The role of a fixed combination of ibuprofen/paracetamol in the management of acute pain: an Italian expert narrative review

F. Coluzzi, P. Tranquilli Leali, D. Perugia, R. Pellegrino, P. Romualdi

Department of Surgical and Medical Sciences and Translational Medicine, Sapienza University of Rome, Rome, Italy. flaminia.coluzzi@uniroma1.it

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• Anesthesiology

An Italian multidisciplinary team of pain management experts reviewed ibuprofen and paracetamol in combination for acute pain. Effective treatment of acute pain should target both inflammation and pain signaling to reduce suffering and prevent the development of persistent pain. The combination of a non-steroidal anti-inflammatory drug (NSAID) and paracetamol appears to be a logical choice: paracetamol primarily acts centrally, while NSAIDs inhibit the inflammation that perpetuates the pain response. Both drugs are rapidly absorbed, reaching maximal concentrations within 1-2 hours. Coadministration may enhance paracetamol absorption, leading to earlier onset of pain relief. The rate of drug interactions between ibuprofen and paracetamol is low, and the two do not directly interact with each other. Multiple studies and meta-analyses have shown that the combination is more effective than placebo or either drug used alone in relieving postoperative pain and reducing the need for rescue analgesia after surgery or acute musculoskeletal injury. The most commonly evaluated daily dosage was ibuprofen/paracetamol 400/1,000 mg. A single-pill combination of ibuprofen and paracetamol also reduces the incidence of persistent pain compared with other systemic analgesics, with an adverse-effect profile similar to, or better than, placebo or monotherapy. When prescribing ibuprofen/paracetamol, physicians should consider age, blood pressure, and concomitant medications, particularly aspirin and warfarin.

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