Jan 26, 2021

By Trevor Shewfelt, pharmacist at the Dauphin Clinic Pharmacy

Kids hate having to apologize to their parents. Especially when it is for something really dumb. Something where the kid should have known better. We don't have Canada Post home delivery on our street. We have to walk to our mailbox at the end of our street. That means getting the mail is always a bit of an outing. First, getting the mail usually means Sheldon gets a walk. You have to remember the mailbox keys, poopy bags for Sheldon and it is helpful to take a reusable grocery bag with you to put the mail in. A key to the whole process that I hadn't thought of before is to remember to fully empty the reusable grocery bag of mail when you get home.

Combogesic is the first fixed dose combination of acetaminophen and ibuprofen to be marketed in Canada. It is made by the company BioSyent Pharma and it contains 325 mg of acetaminophen and 97.5 mg of ibuprofen per tablet. Combogesic is indicated for adults. It is intended to treat mild to moderate short term or acute pain and for short term fever. The recommended dose is one to two tablets every 6 hours. There is an interesting caveat that if the pain isn't helped by 2 tablets, the patient can try 3 tablets six hours later if okayed by their doctor. No one should take more than 12 tablets in 24 hours. Combogesic should not be taken for more than 3 days to treat a fever or more than 5 days to treat pain without talking to their doctor first.

Have your ever listened to a movie review and tried to decide "Should I watch it?" Well, let's do that with Combogesic. Should I take it? I'll declare my bias right off the hop. I thought Combogesic was a dumb idea. Thirty tabs of Combogesic, which each contain 325 mg of acetaminophen and 97.5 mg of ibuprofen, will cost you about $15.00. A bottle of 24 generic acetaminophen 325 mg will cost you less than $5. A bottle of 24 generic ibuprofen 200 mg, which you could split in ½ and get close to the 97.5 mg of ibuprofen, will cost you less than $5. That means for under $10, you could buy about 30 doses worth of the ingredients in Combogesic, as opposed to about $15 for the actual Combogesic. That is why my initial thought was no, don't take the Combogesic.

Then a smart, young DCP pharmacist, Rachel, piped up. She thought that Combogesic was a great idea. She loved the idea of only having to take one pill instead of two. Okay, now I had to do a little digging.

AFT Pharmaceuticals actually did a study 408 people, 133 male, 275 female with an average age of 25. The participants either got Combogesic, acetaminophen 325 mg on its own, ibuprofen 97.5 mg on its own or placebo. The results were that the Combogesic worked better at treating pain than either of the acetaminophen or ibuprofen on their own. And there were other studies that showed acetaminophen 500mg and ibuprofen 150 mg, which is almost identical to the strength of 2 Combogesic tablets, as better at treating pain than either ingredient alone. The Combogesic manufacturer implied that the ratio of 3.3:1 of acetaminophen to ibuprofen was some magical sweet spot in analgesic dosing. That means that there is a little bit of science behind why you might want to take a Combogesic.

Are these small studies enough to convince me that Combogesic is wonderful? Not really. I mean, there is nothing wrong with Combogesic. But you could just take the separate ingredients together and get the same effect for cheaper. I guess the question is one of convenience. Are you willing to pay a little extra to get your ibuprofen and acetaminophen together in the same pill?

Who shouldn't take Combogesic? The same people who shouldn't take ibuprofen or acetaminophen. Ibuprofen can cause bleeding stomach ulcers. Symptoms of bleeding in your stomach can include: feeling faint, vomiting up blood which will often look like coffee grounds, or pooping out blood which will often look black and tarry. Ibuprofen can be hard on the kidneys. Ibuprofen can effect how your blood clots. If you have problems with any of these, talk to your doctor or pharmacist before taking Combogesic. Ibuprofen is an NSAID. Don't take Combogesic with other NSAIDS like naproxen, diclofenac or with ASA. Acetaminophen can be hard on the liver. Don't take more than 12 tabs in 24 hours. Don't take Combogesic with other acetaminophen containing products. Don't take Combogesic while drinking 3 or more alcoholic beverages per day. Symptoms of liver damage may include yellowing of the skin/eyes, dark urine, nausea, vomiting, stomach pain, unusual tiredness and/or loss of appetite.

Emily's birthday was back on January 10th. Her grandmother from Pinawa hand painted her a birthday card with yellow daisies on it. The painting was a lovely, one-of-a-kind, birthday card sized watercolor. Emily takes after her grandmother when it comes to artistic ability. Emily even sent her grandparents paintings for Christmas. Emily's hand painted birthday card also contained some birthday money. Emily's grandmother is always very prompt and time conscious. She always sends birthday cards so they arrive before the birthday. And Emily's grandmother watches her bank statements to see when the birthday cheques are cashed. So, with much embarrassment, last night I reached into a reusable grocery bag and found some left over mail. It was Emily's birthday card. I'm pretty sure it had been in there for a couple of weeks. Now, I've gotta go call my mom and apologize. It wasn't Canada Post who lost Emily's card.

As always if you have any questions or concerns about these or other products, ask your pharmacist.

The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.


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