?? why?

[securespark]

If you need more than 200mg of ibuprofen, you can have 400mg every 4 hours with a maximum of 3 doses every 24h.

I have been prescribed 600mg 4 times a day, but that was under the strict supervision of the surgeon.

I have also taken ibuprofen with paracetamol and codeine, all at the same time.
My surgeon told me the the max. dose of codeine in 24h should be no more than 240mg. 8 x 30mg, 4 hours apart.

But codeine bungs me up horribly. And ibuprofen shouldn't be taken by patients with hypertension.

 

[JohnW2]

If you need more than 200mg of ibuprofen, you can have 400mg every 4 hours with a maximum of 3 doses every 24h.

Indeed. My wife takes 400mg doses, two or three times per day, for her arthritis. However, the 'standard dose' is 200mg, and the recommendation is that one should take only one Nuromol (which contains 200mg ibuprofen and 500mg paracetamol) at a time - hence the 'standard dose' of ibuprofen, but only a 'half dose' of paracetamol.

I have been prescribed 600mg 4 times a day, but that was under the strict supervision of the surgeon.

Yes, and I've seen people take much higher doses than 600mg ('under supervision') but the higher the dose, the greater the risk of stomach complications, ultimately bleeding and/or ulcers. The same is true of all non-steroidal anti-inflammatory drugs (including aspirin) with the massive doses that rheumatologists sometimes prescribe.

I have also taken ibuprofen with paracetamol and codeine, all at the same time.

There are all chemically and pharmacologically totally different from one another, so no reason why they can't be taken simultaneously.

My surgeon told me the the max. dose of codeine in 24h should be no more than 240mg. 8 x 30mg, 4 hours apart. But codeine bungs me up horribly.

It does/can. It's about the weakest of the opiate family of drugs (as in morphine, diamorphine {'heroin} etc.) and all of them are quite good at treating diarrhoea (as well as doing other things!)

And ibuprofen shouldn't be taken by patients with hypertension.

Nor, theoretically, by the 'elderly' who are more likely to develop heart failure when taking it.

 

[SUNRAY]

I'm on Cocodamol at the moment and that leaflet states not to mix with Ibroprofen but doesn't list it in the ingredients.

And yes it's bunging me up which is not good for my hernia

 

[Scally-Ho]

I'm very lucky with a totally sympathetic doc who prescribes dihydrocodeine for me and I have it on my repeat list. I doubt if I'll ever receive a new right hip and knee, so I'm probably on the strong stuff until I turn my toes up. To ensure I do not become bunged up, I'm also prescribed lactulose.

 

[JohnW2]

I'm on Cocodamol at the moment and that leaflet states not to mix with Ibroprofen but doesn't list it in the ingredients.

Co-codamol is the official name for a combination of codeine and paracetamol. It contains no ibuprofen or any other active ingredients.

Since co-codamol contains paracetamol there is, as expected, a warning that it should not be taken together with any other paracetamol-containing medicines (as well as warnings in relation to other medications). However, I see absolutely no reason why it should not be taken at the same time as ibuprofen and neither the Patient Information Leaflet nor the documentation used by doctors appears to mention such a restriction. Where did you read that it 'should not be mixed with ibuprofen'?

And yes it's bunging me up which is not good for my hernia

As discussed, being an opioid, codeine does have that effect in many/most people. Another problem with it being an opioid (it is converted to morphine by one's liver) is that addiction can result from long-term administration of codeine.

 

[JohnW2]

I'm very lucky with a totally sympathetic doc who prescribes dihydrocodeine for me and I have it on my repeat list. I doubt if I'll ever receive a new right hip and knee, so I'm probably on the strong stuff until I turn my toes up. To ensure I do not become bunged up, I'm also prescribed lactulose.

Dihydrocodeine is a fairly good pain killer, but has no anti-inflammatory activity. If the problem with your hip and knee is arthritis, you might benefit from an anti-inflammatory drug (such as ibuprofen, but there are many others), which could be given in addition to the dihydrocodeine if the anti-inflammatory drug alone was not adequate.

As I've just written of codeine, since dihydrocodeine also gets turned into morphine in your body, its long-term use (as in your case) can lead to addiction, possibly requiring ever-increasing doses to control your symptoms. You certainly should never stop taking the dihydrocodeine abruptly, since that could lead to quite nasty withdrawal symptoms.

