Paracetamol 500mg / Ibuprofen 150mg tablets

Paracetamol and nonsteroidal antiinflammatory drugs (NSAIDs), particularly ibuprofen, are frequently administered together. A systematic review of clinical studies using combined or alternating regimes of NSAIDs was performed up to May 2023. Clinical evidence (77 studies) confirms that in many cases efficacy is enhanced by paracetamol + NSAID combinations, but quite a few studies show no added benefit. Synergism is more commonly found with combined regimens in analgesia for surgery, and with alternating regimes in antipyresis. In some instances the advantage may be related to the short duration of the effect of paracetamol. Mechanistically, central and peripheral actions associated with inhibition of cyclooxygenase have been documented for both paracetamol and NSAIDs, which are relevant for analgesia, antipyresis and closure of patent ductus arteriosus in neonates. In addition, paracetamol may achieve analgesia via different central pathways independently of cyclooxygenase. Hence, increased analgesia may result from NSAID and paracetamol acting at least partly via different mechanisms, while enhancement of antipyresis probably is explained simply by augmented or more prolongued inhibition of cyclooxygenase. Because of the inconsistencies found in the available evidence, added benefit should not be assumed for paracetamol/NSAID combinations. In addition, combining paracetamol and NSAIDs may lead to increased dosing errors, and may result in increased toxicity as a result of enhanced cyclooxygenase interference, a possibility that has barely been scrutinized. We conclude that combining paracetamol and NSAIDs may be justified in analgesia, but further studies are warranted to establish when and how an enhanced effect is achieved with this strategy.

Abstract licence: CC BY-NC

AimsFever is one of the most frequent reasons for paediatric consultations. While traditionally managed by reducing body temperature, recent guidelines emphasize alleviating discomfort as the primary therapeutic goal. Although different interventions have been described to manage fever-associated discomfort in children, their effectiveness and safety has never been systematically analysed. The aim of this study was to review the evidence on the effectiveness and safety of pharmacological and nonpharmacological interventions for managing discomfort in febrile children.MethodsA systematic review was conducted following PRISMA guidelines (PROSPERO: CRD420250655721). PubMed, Embase and Cochrane Library were searched up to 31 January 2025, for studies involving children aged 29 days to 18 years that assessed interventions for fever-associated discomfort. Randomized controlled trials and observational studies were included. Risk of bias was assessed using Cochrane and STROBE tools. Results were synthesized narratively and grouped according to the type of intervention.ResultsEight studies (5 randomized controlled trials, 3 observational) involving 1877 children were included. Study designs, including dosage of antipyretics and quality varied across studies. Studies comparing ibuprofen and paracetamol provided conflicting results, while combination therapy (paracetamol + ibuprofen) appeared more effective than using a single drug in -one trial. Tepid sponging, despite reducing temperature, was associated with increased discomfort. No serious adverse events were reported.ConclusionPharmacological treatments appear effective and safe, whereas physical methods offer limited benefit. The available evidence is limited by the small number of studies, methodological heterogeneity, and concerns about risk of bias and outcome measurement inconsistency. New high-quality studies are needed to guide clinical practice for the management of fever-associated discomfort in children.

Abstract licence: CC BY