Acute pain is a common symptom experienced by children during illness. Paracetamol and ibuprofen are the most commonly used analgesic drugs in the pediatric field. Multimodal pain management using a combination of paracetamol and ibuprofen has been shown to produce greater analgesia efficacy.
The investigation was conducted using two open-ended (non-anonymous) questionnaires sent sequentially to a Board of ten expert physicians to understand their opinions on the use of a combination of paracetamol and ibuprofen.
The aim of the investigation was to assess expert opinion on the most appropriate use of paracetamol and ibuprofen in a fixed-dose combination (3.3:1 dose ratio) for the treatment of mild to moderate acute pain in children. To illustrate the dose, for patients weighing less than 50 kg, the recommended dose is 15 mg/kg paracetamol and 4.5 mg/kg ibuprofen, given every 6 hours as needed. This equates to a maximum single dose of 750 mg paracetamol and 225 mg ibuprofen, and a total daily dose of 3,000 mg (3 g) paracetamol and 900 mg ibuprofen.
Results:
- The board reached a final consensus regarding the better analgesic power of paracetamol and ibuprofen in fixed-dose combinations compared to monotherapy, notwithstanding the safety profile.
- A strong consensus was reached on the opinion that a fixed-dose combination of paracetamol and ibuprofen can be a useful option if monotherapy is ineffective, especially in cases of headache, odontalgia, ear pain, and musculoskeletal pain.
- The use of fixed-dose combinations is also considered suitable for post-operative pain management.
Conclusion:
The use of a fixed-dose combination of paracetamol and ibuprofen with a dose ratio of 3.3:1 may provide advantages in terms of efficacy and safety, allowing better control of paracetamol and ibuprofen doses as monotherapy, thus minimizing the risk of dosing errors.
Image: Illustration (Source: lifeforstock-Freepik)
Reference:
- Parri N, Silvagni D, Chiarugi A, Cortis E, D'Avino A, Lanari M, et al. Combination of paracetamol and ibuprofen for the management of mild to moderate acute pain in children: expert consensus using Nominal Group Technique (NGT). Ital J Pediatr. 2023;49(1):36
- Combogesic® IV [Package Insert]. Auckland, New Zealand: AFT Pharmaceuticals Ltd; 2023. https://www.dropbox.com/scl/fi/95rn5ocktedbynv4ulrl3/Combog esic-IV-FDA-approved-label.pdf?rlkey=ttl8z3l0jebqb7xg1wkrng9sh&dl=0
