Elliot V Hersh

    Affiliation

    1 Department of Oral Surgery and Pharmacology, School of Dental Medicine, University of Pennsylvania, Philadelphia, USA. [email protected]

    PMID: 23904576

    DOI: 10.14219/jada.archive.2013.0207

    Abstract

    Background: Effective and safe drug therapy for the management of acute postoperative pain has relied on orally administered analgesics such as ibuprofen, naproxen and acetaminophen, or N-acetyl-p-aminophenol (APAP), as well as combination formulations containing opioids such as hydrocodone with APAP. The combination of ibuprofen and APAP has been advocated in the last few years as an alternative therapy for postoperative pain management. The authors conducted a critical analysis to evaluate the scientific evidence for using the ibuprofen-APAP combination and propose clinical treatment recommendations for its use in managing acute postoperative pain in dentistry. Types of studies reviewed: The authors used quantitative evidence-based reviews published by the Cochrane Collaboration to determine the relative analgesic efficacy and safety of combining ibuprofen and APAP. They found additional articles by searching the Ovid MEDLINE, PubMed and ClinicalTrials.gov databases. Conclusions: The results of the quantitative systematic reviews indicated that the ibuprofen-APAP combination may be a more effective analgesic, with fewer untoward effects, than are many of the currently available opioid-containing formulations. In addition, the authors found several randomized controlled trials that also indicated that the ibuprofen-APAP combination provided greater pain relief than did ibuprofen or APAP alone after third-molar extractions. The adverse effects associated with the combination were similar to those of the individual component drugs. Practical Implications. Combining ibuprofen with APAP provides dentists with an additional therapeutic strategy for managing acute postoperative dental pain. This combination has been reported to provide greater analgesia without significantly increasing the adverse effects that often are associated with opioid-containing analgesic combinations. When making stepwise recommendations for the management of acute postoperative dental pain, dentists should consider including ibuprofen-APAP combination therapy. Keywords: Ibuprofen; acetaminophen; analgesics; drug combinations; practice guidelines.

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    (PDF) Combining ibuprofen and acetaminophen for acute pain management after third

    PDF | Background: Effective and safe drug therapy for the management of acute postoperative pain has relied on orally administered analgesics such as... | Find, read and cite all the research you need on ResearchGate

    HomeMedical PharmacologyPharmacologyClinical PharmacologyChemistryAcetaminophen

    ArticlePDF AvailableLiterature Review

    Combining ibuprofen and acetaminophen for acute pain management after third-molar extractions: Translating clinical research to dental practice

    August 2013Journal of the American Dental Association (1939) 144(8):898-908

    DOI:10.14219/jada.archive.2013.0207

    SourcePubMed Authors: Paul A Moore

    University of Pittsburgh

    Elliot V Hersh

    University of Pennsylvania

    Abstract and Figures

    Background: Effective and safe drug therapy for the management of acute postoperative pain has relied on orally administered analgesics such as ibuprofen, naproxen and acetaminophen, or N-acetyl-p-aminophenol (APAP), as well as combination formulations containing opioids such as hydrocodone with APAP. The combination of ibuprofen and APAP has been advocated in the last few years as an alternative therapy for postoperative pain management. The authors conducted a critical analysis to evaluate the scientific evidence for using the ibuprofen-APAP combination and propose clinical treatment recommendations for its use in managing acute postoperative pain in dentistry. Types of studies reviewed: The authors used quantitative evidence-based reviews published by the Cochrane Collaboration to determine the relative analgesic efficacy and safety of combining ibuprofen and APAP. They found additional articles by searching the Ovid MEDLINE, PubMed and ClinicalTrials.gov databases. Conclusions: The results of the quantitative systematic reviews indicated that the ibuprofen-APAP combination may be a more effective analgesic, with fewer untoward effects, than are many of the currently available opioid-containing formulations. In addition, the authors found several randomized controlled trials that also indicated that the ibuprofen-APAP combination provided greater pain relief than did ibuprofen or APAP alone after third-molar extractions. The adverse effects associated with the combination were similar to those of the individual component drugs. Practical Implications. Combining ibuprofen with APAP provides dentists with an additional therapeutic strategy for managing acute postoperative dental pain. This combination has been reported to provide greater analgesia without significantly increasing the adverse effects that often are associated with opioid-containing analgesic combinations. When making stepwise recommendations for the management of acute postoperative dental pain, dentists should consider including ibuprofen-APAP combination therapy.

