Famotidine + Ibuprofen + Paracetamol

Usage

This combination is not a standard, FDA-approved medication. While famotidine, ibuprofen, and paracetamol are individual drugs often prescribed and used together, they are not available as a single, combined pill or formulation. Therefore, information provided here relates to the usage of each drug individually and in combination, not as a unified product.

• Famotidine: Belongs to the histamine H2-receptor antagonists class. It reduces stomach acid production. Used for heartburn, gastroesophageal reflux disease (GERD), and ulcers.
• Ibuprofen: Belongs to the nonsteroidal anti-inflammatory drugs (NSAIDs) class. It reduces pain, fever, and inflammation. Used for conditions like headaches, menstrual cramps, arthritis, and other types of pain.
• Paracetamol: Belongs to the analgesics and antipyretics class. It reduces fever and pain. Used for fever, headaches, and other mild to moderate pain.

This combination is intended for use in patients experiencing pain conditions along with heightened risk of developing ulcers or those who require the long-term use of an NSAID like ibuprofen. Famotidine is included to mitigate the risk of ulcer development associated with NSAID use.

Alternate Names

This combination doesn’t have an international nonproprietary name (INN) as it is not a recognized combined medication. Individually:

• Famotidine: Pepcid, Pepcid AC
• Ibuprofen: Advil, Motrin, Nurofen
• Paracetamol: Acetaminophen (US, Canada), Tylenol, Panadol

A combined medication containing famotidine and ibuprofen is marketed under the brand name Duexis. Duexis does not contain paracetamol.

How It Works

• Famotidine: Reversibly inhibits the action of histamine at the H2 receptors of the parietal cells in the stomach, thus decreasing gastric acid secretion. Metabolized minimally, primarily excreted renally.
• Ibuprofen: Non-selectively inhibits cyclooxygenase (COX) enzymes, reducing prostaglandin synthesis, thus decreasing inflammation and pain. Metabolized hepatically, excreted renally.
• Paracetamol: Mechanism not fully understood. Thought to inhibit COX enzymes in the central nervous system, but with minimal peripheral effects. It also acts on the hypothalamic heat-regulating center to reduce fever. Metabolized hepatically, excreted renally.

Dosage

As this specific drug combination is not an official pharmaceutical product, dosage information applies to separate administration. Dosages for each drug should be followed as per individual product guidelines. Duexis (famotidine/ibuprofen combination) dosing is different from taking each drug individually and should be prescribed and monitored by a physician.

Standard Dosage

Refer to individual drug information for standard dosage instructions. The combination of ibuprofen and paracetamol is often used with staggered doses, with ibuprofen administered every 6-8 hours and paracetamol every 4-6 hours as needed for pain or fever.

Adults: Refer to individual drug information.

Children: Refer to individual drug information. Ibuprofen and paracetamol have pediatric formulations and dosing guidelines. Famotidine use in children needs careful consideration.

Special Cases: Refer to individual drug information. Dosage adjustments are necessary in elderly patients and those with renal or hepatic impairment.

Clinical Use Cases

This combination is not generally used in specific clinical settings like intubation, surgical procedures, or the ICU. In such settings, pain and ulcer prophylaxis are managed with specific protocols depending on the case.

Dosage Adjustments

Refer to individual drug information. Dose adjustments are drug-specific.

Side Effects

Common Side Effects

• Famotidine: Headache, dizziness, constipation, diarrhea.
• Ibuprofen: Nausea, heartburn, stomach pain, fluid retention.
• Paracetamol: Generally well-tolerated, rarely causes allergic reactions.

Rare but Serious Side Effects

• Famotidine: Serious allergic reactions, confusion, hallucinations.
• Ibuprofen: GI bleeding, ulceration, perforation, cardiovascular events.
• Paracetamol: Liver damage with overdose.

Long-Term Effects

• Ibuprofen: Increased risk of cardiovascular and renal complications.

Adverse Drug Reactions (ADR)

Refer to individual drug monographs for a complete list of ADRs.

Contraindications

Refer to individual drug monographs.

Drug Interactions

Refer to individual drug monographs for complete interaction lists. Highlights:

• Ibuprofen can interact with aspirin, warfarin, and other NSAIDs.
• Famotidine can interact with ketoconazole, itraconazole.

Pregnancy and Breastfeeding

• Famotidine: Generally considered safe during pregnancy and breastfeeding.
• Ibuprofen: Avoid during the third trimester. Use caution in other trimesters. Generally considered safe during breastfeeding in usual doses.
• Paracetamol: Generally considered safe during pregnancy and breastfeeding.

Drug Profile Summary

Refer to individual drug monographs.

Popular Combinations

Ibuprofen is often combined with paracetamol for synergistic pain relief. Famotidine is sometimes co-prescribed with NSAIDs for gastroprotection.

Precautions

Refer to individual drug monographs for specific precautions.

FAQs (Frequently Asked Questions)

Q1: What is the recommended dosage for Famotidine + Ibuprofen + Paracetamol?

A: This combination doesn’t have a set dosage. Refer to individual drug information and Duexis prescribing information for famotidine/ibuprofen. Paracetamol would be dosed separately as needed.

Q2: Can this combination be used in children?

A: Famotidine use in children requires careful consideration and should be determined by a physician. Ibuprofen and paracetamol have pediatric dosing guidelines.

Q3: Are there any specific drug interactions I should be aware of?

A: Yes. Each of these drugs has a potential for interactions. Consult individual drug monographs and check for potential interactions with other medications the patient is taking.

Q4: What are the signs of ibuprofen overdose?

A: Signs include stomach pain, nausea, vomiting, lethargy, and tinnitus. Seek immediate medical attention if overdose is suspected.

Q5: Can this combination be used during pregnancy?

A: Ibuprofen should be avoided during the third trimester and used with caution in other trimesters. Famotidine and paracetamol are generally considered safe during pregnancy, but consult with a physician before use.

Q6: Can this combination be used during breastfeeding?

A: All three drugs can be present in breast milk. While generally considered safe in recommended doses, always discuss any potential risks with a physician.

Q7: What are the main side effects of this combination?

A: Common side effects can include gastrointestinal issues (nausea, heartburn, diarrhea, constipation), headache, and dizziness. Serious side effects can include GI bleeding, cardiovascular events, and liver damage (with paracetamol overdose).

Q8: What should I monitor in a patient taking this combination?

A: Depending on the patient’s health status and the duration of treatment, monitoring renal function, liver function, and cardiovascular health may be necessary. Regular complete blood count (CBC) tests can help assess for potential anemia or other blood-related issues. Monitor for signs of GI bleeding.

Q9: Is this a standard treatment for arthritis?

A: The combination of ibuprofen and famotidine (Duexis) is approved for arthritis treatment. The addition of paracetamol should be individualized based on the patient’s needs for additional pain and fever control.

Q10: What are the alternatives to this combination?

A: Other NSAIDs, COX-2 inhibitors, or other pain medications may be considered depending on the specific condition. Other H2 blockers or proton pump inhibitors can be used for gastroprotection.