Combiflam: Uses, How It Works, Side Effects

What is Combiflam used for?

Combiflam is used for short-term relief of mild to moderate pain and inflammation, and to reduce fever.

• Headache, including migraine headache
• Period pain
• Dental pain
• Pain after an operation
• Muscle and joint pain
• Sprains and strains
• Fever

How does Combiflam work?

Ibuprofen blocks enzymes called COX-1 and COX-2, which lowers prostaglandins, the chemical messengers that cause pain, swelling and fever. Paracetamol works mainly in the brain and spinal cord to turn down pain signals and lower the body's temperature set-point. Together they act in two different ways.

What happens in your body after you take it

1. You swallow the tablet

   The tablet breaks apart in the stomach and both medicines pass into the small intestine.

2. Absorbed into the blood

   Both ibuprofen and paracetamol are absorbed quickly in the small intestine. Taking the tablet with food can make the effect start a little later.

3. Ibuprofen lowers prostaglandins where the body is hurt

   Ibuprofen blocks COX enzymes in the body's tissues. With fewer prostaglandins, pain, swelling and heat in the area ease. The same blocking in the stomach lining and kidneys is why this type of medicine can irritate the stomach or affect the kidneys.

4. Paracetamol turns down pain signals in the brain

   Paracetamol acts mainly in the brain and spinal cord, where it reduces prostaglandins. This dampens pain signals and brings the fever set-point back down.

5. The liver and kidneys clear the medicines

   The liver changes most of the paracetamol and part of the ibuprofen into forms the body can remove. They leave mainly through the urine, so the effect fades after about 4 to 6 hours.

How to take Combiflam

Take Combiflam exactly as your doctor advises or as printed on the pack, and use it for the shortest time needed. Do not take more, more often or for longer than directed.

• The label for adults and for adolescents aged 12 and over weighing at least 40 kg describes one tablet at a time, with at least 6 hours between doses and no more than 3 tablets in 24 hours.
• It is meant for short-term use. The label says not to use it for more than 3 days for fever or more than 4 days for pain unless a doctor advises. See a doctor if symptoms continue or get worse.
• People with a sensitive stomach should take it with food. Swallow the tablet with water.
• Many cold, flu and pain medicines also contain paracetamol or an NSAID. Check labels so you do not double up.
• The label says Combiflam tablets are not for children under 12 years or for adolescents under 40 kg.

Side effects of Combiflam

Most people tolerate Combiflam for a short time. The most common problems are stomach upset, and the serious risks are stomach bleeding, kidney or heart problems, liver damage from too much paracetamol, and skin reactions.

Uncommon or mild

• Heartburn, indigestion or stomach pain
• Feeling sick (nausea) or vomiting
• Diarrhoea or constipation
• Headache or dizziness
• Mild skin rash

Who should be careful

Because Combiflam contains an NSAID (ibuprofen), more people need to check with a doctor before taking it than with paracetamol alone.

• A past stomach or gut ulcer or bleeding, or ulcerative colitis or Crohn's disease
• Heart disease, heart failure, high blood pressure, or a past heart attack or stroke
• Kidney disease, or being dehydrated from vomiting or diarrhoea
• Liver disease, heavy or regular drinking, or poor nutrition
• Asthma, hay fever or nasal polyps, especially if aspirin or another painkiller has caused wheezing or a rash before
• Lupus or related conditions
• Pregnancy or breastfeeding: ask a doctor first; it is not for the last 3 months of pregnancy
• Older adults, who are more likely to have stomach bleeding and kidney effects
• Taking blood thinners, steroids or other painkillers, or having surgery soon
• Children under 12 and adolescents under 40 kg: not for these groups

Medicines and things that interact with Combiflam

Several medicines add to the stomach, kidney or bleeding risks of ibuprofen, or double up the paracetamol. Tell your doctor or pharmacist about everything you take.

• Other painkillers of the NSAID type, including aspirin and diclofenac: more stomach, kidney and bleeding risk, so taking two together is avoided
• Other medicines containing paracetamol, including many cold and flu products: risk of overdose
• Blood thinners such as warfarin, and antiplatelet medicines: higher bleeding risk
• Steroid tablets and SSRI-type antidepressants: higher risk of stomach bleeding
• Water tablets (diuretics), ACE inhibitors and similar blood-pressure medicines: can affect the kidneys and reduce their effect
• Methotrexate and lithium: levels may rise
• Alcohol: raises the risk of stomach irritation and, with paracetamol, liver damage

If someone takes too much

Storage

Store as directed on the pack, usually in a cool, dry place away from direct sunlight and out of the reach of children. Do not use after the expiry date.

Regulatory status in India

Approved for sale in India. The ibuprofen 400 mg + paracetamol 325 mg combination appears on CDSCO's list of approved fixed-dose combinations. Combinations that pair paracetamol or ibuprofen with other medicines have been banned in India, so check that the pack lists only ibuprofen and paracetamol.

Other brands with the same medicine

Other brands and generic tablets that contain ibuprofen 400 mg with paracetamol 325 mg work the same way. Check the ingredients and strength printed on the pack, because some products with similar names contain different amounts or other ingredients.

Other strengths and forms

Combiflam is also sold as a suspension for children and in other variants, so check the pack to be sure which strength and ingredients you have. Dosing for the suspension is by body weight, as a doctor advises.

Common questions