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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 pts <50 kg, properly program infusion pumps, and do not exceed maximum total daily dose limits of acetaminophen from all sources
Hepatotoxicity
acetaminophen assoc. w/ acute liver failure incl. cases of liver transplant and death; most liver injury assoc. w/ acetaminophen doses >4000 mg per day and >1 acetaminophen-containing product
Cardiovascular Risk
NSAIDs incr. risk of serious and potentially fatal cardiovascular thrombotic events, incl. MI and stroke; risk may occur early in tx and may incr. w/ duration of use; contraindicated in CABG periop setting
GI Risk
NSAIDs incr. risk of serious and potentially fatal GI adverse events incl. bleeding, ulcer, and stomach or intestine perforation; GI events may occur at any time during use and w/o warning sx; elderly pts and pts w/ hx 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 w/ 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 w/ 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 dz: not defined, caution advised; severe impairment/active dz: contraindicated
Peds Dosing .
Peds dosing is currently unavailable or not applicable for this drug.