Last Updated April 25th, 2019
Combiflam tablets are used to relieve, control, prevent and improve various conditions of pain and fever. It is widely used as a very effective painkiller especially for the discomfort associated with rheumatoid arthritis, osteoarthritis, spondylitis, periods, headaches and migraines It is also employed for pains associated with muscles, febrility and gout. Combiflam is seen to be effective to relieve earache, cold, joint inflammations, musculoskeletal disorders and body pains.
Do I need a prescription?
These drugs are given under prescription of a qualified physician.
Combiflam is a combination of paracetamol and ibuprofen. The two are combined because of specific properties of each that make the resulting drug more effective. Paracetamol is an analgesic and antipyretic. Analgesics are drugs that relieve pain while antipyretics reduce or relieve fever. Ibuprofen, on the other hand is a non-steroidal anti-inflammatory drug (NSAID). Generally, NSAIDs are drugs used to reduce pain, swelling and can decrease blood clots when administered in large quantities.
These are normally prepared as tablets containing ibuprofen 400mg and paracetamol 325mg. There are also syrups that contain 100mg of ibuprofen and 162.5mg of paracetamol. It is available in form of tablets, capsules that are taken with or without food.
Mechanism of Action
Its mode of action is by inhibition of the effects of cyclo-oxygenase (COX) enzymes, which are naturally produced in the body. These enzymes are utilised in production of prostaglandin chemicals whose function is causing of pain, swelling and blushing of skin on areas of injury. Thus, when these enzymes are inhibited, pain is reduced, and flow of blood is increased to the inflamed area. The drug increases the loss of heat and induces sweating.
Combiflam works very fast, you will feel signs of relief usually within an hour of taking the medicine. However, the speed of action also depends on other factors such as absorption, disintegration and penetration of the medicines. There may be a variation on speed of relief as this also depends on specific areas of pain targeted.
The drug should not be used by people who have certain conditions that may interfere with the drug, resulting in worsening of the problem. It is necessary that you inform your doctor of any other medications you are using before taking Combiflam.
Some of those that should be mentioned include:
- vitamin and other health supplements,
- allergy medications,
- whether one is due for surgery
Other conditions that should be considered when taking this drug:
- Consumption of alcohol (especially everyday) or salicylates should be avoided. Alcohol causes the drug to be associated with other effects such as dizziness, general body weakness, worsening of pains at joints, rashes and nausea.
- Presence of allergies to paracetamol-based drugs
- Bleeding gums or people predisposed to bleeding easily
- Present conditions of lupus erythematosus (an autoimmune disease that affects body tissues and organs such as skin, joints, brain and among others).
- People with liver and kidney disorders should seek medical assistance before taking this medicine as it has a potential of damaging these organs. Usually, dosage of the medication is adjusted for patients with liver or kidney problems.
- If you have any allergies to any of the constituents of Combiflam tablets you should take precautions.
- Also, if you are allergic to Aspirin and Non-Steroidal Anti-Inflammatory Drugs (NSAID) such as Diclofenac, you should not take the drug without the consultation of a doctor
- Asthmatic or those with any breathing complications, are advised to refrain from this drug or seek medical advice for the safe usage of the drug
- People with porphyria conditions need medical supervision before taking the drug
- Heart and stroke patients need the attention of a doctor before consumption of the drug
The drug is also not advisable if you are:
- Have Peptic ulcers that are active
- Suffer from Gastrointestinal bleeding
- Diagnosed with Hepatic impairment
- Have Hypersensitivity
- If you are an Expectant mother
- Or are recovering from a recent heart surgery
There are minor and major effects that are associated with this drug. These include:
- gastric or mouth ulcers
- ringing sound to ears
- vision disorders
Severe effects include:
- abdominal discomfort
- low production of urine
- yellow colouration of eyes
- swelling of facial features
- hematemesis (possible vomiting of blood)
- agranulocytosis (this is a blood disorder that is usually caused from administration of other drugs and leads to reduction of granulocytes in the body)
Other rare symptoms include the following:
- loss of appetite
- low urine output
- vomiting of blood and
- abdominal discomfort
- excessive pain
- seek medical attention of vision is blurred when taking this medication
- wheezing or difficulties in breathing
- vomiting and
- rashes in the skin that can be itchy
These rare symptoms affect only a small percentage of population. In severe cases mentioned such as drowsiness, low urine output, vomiting of blood, yellow colouration of eyes and heartburn need urgent attention of doctors for further guidance. There may be other side effects that are not listed but associated with taking of Combiflam drug.
In cases of vomiting, patients are advised to take a lot of fluids such as milk. Antacids, fatty and fried foods should be avoided, as they can worsen nausea and vomiting. For some patients with wounds/sores in the mouth, the drug may make them feel more painful.