 

[SUNRAY]

As I've just written of codeine, since dihydrocodeine also gets turned into morphine in your body, its long-term use (as in your case) can lead to addiction, possibly requiring ever-increasing doses to control your symptoms. You certainly should never stop taking the dihydrocodeine abruptly, since that could lead to quite nasty withdrawal symptoms.

I've been on Cocodamol for 3 months but only using them when the pain dictates however I'm finding I tend to use full doses (8 per day) for around a week then ease off them when the pain is not too bad, in truth if it doesn't hurt I don't think to take any and 1½ - 2 days later the migraines start. I hate to think how much worse it would be for long term/addicted patients.

Since co-codamol contains paracetamol there is, as expected, a warning that it should not be taken together with any other paracetamol-containing medicines (as well as warnings in relation to other medications). However, I see absolutely no reason why it should not be taken at the same time as ibuprofen and neither the Patient Information Leaflet nor the documentation used by doctors appears to mention such a restriction. Where did you read that it 'should not be mixed with ibuprofen'?

It was in the hospital supplied Cocodamol's patient information sheet, I am positive it was there as I made a Flameport style comment something to the effect of: 'I wouldn't take them anyway'. Like yourself I find Ibuprofen has very little effect on me,

However I don't see similar warning on the current sheet.

 

[ebee]

I reckon that John has got it all pretty much spot on, I think one or two might be confused the the co codamol , co meaning two things in this case. Codomol, Ibuprofen and paracetomol are in the three different groups therefore you can (usually) take them together (staggering them to make the peaks of benefit no coincide seems to make perfick sense sometimes).
If you read the instructions any of the so called simple everyday medicines can harm even kill you without overdosing.
Supposedly Bruce Lee died from such a simple type of thing, was it coincidence that one of his films had a similar theme?

 

[JohnW2]

I've been on Cocodamol for 3 months but only using them when the pain dictates however I'm finding I tend to use full doses (8 per day) for around a week then ease off them when the pain is not too bad, in truth if it doesn't hurt I don't think to take any and 1½ - 2 days later the migraines start. I hate to think how much worse it would be for long term/addicted patients.

Fair enough. It sounds that your fairly intermittent usage is sparing you any major addiction problems. For those on full doses (or higher) continuously for fairly long periods, sudden cessation can sometimes result in withdrawal symptoms as bad as those seen with heroin withdrawal.

It was in the hospital supplied Cocodamol's patient information sheet,

Well, with due respect to whoever wrote it, I think they were wrong, since I can think of no rational reason why one should not take co-codamol and ibuprofen concurrently. Can you recall whether it actually said (as it definitely should have done) that one should no mix co-codamol with any other paracetamol-containing medicine? If not, the author of what you saw may have, for some reason,written "ibuprofen" when they should have written "paracetamol"!

Like yourself I find Ibuprofen has very little effect on me,

I didn't say quite that. Ibuprofen works reasonably well for me but, in general, not quite as well (for minor pains and high temperatures) as does paracetamol.

However I don't see similar warning on the current sheet.

As I said, such a warning does not exist in any current co-codamol documentation, and, as above, I see no reason why it ever should have done. If there really were a reason for such a warning, there would have to be a corresponding one on the ibuprofen documentation (warning not to mix it with co-codamol) - but, again, there isn't.

 

[JohnW2]

I reckon that John has got it all pretty much spot on, I think one or two might be confused the the co codamol , co meaning two things in this case.

There are dozens, probably hundreds, of medicines whose official name starts with "co-" (note the hyphen), in all cases indicating that it is a combination of two or more active ingredients.

Codomol, Ibuprofen and paracetomol are in the three different groups therefore you can (usually) take them together (staggering them to make the peaks of benefit no coincide seems to make perfick sense sometimes).

You've rather confused things there. There is no such medicine as "Codomol". I think you probably meant to type "Codeine" - in which case, as I've said, what you've written would be totally correct. When two or more medicines are chemically totally different and/or work by different pharmacological actions, there is no reason why they can't be taken simultaneously (other than that you might end up with 'side effects' of two or more medicines )

If you read the instructions any of the so called simple everyday medicines can harm even kill you without overdosing.

Unfortunately true, particularly of paracetamol. It generally takes at least a dozen tablets, usually more, to kill but, extremely rarely, very unlucky people have been known to die after taking their one and only very first dose ( because of 'the way they were made').

 

[ebee]

You've rather confused things there. There is no such medicine as "Codomol".

Hah. Good. I was wondering which one of you would spot that one!

