Ibuprofen/acetaminophen for pain after wisdom teeth extractions

[Kassia]

Does anyone know if it's better to stagger these two meds or take them together?  I've always thought staggering was standard, but recently I've heard it's better to actually take them together.  I can research this, but I was wondering if anyone here knows or has had experience with this for pain relief.  

[Annie G]

Nothing but personal experience here, but last month oldest granddaughter had her wisdom teeth out and used the alternating method (I made a chart for her to follow/mark times on and had her set phone alarms so she took things on schedule) I was only there for the first two days but her pain was well controlled with that method.  Ice packs also used,  but I think that was for the swelling. 
 

I’ve never heard of taking them together. How often do you take them? 
Sending good vibes for your person having them removed. 

[cintinative]

we were told to stagger. That way, you are taking one as the other is starting to wear off. 

[Katy]

Staggering is better, so one med level is high while the other is dropping. 

[Kassia]

5 minutes ago, Katy said:

Staggering is better, so one med level is high while the other is dropping. 

 

38 minutes ago, cintinative said:

we were told to stagger. That way, you are taking one as the other is starting to wear off. 

that makes a lot of sense!  Thanks!

[Kassia]

1 hour ago, Annie G said:

 

I’ve never heard of taking them together. How often do you take them? 
 

I don't remember.  My MIL was told to do this a couple of years ago when she broke her wrist.  I was surprised because I had never heard of it being done that way so I looked it up and read that it is actually more effective than staggering.  And when I started looking it up for oral surgery, I saw one place say the same thing so I thought I'd ask here for crowdsourcing.  🙂  

[wintermom]

I've been recommended by nurses to take both together, and then there is natually some staggering as one lasts 4 hrs and one 6 (or 12). They each function differently, and that combined affect is good to have initially.

[cjzimmer1]

Just got home from the oral surgeon a few minutes ago with DD.  I've always heard stagger but he said we could stagger every 3 hours or take both together every 6 hours whichever worked better for DD.  We've used the same clinic for all 3 older kids and we were always told to stagger.  This was the first time I have been told they could be taken together.

[Kassia]

15 minutes ago, cjzimmer1 said:

Just got home from the oral surgeon a few minutes ago with DD.  I've always heard stagger but he said we could stagger every 3 hours or take both together every 6 hours whichever worked better for DD.  We've used the same clinic for all 3 older kids and we were always told to stagger.  This was the first time I have been told they could be taken together.

thank you!  Hope your dd heals well.  

Would you mind sharing the dosage for staggering and/or taking together?  

[cjzimmer1]

12 minutes ago, Kassia said:

thank you!  Hope your dd heals well.  

Would you mind sharing the dosage for staggering and/or taking together?  

The dosage of the individual meds was the same whether taken together or separately. The paperwork says 600mg of ibuprofen and 325-650 mg of acetaminophen.

[kbutton]

2 hours ago, wintermom said:

I've been recommended by nurses to take both together, and then there is natually some staggering as one lasts 4 hrs and one 6 (or 12). They each function differently, and that combined affect is good to have initially.

I suppose that depends on the dose. If you take a lower dose of ibuprofen, or can be given more often, but we always cut to the chase and use a higher dose less often.

There is also extended release acetaminophen, which makes for even more options.

One of my kids was in agony while teething (he would have four breaking through all at once and four more swollen right behind them!), and it seems to me that the worst times were when both meds wore off close together because every few doses, the timeframes overlapped more closely. Hmmm.

2 hours ago, Kassia said:

I don't remember.  My MIL was told to do this a couple of years ago when she broke her wrist.  I was surprised because I had never heard of it being done that way so I looked it up and read that it is actually more effective than staggering.  And when I started looking it up for oral surgery, I saw one place say the same thing so I thought I'd ask here for crowdsourcing.  🙂  

Do you remember if it gave a mechanism for this?

[kbutton]

6 minutes ago, cjzimmer1 said:

The dosage of the individual meds was the same whether taken together or separately. The paperwork says 600mg of ibuprofen and 325-650 mg of acetaminophen.

That might work better all around. For adults, a lot of docs prescribe 800 mg of ibuprofen every eight hours. Maybe going middle of road on dosing evens out some of the wearing off—fewer peaks and valleys. 

[KSera]

For something with a lot of pain, I take both together for the first dose, and then stagger after that. Since Ibuprofen has a wider safe dosing range and is often prescribed at higher doses for pain, I do the usual 2 tablet dose of it initially with the Tylenol, but then if necessary, the ibuprofen could be taken again at 3 hours later, Tylenol 3 hours after that, etc. I don’t ever take any more Tylenol or at any closer together than the box shows. 

[Kassia]

17 minutes ago, kbutton said:

 

Do you remember if it gave a mechanism for this?

no, but I have access to her patient portal and can see if I can find it.  It was a couple of years ago, though.

ETA  There's only a record of her ER visit, but no details.  

Edited Wednesday at 04:52 PM by Kassia

[wathe]

I'm not sure that it matters much.  I think that advice given by HCP regarding alternating vs taken together regimens for pain management are based on opinion.  I haven't seen good data to support either practice.  Most of the data that I can find on co-administration of acetaminophen and ibuprofen are for fever management rather than pain management.

As long as you don't exceed the daily maximum dose for either, I don't think it matters much.

Alternating, in theory, avoids troughs (having both meds wear off at the same time), but means more frequent dosing intervals, and increases risk of error (forgetting which med was given last, leading to accidental double dosing.)  

But, acetaminophen and ibuprofen have different pharmacokinetics, so strict every 3 hour alternating wouldn't necessarily  provide a smooth steady-state, and taken together likely doesn't have quite the peak/trough pattern most people think either.

 I, personally, can't stand frequent dosing intervals and tracking what was taken when, so I default to a three times a day taken together for convenience regimen for my family, even for post-operative pain.  It's been fine.   Worked well after oral surgery for my DS.

(Off topic, but It's notable that the AAP used to advise against routine co-administration of ibuprofen and acetaminophen for fever management, and I think still does.  UK NICE still does for under 5's.   IIRC, the reasoning is poor data, interference with immune function, and concern for increased risk of med errors.)

[Kassia]

@wathethank you so much!  I value and appreciate your input!  

[Kassia]

4 minutes ago, wathe said:

default to a three times a day taken together for convenience regimen for my family, even for post-operative pain.  It's been fine.   Worked well after oral surgery for my DS.

 

what dosage did you use for each for your ds if you can share?  

[wathe]

2 hours ago, Kassia said:

what dosage did you use for each for your ds if you can share?  

Mine are adult sized teen now, so I give them 800mg of ibuprofen and 1000mg of acetaminophen, three times daily, when needed.    

When they were little, I used 10mg/kg body weight of ibuprofen and 15mg/kg acetaminophen, three times daily.

This underdoses the acetaminophen a little, but it's been effective for us.

 

[Ottakee]

5 hours ago, Kassia said:

@wathethank you so much!  I value and appreciate your input!  

Always

[J-rap]

It's fine to take them together, so at the start when the pain is extreme and you're just trying to get it under control, you can do that.  Once the pain feels under control, you can stagger them if you like.  The reason you might take them together is that they work differently, so you're kind of sending the whole army in to attack the pain at first.

This is the "recipe" we've always used.  It also sometimes takes the edge off of really bad migraines.

If you are experiencing moderate to severe pain, you can take up to 600mg of ibuprofen and 1000mg of acetaminophen at the same time.  You can do this no more than once every 6 hours, up to 24 hours.

[Kassia]

thank you @J-rap!  🙂