The drug is associated with interactions that include the following:
- Cholesterol reducing agents such as Cholestyramine and Metoclopramide
- Diuretics such as Chlorothiazide
- High blood pressure-related drugs
- Some antibiotics such as isoniazid (antibiotics can interact with ibuprofen, which can damage the kidney and for some patients, this interaction can lead to increased stomach bleeding)
- Aspirin (it displaces ibuprofen and locks it from intended areas, hence reducing its intended activity, although the two are often used for same purpose and both can cause stomach bleeding).
- Drugs-based on lithium
- Methotrexate (the drug is likely to cause liver damage is take with methotrexate due to increase of this substance in the blood). These drugs are used to treat cancer and arthritis.
- Ketoconazole (oral drugs used to treat and help prevent spread of fungus)
- Combiflam can interfere with some laboratory tests
- Heart treatment drugs such as digoxin. These are drugs that are used to treat heart failure and regularisation of heartbeats)
- Some HIV treatment drugs such as Zidovudine
- Immunodepression drugs such as Ciclosporin and Tacrolimus
- Drugs used to lower blood sugar level
- Anticonvulsants such as Amobarbital and Anticonvulsant drugs – Amobarbital, Butalbital, Pentobarbital, Phenobarbital, Secobarbital, and Carbamazepine
Other known interactions with Combiflam include sodium nitrate, methotrexate, leflunomide and prilocaine. Mild interactions can also occur with other elements that include Carbamazepine, Phenytoin, Corticosteroids and anticoagulants. These are chemicals that prevent blood clotting. Use of Combiflam may worsen the condition of bleeding.
Although it is necessary that Combiflam be taken after or with food, it may interact with ibuprofen due to its higher concertation velocity in the body.
Skipping of dose
If you miss a dose, take the drug as soon as you remember. Take note that the time of taking the dose should not be too close to the next dose. Allow even spacing between doses and forego a dose if it is about time for the next dose. Also, take caution not to take extra dose at any time even if you missed others before. Frequent missing of doses is not recommended. Patients with problems of forgetting or are on a busy schedule are advised to make necessary reminders such as stickers or set alarms. You can also request friends to remind you to take medicine at a certain time.
Combiflam is a prescription drug where monitored administration is done on a patient. The following recommendations will help you get the most out of the drug:
- Do not take the drug with alcohol. Doing so is likely to result in serious side effects that include general body weakness, gastrointestinal bleeding, painful joints, dizziness, rashes, nausea among others.
- If you have a medical condition such as hepatic (liver problems), bronchial asthma, haemorrhage, pregnancy and lactating mothers, please seek medical advice before taking the medicine or inform a doctor when prescribing the drug.
- Special precaution should also be noted for people using anticoagulants (substances that prevent blood from clotting).
- The drug is also not recommended for use during pregnancy. It should be consumed only when benefits outweigh potential risks. This means that expectant mothers need to consult before taking it. The same precaution should be taken by breastfeeding mothers.
- It is not recommended for newborn infants. Only patients aged above 6 months can use the drug
- Take the drug with a lot of water, especially if you have side effects such as stomach upsets and indigestion.
- Also, people with history of gastric disorders should inform the doctor before prescription of the drug. In such cases, a patient may be advised to consider taking it with food or milk.
- Prolonged dependence of the drug is also not recommended. Patients should also stick to dosage advised by a doctor.
- Combiflam should never be chewed. Instead, it is recommended to be taken whole without dispersing in water or crushing it.
- Combiflam has no any effect on driving ability of a user and the drug has no any habit-forming tendency on users.
- The maximum of Combiflam that can be taken in a day is 4g for adults and 10 to 15mg/kg after intervals of between 4-6 hours.
- Avoid excess dosage.
Some of the following drugs have been used as alternatives to Combiflam:
- Flexon Tablet by Aristo Pharmaceuticals
- Fenceta 400mg/325mg Tablets by Alkem Pharmaceticals
- Zupar 400mg/325mg Captab by GlaxoSmithKline Ltd
- Brufamol Tablet by Menarini India
- Zupar 400mg/325mg Tablet by Glaxo SmithKline Pharmaceuticals Ltd
- Renofen 400 mg/325 mg Tablet by Indoco Remedies Ltd
- Brustan 400 mg/325 mg Tablet by Sun Pharmaceutical Industries Ltd
- Bruace 400 mg/325 mg Tablet by Jagsonpal Pharmaceuticals Ltd
Facts about Combiflam
- It is one of Sanofi’s top five selling brands in India
- Combiflam is used in 1 in 3 Indian households
- The drug was recalled in 2016 for claims of slow rates of disintegration. The company responded that these rates do not affect its efficacy or patient safety
- Due to popularity of brands, Combiflam Plus that contains
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