Can you take paracetamol with ...
Advice for patients

Can you take paracetamol with … ?

Paracetamol is one of the most commonly purchased over the counter medication. It is still one of the most commonly prescribed drugs in the UK with more than 17mln items prescribed in the last 12 months (Sep ’18—Aug ’19), costing NHS over £46 mln (Openprescribing.net, 2019). I previously wrote a couple of posts on use of paracetamol and naproxen and paracetamol and ibuprofen. Can you take paracetamol with … covers concomitant use of paracetamol with other common drugs, purchased from the pharmacy or prescribed.

Can you take paracetamol with ibuprofen?

Paracetamol and ibuprofen can be taken together. This advice generally applies to anyone who 16 and over (NHS, 2017).  There is no interaction between drugs.

Is taking paracetamol and ibuprofen together more effective in reducing pain than taking drugs alone?

Ibuprofen belongs to a group of drugs called nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs reduce pain, help with fever and decrease inflammation. The inflammatory action of ibuprofen is the main difference when comparing to paracetamol, which is mainly used to manage the pain and fever. The distinct mechanism of actions contributes to better-combined analgesic effectiveness.

Cochrane reviewed information from thee clinical trials and compared the effectiveness of paracetamol and ibuprofen as single and combined doses in patients who had a wisdom tooth removed (moderate to severe pain in over 1600 patients). This review concluded that ibuprofen plus paracetamol combinations provided better analgesia than either drug alone, when the same dose was given (Derry et al, 2013).

A combination product, Nuromol, contains both paracetamol and ibuprofen. Nuromol can be purchased from the pharmacy.

Can you take paracetamol with naproxen?

Paracetamol and naproxen can be taken together. There is no interaction between drugs. More details can be found in a separate post.

Can you take paracetamol with codeine?

Paracetamol and codeine can be taken together. There is no interaction between drugs. Combination products (Co-codamol) containing both paracetamol and codeine exist in various forms, and in lower strength, co-codamol can be purchased from the pharmacy, for example co-codamol (8mg of codeine and 500mg of paracetamol per tablet) or slightly higher strength as branded product, Solpadine Max (12.8mg of codeine and 500mg of paracetamol per tablet). Higher strengths of co-codamol (containing 15mg or 30mg of codeine) in combination with paracetamol can only be prescribed on prescription.

Is co-codamol more effective in reducing pain than paracetamol alone?

A single dose of codeine, possibly combined with paracetamol, has greater analgesic efficacy than paracetamol alone (Prescrire Int., 2016), but the advantages of this combination product have not been demonstrated (BNF, 2019).

Is it ok to take paracetamol with co-codamol?

Paracetamol and co-codamol should not be taken at the same time. Co-codamol contains a combination of paracetamol and codeine. One can alternate between both drugs e.g. a dose of co-codamol can be followed (after six hours) with a dose of paracetamol.

Can you take paracetamol with aspirin?

Anadin Extra contains paracetamol and aspirin in a single product.

Paracetamol can be taken together with aspirin. Aspirin similarly to ibuprofen and naproxen is an NSAID. Combined products containing both paracetamol and aspirin can be purchased, for example, Anadin Extra.

Can you take paracetamol with antibiotics?

Paracetamol can be taken with antibiotics such as penicillins (amoxicillin, phenoxypenicillin), metronidazole, clarithromycin, etc. There is no listed interaction between paracetamol and any antibiotic.

When in doubt, always read product information leaflet or speak to a pharmacist.

References:

BNF (2019). Analgesics. Available at: https://bnf.nice.org.uk/treatment-summary/analgesics.html Accessed on 13/11/2019

Derry CJ, Derry S, Moore R (2013). Single dose oral ibuprofen plus paracetamol (acetaminophen) for acute postoperative pain. Available at: https://www.cochrane.org/CD010210/SYMPT_single-dose-oral-ibuprofen-plus-paracetamol-acetaminophen-acute-postoperative-pain Accessed on 09/11/2019

Openprescribing.net (2019). Items for paracetamol by all CCGs. Available at: https://openprescribing.net/analyse/ Accessed on 12/11/2019

Prescrire Int. (2016). “Weak” opioid analgesics. Codeine, dihydrocodeine and tramadol: no less risky than morphine. Prescrire Int. 2016 Feb;25(168):45-50. Available at: https://www.ncbi.nlm.nih.gov/pubmed/27042732 Accessed on 13/11/2019

I am a community pharmacist working in UK. I blog about drugs, health and pharmacy.

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