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Combogesic IV
acetaminophen/ ibuprofen
Black Box Warnings .
Medication Error Risk (IV use)
ensure accuracy when prescribing, dispensing, and administering acetaminophen/ibuprofen INJ; dosing errors can result in overdose and death; do not confuse dose in mg and mL, use weight-based dosing for patients <50 kg, properly program infusion pumps, and do not exceed maximum total daily dose limits of acetaminophen from all sources
Hepatotoxicity
acetaminophen associated with acute liver failure including cases of liver transplant and death; most liver injury associated with acetaminophen doses >4000 mg per day and >1 acetaminophen-containing product
Cardiovascular Risk
NSAIDs incr. risk of serious and potentially fatal cardiovascular thrombotic events, including MI and stroke; risk may occur early in tx and may incr. with duration of use; contraindicated in CABG periop setting
GI Risk
NSAIDs incr. risk of serious and potentially fatal GI adverse events including bleeding, ulcer, and stomach or intestine perforation; GI events may occur at any time during use and without warning symptoms; elderly patients and patients with history of PUD or GI bleeding at greater risk for serious GI events
Adult Dosing .
Dosage forms: INJ
pain
- [<50 kg]
- Dose: 15 mg/kg/dose acetaminophen and 4.5 mg/kg/dose ibuprofen IV q6h prn; Max: 750 mg/dose up to 3000 mg/day acetaminophen, 225 mg/dose up to 900 mg/day ibuprofen; 4000 mg/day acetaminophen from all sources; Info: for short-term use <5 days; use lowest effective dose, shortest effective tx duration; may use with opioids for moderate-severe pain
- [>50 kg]
- Dose: 1000 mg/300 mg IV q6h prn; Max: 4000 mg/day acetaminophen from all sources, 1200 mg/day ibuprofen; Info: for short-term use <5 days; use lowest effective dose, shortest effective tx duration; may use with opioids for moderate-severe pain
renal dosing
- [see below]
- CrCl >60: no adjustment; CrCl 30-60: not defined, caution advised; CrCl <30: avoid use
- HD/PD: avoid use
hepatic dosing
- [see below]
- mild-moderate impairment/active disease: not defined, caution advised; severe impairment/active disease: contraindicated
Peds Dosing .
Peds dosing is currently unavailable or not applicable for this drug.