Can You Take Paracetamol and Ibuprofen Together?

Paracetamol and ibuprofen are both effective pain-relief medications which work differently to relieve mild to moderate pain.

Paracetamol also known as Acetaminophen is known to be a first line treatment for mild to moderate pain and fever and works by inhibiting prostoglandin synthesis in the body to treat nociceptive pain. It can be taken with or without food. However, paracetamol should be taken with caution and dosing guidelines followed strictly as overdosing on paracetamol is extremely common which can lead to liver failure and other complications. 

Ibuprofen on the other hand is a nonsteroidal anti-inflammatory drug (NSAID) used to treat various issues such as mild to moderate nociceptive pain, arthritic conditions, inflammation, fever and so on. It is not recommended to take ibuprofen on an empty stomach as ibuprofen is known to be a stomach irritant particularly causing gastric bleeds and peptic ulcers therefore should be taken with or after food. In the case of nausea or vomiting in children where a full meal is not possible, a small snack or drink is recommended alongside the ibuprofen. 

According to the World Health Organisation (WHO) pain ladder scale, both paracetamol and ibuprofen should be given as a first-line treatment to manage pain ranging from mild to moderate. They can be taken alongside other pain relief analgesics when the severity of pain becomes hard to control with only paracetamol and ibuprofen. 

Both paracetamol and ibuprofen can be taken together for short term use in the case of acute pain or fever but patients are advised to stagger the doses especially in children under 16 years of age. It is recommended to take paracetamol first, monitor the symptoms and allow the effects of paracetamol to occur ranging from 30 minutes to an hour. If there are no changes in symptoms, then ibuprofen can be administered an hour after the first dose of paracetamol. The next dose of paracetamol can then be administered again 4 hours later. 

What Are Paracetamol and Ibuprofen Used For?

Paracetamol and ibuprofen uses are plenty however, they are each used to manage different needs.  

Paracetamol also known as acetaminophen is used to manage high fever caused by colds and flu, headaches, muscle strains, toothaches and in general to treat mild to moderate pain. It is available in various formulations such as tablets/caplets, soluble tablets (dissolved in water before being taken orally), liquids, capsules, suppositories (inserted into the rectum), and intravenous injections (normally administered in hospitals). 

It can be bought over the counter or on prescription – stronger doses or in combination with other pain killers such as codeine (co-codamol). It is available in general stores and pharmacies as part of their own brand medication or under household brands such as Panadol, Calpol. You can also find them on our Meds for Less website which has an array of medications to suit your medical needs.

Conversely, Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID). It is used to treat mild to moderate pain similar to paracetamol but by using a different mechanism of action. It is also useful to treat pain and inflammation in patients with rheumatoid or osteoarthritis which can cause intense pain and swelling and generally reduced movement in patients hence ibuprofen can provide relief and a reduction in pain intensity. 

It can also be used for treating mild to moderate pain such as headaches, toothaches, dysmenorrhoea (painful period cramps) and migraines. It is available in various formulations such as tablets, liquids, capsules, gels, creams or as a spray. This is especially useful for when patients want relief from injuries such as muscle strains, or back pain. 

The gel and spray formulations allow patients who are asthmatic or hypertensive – both of which are contraindicated in the use of ibuprofen – to use the ibuprofen gel or spray externally without needing to ingest the medication hence avoiding unnecessary complications. 

How Ibuprofen and Paracetamol Work Differently?

Paracetamol also known as Acetaminophen – N-acetyl-para-amoniphenol (APAP) is an analgesic (pain) and an antipyretic (fever) medication and is known to be an effective tool in managing pain relief and fever. It can be used on its own to treat mild to moderate pain or alongside another analgesic such as codeine to treat and manage more severe forms of pain. 

It is a first-line treatment for patients who cannot take certain pain-relief medications like NSAIDS such as patients with peptic ulcer diseases, haemophilia, certain types of asthma such as bronchial asthma and pregnant and breastfeeding women. 

Paracetamol works by inhibiting specific enzymes known as Cyclooxygenase (COX) enzymes in the central nervous system (CNS). These enzymes are crucial for the production of prostaglandins which regulate several physiological processes in the body such as pain, temperature, inflammation, platelet production and so on. 

By inhibiting COX enzymes – specifically COX-1 and COX-1 enzymes, paracetamol reduces prostoglandin synthesis hence reducing temperature and the perception of pain in the body. As paracetamol primarily targets the CNS, it acts to relieve pain and temperature but does not possess any anti-inflammatory properties. 

Ibuprofen on the other hand is a nonsteroidal anti-inflammatory drug (NSAID) used to manage nociceptive pain ranging from mild to moderate, fever, painful periods (dysmenorrhoea), migraines, arthritis conditions such as rheumatoid and osteoarthritis and many others. 

Ibuprofen works by inhibiting COX-1 and COX-2 enzymes and their pathways which in turn inhibits prostoglandin synthesis. This reduces the effect of prostaglandins on physiological processes in the body which are involved in upregulating pain, temperature, and inflammatory responses. 

Hence, ibuprofen exerts an analgesic, antipyretic and an anti-inflammatory effect in the body and works to manage mild to moderate pain, temperature, swelling, redness and other general indications of an inflammatory response. 

Is It Safe to Take Ibuprofen and Paracetamol Together?

Ibuprofen and paracetamol can be taken together only in the cases of acute short term pain or fever but not for young children. Staggering the doses however, is highly recommended especially in young children under 16 years of age.

The National Health Service (NHS) has guidelines for children under 16 years of age where both ibuprofen and paracetamol should not be given together but instead one medication should be given first, preferably paracetamol. The medication may take from 30 minutes up to an hour to work during which the child should be monitored. If symptoms persist or there’s no changes in the management of pain or fever, then ibuprofen can be given an hour later. The next dose of paracetamol can then be administered again 4 hours later. 

