Combined acetaminophen and ibuprofen for pain relief after oral surgery in adults: a randomized controlled trial

TLDR

Acetaminophen is commonly paired with NSAIDs for acute pain, but they have traditionally been administered separately; Maxigesic tablets combine acetaminophen and ibuprofen in appropriate doses to simplify dosing. The study compared the pain‑relief efficacy of Maxigesic versus its individual components in adults undergoing third‑molar extraction. Participants received two tablets before surgery and then every 6 h for up to 48 h, with the primary outcome being the time‑corrected area under the curve of 100‑mm visual analogue scale pain scores at rest and during activity. Maxigesic produced significantly lower pain AUCs than either acetaminophen or ibuprofen alone (P < 0.01), with no pharmacokinetic interaction observed.

Abstract

Acetaminophen is often used with a non-steriodal anti-inflammatory drug for acute pain. Hitherto, these drugs have had to be given separately, typically at different time intervals. Maxigesic tablets combine acetaminophen and ibuprofen in clinically appropriate doses to simplify administration and dosage regimen. We compared this combination with each of the constituent drugs for the relief of pain after extraction of third molar teeth.Adults (more than 16 yr) having one or more wisdom teeth removed under general or local anaesthesia were instructed to take two tablets before operation, then two tablets every 6 h for up to 48 h of: (i) a combination of acetaminophen 500 mg and ibuprofen 150 mg per tablet (Maxigesic); (ii) acetaminophen 500 mg per tablet alone; or (iii) ibuprofen 150 mg per tablet alone. The primary outcome measure was the area under the curve (AUC) of the 100 mm visual analogue scale pain measurements taken for up to 48 h after surgery, divided by time, at rest and on activity. Pharmacokinetic data were collected in a subset of patients.The mean (sem) time-corrected AUC on rest and activity, respectively, were: combination group 22.3 (3.2) and 28.4 (3.4); acetaminophen group 33.0 (3.1) and 40.4 (3.3); and ibuprofen group 34.8 (3.2) and 40.2 (3.4); P<0.01 for each of the four comparisons of combination vs constituent drug. There was no pharmacokinetic interaction between acetaminophen and ibuprofen administered together.Maxigesic tablets provide superior pain relief after oral surgery to acetaminophen or ibuprofen alone.