pain relief: is it safe to mix acetaminophen and ibuprofen?

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”.

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.

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?

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.

(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. )

potential side-effects of combining painkillers

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.

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

emma jones is a multimedia editor with healthing. you can reach her at emjones@postmedia.com or on instagram and twitter @jonesyjourn .