The suggested dosages for both drugs should be followed, with a maximum of three doses of Ibuprofen and four doses of Paracetamol allowed in a 24-hour period, respectively.

When Should You Take Paracetamol and Ibuprofen at the Same Time?

Paracetamol and ibuprofen can be taken at the same time only in severe cases when pain and temperature cannot be managed with just one medication. However, it is not recommended to co-administer both medications especially in young children under 16 years of age. 

Instead, the NHS recommends staggering the doses according to the child’s age, weight and symptoms following medication guidelines provided in this article and also in the patient information leaflet in the medication packs. 

It is advised to adhere to the maximum dosages for both drugs; for example, paracetamol should not exceed four doses in a 24 hour period, and ibuprofen should not exceed three doses.

Should You Take Ibuprofen and Paracetamol Together or Separately?

Ibuprofen and paracetamol can be taken together in short term cases where moderate to severe pain cannot be managed with just paracetamol. However, it should not be co-administered in patients with a history of peptic ulcers, issues with kidney functions, heart conditions or asthma which can be exacerbated by ibuprofen. 

It is highly recommended to stagger the doses especially in children under 16 years of age. Administer the first dose of paracetamol and then monitor for any improvements in symptoms. Ibuprofen can be given an hour later if there are no changes in symptoms. The second dose of paracetamol can then be administered 4 hours later.

Can You Use Ibuprofen and Paracetamol Tablets Together for Children?

The National Health Service (NHS) does not recommend giving paracetamol and ibuprofen together for children under 16 years of age. Instead, parents and caregivers are advised to stagger the doses with an hour-long gap between each medication. 

Therefore, if paracetamol is given first, monitoring the child is recommended as the paracetamol should take around 30 minutes to 1 hour to work. If the child is still unable to manage pain or high fever then ibuprofen can be given an hour after the first dose of paracetamol. The next dose of paracetamol can then be administered again 4 hours later. 

It is advised to adhere to the maximum dosages for both drugs, which stand at no more than three doses of Ibuprofen and four doses of Paracetamol every 24 hours, respectively.

What Are the Side Effects of Taking Ibuprofen and Paracetamol Together?

Although taking ibuprofen with paracetamol is considered safe, it is advised to do so in staggering doses as both medications have several possible side effects.

Who Should Avoid Taking Ibuprofen and Paracetamol Together?

Although both ibuprofen and paracetamol have plenty of uses, they each come with their own set of side effects which can be minimised by following appropriate dosage guidelines and instructions on who can use these medications. 

Ibuprofen is from a class of non-steroidal anti-inflammatory drugs (NSAIDS). Ensure to consult with a doctor or pharmacist before taking ibuprofen especially if you are aged 65 and over.

You should not take ibuprofen if you have or have had:

• Heart conditions such as heart failure
• Reaction to ibuprofen in the past or other NSAIDs such as naproxen 
• Liver disease
• Stomach ulcers
• gastrointestinal bleeding from NSAIDs or another medication
• Kidney disease
• Severe dehydration from loss of fluids caused by diarrhoea 
• Asthma which gets exacerbated by NSAIDs 

Proceed with caution and read the list below before taking ibuprofen. Consult with a doctor or pharmacist if required. 

• Liver, heart or kidney disease
• If you are breastfeeding
• If you are pregnant (first 6 months of pregnancy)
• If you suffer from inflammatory diseases such as ulcerative colitis or Crohn’s disease
• If you have an active infection 
• Any recent major surgeries 
• Hypertension 
• Asthma 
• Allergic reactions to NSAIDs
• History of stroke 
• If you are taking beta blockers, anti-depressants or diuretics 

Paracetamol can be taken safely by most people including pregnant and breastfeeding women for fever and management of pain. However, consult with your doctor or a pharmacist if you have any of the following before taking paracetamol:

• Liver or kidney disease
• History of drinking alcohol 
• Underweight 
• Allergic reactions to paracetamol in the past 
• If you take warfarin – blood thinner
• If you take other medications containing paracetamol such as co-codamol
• Carbamazepine – used for seizures in epilepsy

In the cases of both ibuprofen and paracetamol, not adhering to the maximum dosage guidelines can lead to an overdose. In the case of an overdose please look out for the following signs and symptoms:

• Nausea
• Vomiting 
• Ringing in the ears (tinnitus)
• Abdominal aches (tummy pain)

Oftentimes, patients show no obvious signs of an overdose hence monitoring of dosage is extremely important. If you do suspect an overdose, please call emergency services or find your nearest A&E as soon as possible. 

How to Use Ibuprofen and Paracetamol Tablets Responsibly

Ibuprofen and paracetamol dosing should be followed correctly to avoid any side effects or an overdose. 

Please also refer to the dosing guidelines as outlined in the patient information leaflet (PIL) provided with your medication pack. If further assistance is needed to understand dosing, please reach out to your nearest local pharmacy for further information. 

The following table outlines the dosing guidelines for ibuprofen in liquid and tablet forms. Tablets for children are only available from 12 years of age and above. Ibuprofen is not licensed for use in children under 3 months and/or below a body weight of 5kg.

*Ensure ibuprofen is given and/or taken with or after food. Ibuprofen should be avoided being given on an empty stomach. If a child is unable to eat a full meal due to nausea or vomiting, a small snack or drink is recommended alongside the medication. 

The following table outlines the dosing guidelines for paracetamol in liquid and tablet forms. Tablets for children are only available from 12 years of age and above. Paracetamol is not licensed for use in children under 2 months orally or under 3 months by rectum.

*Paracetamol can be taken with or without food. Patients are advised to not take any other medications which contain paracetamol alongside this medication to avoid instances of an overdose.

FAQ