The combination of two analgesics with different modes of action results in an additive rather than a synergistic effect the efficacy of the combination in acute pain is roughly similar to the sum of the efficacies of individual agents. 4 Paracetamol has minimal anti-inflammatory activity, implying a different mode of action from that of NSAIDs. 4ĭespite its widespread use, the mode of action of paracetamol is yet to be fully determined, although a centrally mediated analgesic action is thought likely. Their analgesic and anti-inflammatory effects are a consequence of COX-2 inhibition. They inhibit synthesis of prostaglandins by inhibiting cyclo-oxygenase (COX), present as COX-1 and COX-2. NSAIDs, such as ibuprofen, have analgesic, antipyretic and anti-inflammatory actions.
What is the clinical evidence behind these combination products? Where do they fit into the pain management ladder? Can prescribers and pharmacists confidently offer paracetamol/ibuprofen combinations as an alternative to codeine-based analgesics?Ĭurrent evidence suggests that for some types of pain, combining paracetamol with an NSAID may offer better analgesia than either drug alone.
While most health professionals are already familiar with paracetamol and NSAIDs for pain relief, the paracetamol/ibuprofen combination medicines may be less well known. Alternative oral OTC products are also available. 1,2Īfter implementation, people who may currently take analgesics containing low-dose codeine and wish to continue using them will need a prescription from their doctor, nurse practitioner or remote area nurse. On 20 December 2016, after a long period of public consultation, the Therapeutic Goods Administration announced its final decision on the rescheduling of codeine-containing products.įrom February 2018, all analgesics and cough and cold medicines containing low-dose codeine and currently Schedule 2 (Pharmacy medicines) or Schedule 3 (Pharmacist Only medicines), will no longer be available over the counter in pharmacies, becoming prescription only.
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