Analgesic Combinations

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Chapter: Essential pharmacology : Nonsteroidal Anti-inflammatory Drugs And Antipyreticanalgesics

Combination of aspirin and paracetamol is additive (not supraadditive) and a ceiling analgesic effect is obtained when the total amount of aspirin + paracetamol is ~ 1000 mg.


ANALGESIC COMBINATIONS

 

Combination of aspirin and paracetamol is additive (not supraadditive) and a ceiling analgesic effect is obtained when the total amount of aspirin + paracetamol is ~ 1000 mg. The same is true of combinations of paracetamol with other NSAIDs like ibuprofen, diclofenac, etc. There is no convincing evidence that such combinations are superior to single agents, either in efficacy or in safety. If at all used, such combinations should be limited to short periods.

 

Combination of codeine (an opioid analgesic) with aspirin or paracetamol is also additive, but in this case combination provides additional analgesia beyond the ceiling effect of aspirin/ paracetamol. The mechanisms of pain relief by these two classes of drugs are different. Such combination can be considered rational for providing greater analgesia. Adequate clinical data supports use of such combination for pain refractory to single agent.

 

To obviate in-advertant misuse and chance of producing dependence, fixed dose combinations of analgesics with hypnotics/sedatives/anxiolytics is banned in India.


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