 

[ebee]

Just to add to that one.
Someone in my circle has been given some additional medication by a GP.
One of a group practice so not quite their usual GP as such.
They read the leaflets and amongst the many warnings they list a few items that might affect the patient according to what is on the leaflets.
The patient mentioned this to the pharmacy just as a "quick overcheck" and left the matter with the pharmacy and agreed to ring back in a few hours time.
Ringing back was advised to check with the GP (the pharmacy passed the buck!).
From my own personal experience and of many in my circle a GP appointment within three weeks is impossible so the patient has decided to go ahead and take the additional medication under the presumption that the GP issuing the prescription has applied due diligence prior to prescribing.
The patients existing "Ailments" are
Atrial Fibrillation.
"Probable Asthma/COPD"
Type 2 Diabetes.
Cellulitis of leg.
Essential Hypertension.
Obstructive Sleep Apnoea. (CPAP machine used every night).
Osteopenia.
Hip Osteoarthritis.
Venous Ulcer of leg.
Osteoarthritis. (both shoulders and both knees) .

Medication
Ramipril.
Metformin.
Omeprazole.
Adizem SR.
Warfarin.
Atorvastatin.
CoCodomol.
Epimax Excetra Cream.
Fostair Nexthaler .
Salamol Inhaler.
Bendroflumeethiazide.
Patient is 70 years old and overweight.
These are repeat medications.

The additional medication that is of concern when reading the leaflets are:-
Prednisolone 5mg 6 capsules once daily for 7 days.
Doxycycline 100mg caps 6 capsules total 2 on the 1st day and 1 on the remaining 4 days.
The patient has taken this once before in 2024 and a further dose the month before of 2 capsules for 7 days.

(I have highlighted in bold what the patient thinks according to the contras listed on the leaflet.)

Some of you will know doubt know yourself or because of having people in your own circle having some of those conditions and knowing some of the contras.
Some of you might even have had some medical training and/or qualifications.

No doubt some "could be serious" but most probably not and hopefully the GP has taken all of this into account.

Every operation (procedure I think they calls them these days) and every medication (simple or not) can have serious repercussions in some unlucky persons in some circumstances.

I myself was given the choice by a surgeon of having a joint operation and after listing all of the possible outcomes and the percentages I started thinking do I risk it for the possible reward or do I play "safe" and let nature take its course (let it worsen) or do I go thru it all and there is none or little improvement, He gave me 12 months to decide then he would discharge me.
Within a week of that meeting Boris put us into the first lockdown, so my niggling doubts seemed to take a back seat to what was happening to the world so I left it in abeyance.

 

[morqthana]

Horses for courses. I personally generally find paracetamol to be more effective than anti-inflammatory drugs like aspirin and ibuprofen but others, probably like you, experience the opposite.

Maybe it depends on the "type" of pain. I never get headaches, for example, and thinking about it, when I do want a painkiller it is pretty much always because of something which needs a NSAID.

Or it needs paracetamol, but combined with a healthy slug of codeine...

Have never (fortunately) needed anything stronger.

EDIT - PS: I'd forgotten about the use of paracetamol to reduce a fever.

 

[morqthana]

Re codeine addiction - I've never had a need for long-term pain relief, but the closest I came was about a week of a root canal infection while we waited for the antibiotic course to run before my dentist got to work, and I self-medicated with co-codamol. I was taking about 50% of the maximum recommended, for about a week, and whilst I didn't get addicted, it was sobering that when I stopped taking it I got withdrawal symptoms.

 

[JohnW2]

Maybe it depends on the "type" of pain. I never get headaches, for example, and thinking about it, when I do want a painkiller it is pretty much always because of something which needs a NSAID.

Yes, it very much depends on the nature, cause and mechanism of the pain. Paracetamol has no anti-inflammatory action - so if the pain is caused by, or associated with, inflammation (e.g. arthritis) then an NSAID should be much more appropriate. In fact, NSAIDs were initially developed 'as' NSAIDs without initially any expectation that they would have a direct pain-relieving and certainly not an expectation that they would reduce elevated temps.

Or it needs paracetamol, but combined with a healthy slug of codeine...

Codeine has no anti-inflammatory activity, either, so if the pain is caused by, or is associated with, inflammation then one is again back to NSAIDs being the most logical treatment. Since codeine (and dihydrocodeine) are converted to morphione in the liver, giving it is essentially the same as giving a small dose of morphine or diamorphine ('heroin').

EDIT - PS: I'd forgotten about the use of paracetamol to reduce a fever.

It's by far the most common reason why I personally take paracetamol, and I personally find it better at that than ibuprofen (but similar to aspirin)