    Pain relief of ibuprofen-acetaminophen combinations. Pain relief was recorded on a five-point scale, in which 0 indicated "none," 1 indicated "a little," 2 indicated "some," 3 indicated "a lot" and 4 indicated "complete." APAP: Acetaminophen, or N-acetylp-aminophenol. mg: Milligrams. Adapted with permission of Elsevier from Mehlisch and colleagues. 57

    Ibuprofen-acetaminophen combinations versus codeine-nonopioid combinations. APAP: Acetaminophen, or N-acetyl-paminophenol. mg: Milligrams. Adapted with permission of the International Association for the Study of Pain from Daniels and colleagues. 61

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    Can You Take Acetaminophen With Ibuprofen?

    It is safe to take acetaminophen with ibuprofen, and studies show taking them together may even be more effective for certain types of pain than opioid medications. The two drugs are broken down by different organs in the body, so as long as you stick to the recommended doses, you should be OK.

    Homechevron_rightClasseschevron_rightNsaids

    Is It Safe to Take Tylenol (Acetaminophen) With Advil or Motrin (Ibuprofen)?

    Written by Sharon Orrange, MD, MPH

    Updated on August 12, 2019

    I get this question a lot: Is it safe to take acetaminophen with ibuprofen?

    The simple answer? Yes, you can safely take acetaminophen and ibuprofen together.

    This may surprise you, though: Taking these two medications together works to relieve pain than taking them separately. Research studies have shown that ibuprofen (Advil, Motrin) and acetaminophen (Tylenol) together work well to relieve certain types of pain with few side effects. In fact, even for extreme dental pain, these medications combined work better than many opioid pain medications (like Vicodin or Norco).

    Here’s why it’s generally safe to take acetaminophen and ibuprofen together and how much of each you can take.

    Ibuprofen vs. Acetaminophen: What to Take When

    0 seconds of 1 minute, 27 secondsVolume 90%

    01:28

    Reviewed by Preeti Parikh, MD

    Why is the combination safe?

    Acetaminophen and ibuprofen work differently, and they’re cleared from the body by different organs. Acetaminophen can put some stress on the liver, and ibuprofen may put some stress on the stomach and kidneys, but if you’re using these drugs in safe amounts, there is minimal concern here.

    Acetaminophen is broken down almost completely by the liver, so the kidneys hardly do any work. However, if you take too much acetaminophen or you take it with alcohol, you could run into acute liver damage because of all the stress you’re putting on your liver.

    In the stomach, ibuprofen blocks the actions of two chemicals that activate inflammation: prostaglandin and prostacyclin. But blocking these two chemicals can also result in irritation of the stomach and esophagus. This is why long-term use of ibuprofen can cause stomach inflammation (gastritis) and gastrointestinal bleeding. (Acetaminophen, on the other hand, is safe on the stomach.)

    Unlike acetaminophen, ibuprofen is mostly broken down by the kidneys, so it’s very safe on the liver. However, the anti-inflammatory properties that can irritate your stomach also dilate blood vessels entering the kidneys. Taking too much ibuprofen can damage your kidneys.

    How much acetaminophen can I take?

    The dosing recommendation for acetaminophen depends on the strength of the pill. For the 325 mg pills, you can take up to 2 pills every 6 hours. For the 500 mg pills (extra-strength tablets), you can take up to 2 pills every 8 hours (or twice a day).

    The highest dose of acetaminophen you should ever take (not that you should try), is 4 grams per day. That would be 8 extra-strength Tylenol tablets (500 mg each) or 12 regular-strength tablets (325 mg each). Don’t take more than that.

    How much ibuprofen can I take?

    To treat mild to moderate pain, 200 mg to 400 mg of ibuprofen every 6 to 8 hours will work. The maximum dose of ibuprofen you should ever take is 2400 mg per day, which is 12 over-the-counter tablets.

    Be sure to take only the minimal amount of ibuprofen or acetaminophen you need to relieve your pain. Always ask your doctor or pharmacist if you aren’t sure of the right dose for your situation.

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