Combiflam tablet: Everything you wish to know about the medicine

Combiflam Tablet combines two components Ibuprofen and Paracetamol. It is a non-steroidal anti-inflammatory drug (NSAID) under Schedule-H category in India. It controls hormones in the body that cause pain and inflammation. It is therefore commonly used as a mild to moderate analgesic, anti-inflammatory and antipyretic to offer relief from medical conditions like a toothache, headache, arthritis, back pain, fever and other types of minor injuries and menstrual cramps. It is administered to both adults and children who are over six months in age. However, due caution should be exercised while using the medicine because of the increased risk of liver damage and bleeding complications.

What is the composition of Combiflam Tablet?

In the tablet form, Combiflam  is commonly available in a combination of Ibuprofen 400 mg and Paracetamol 325 mg.

Why is Combiflam prescribed?

Being a combination drug, Combiflam use is popular as an analgesic, anti-inflammatory and antipyretic to alleviate mild to moderate pain and fever. The common problems where Combiflam use may be effective are:

• Fever and pain: Without treating the underlying cause, Combiflam is used to provide temporary relief from fever and pain.
• Mild to moderate pain: Combiflam may provide relief from a toothache, muscle pain, backache and headache if the pain is mild to moderate.
• Menstrual cramps: Combiflam is used to relieve pain associated with cramps arising during menstruation in women.
• Osteoarthritis: Combiflam use provide relief in tender joints and pains associated with osteoarthritis.
• Rheumatoid Arthritis: This medicine is used to treat swelling, pain and stiffness of joints associated with Rheumatoid Arthritis.
• Gout: Combiflam can treat pain and swelling associated with Gout.

Dosage of Combiflam Tablet:

The physician, after considering several factors, determines the dosage of the medicine:

• Body weight and age of the patient.
• General health condition of the patient
• Severity of the problem.
• History of drug reactions and allergies.

Based on his analysis of the above the indicative dosage of Combiflam tablet could be:

• Adults: Maximum four gms daily Combiflam dosage of 0.5 to 1 gm 4 to 6 hourly as necessary.
• Children:
  • Up to 1 year: 60-120 mg 4 to 6 hourly daily maximum of four Combiflam dosage in 24 hours.
  • 1 to 5 years: 120-250 mg 4 to 6 hourly daily maximum of four Combiflam dosage  in 24 hours.
  • 6 to 12 years: 250-500 mg 4 to 6 hourly daily maximum of four Combiflam dosage  in 24 hours.

How do you take Combiflam Tablet?

Combiflam is usually available in tablet and suspension forms. Consumption of the medicine is done as:

• Tablets are usually taken orally with a glass of water or as directed by your physician.
• The medicine should be taken before or after taking food.
• Never take medicine on an empty stomach.
• Never crush or chew the tablet to consume it.
• Read the patient information carefully.
• You should clear doubts if any with your doctor.

How does Combiflam tablet work?

The tablet works on the brain centres that trigger pain and increased body temperature:

• It inhibits the effects of enzymes called cyclo-oxygenase(COX).
• The naturally appearing enzyme help our body in the production of prostaglandins which are responsible for causing pain, swelling and redness at the site of injury in the body.
• Inhibition of COX enzymes results in the lower production of prostaglandins.
• Since production of prostaglandins is inhibited, it eases the pain and increases blood flow across the skin causing heat loss and sweating.
• Thus your body temperature is regulated to lower it sufficiently with reduced pain and swelling.

When should you avoid Combiflam Tablet?

Notwithstanding the efficacy of the medicine in treating mild to moderate pain and fever, there are certain precautions you need to adhere to obviate drug-related complications. Due to contraindications, do not take Combiflam:

• If you are allergic to any of the constituent of Combiflam tablet.
• If you are allergic to Aspirin or any other non-steroidal anti-inflammatory drug (NSAID) like Diclofenac etc.
• If you have a history of suffering from any of the following on consumption of Combiflam:
  • Asthma
  • Nasal irritation
  • Facial swelling
  • Itchy skin
  • Red bumps on the skin
  • Bleeding in the stomach

• If you are suffering from kidney or liver disease
• If you have suffered a stroke or are suffering from heart disease or failure in the past. Even if you do not have any cardiac problems, prolonged use of Combiflam may trigger a heart attack or stroke.
• If you recently had bypass surgery.
• If you are suffering from any breathing problem.
• If you are in the third trimester of pregnancy – there are definite indications that it harms the fetus.
• In case you are breastfeeding your child, it is best to seek the advice of your physician though there is no conclusive evidence that an infant is affected.
• If you are prone to bleed easily.
• If you are suffering from Porphyria, which is a blood disorder.

Side effects of Combiflam:

Many major and minor side effects are associated with consumption of Combiflam tablet. You may suffer the following.

• Nausea and vomiting.
• Itchy rashes on the skin of the body.
• Gastric and oral ulcer.
• Passing of blood with urine.
• Cloudy urine.
• Severe heartburn
• Fatigue
• Severe abdominal discomfort.
• Severe constipation.
• Grossly reduced urine output.
• Yellowing of the skin and eyes.
• Abnormal blood counts.
• Loss of appetite.
• Severe drowsiness.
• Vomiting of blood.
• Vertigo
• Insomnia

All about drug interaction of Combiflam:

Combiflam interacts with many drugs affecting the efficacy of either of them. You must inform your doctor about all the drugs that you use. You must also take care to inform your doctor about the herbal medicines that you are consuming. Be careful about consuming Combiflam, which you should do only with your doctor’s approval.

• Cholestyramine and Metochlopromide: These are cholesterol-lowering agents.
• Diflunisal: It is a non-narcotic analgesic.
• Quinoline: It is an antibiotic.
• Isoniazid: It is an antibiotic.
• Anticonvulsant drugs like Amobarbital, Butalbital, Pentobarbital etc.
• Cyclosporin: Immunity suppressants.
• Zidovudine: Used in the treatment of HIV.
• Digoxin: Used to treat irregular heartbeats and other heart problems.
• This list is not exhaustive. Generally other drugs such as steroids, medicines used to regulate blood pressure,   diuretics etc. also interact with Combiflam.

Warnings for Combiflam use:

Extreme caution is advocated if you are suffering from:

• Chronic malnutrition: The risk of severe adverse effects cannot be ruled out. Depending on the clinical findings, appropriate adjustments in dosage and prescription of alternate medicine may be a necessity.
• Gastro-intestinal bleeding:  Prolonged usage may trigger gastrointestinal bleeding and perforation, especially if you are elderly and those with gastrointestinal problems.  Combiflam dosage adjustment along with alternative may be required.
• Chronic alcoholism: This medicine is not recommended if you are an alcoholic. You carry the risk of severe liver damage.
• Anaemia: If you are anaemic, extra caution is required for using this medicine as you risk the worsening of your condition. In extreme cases, an alternative medicine could be the only option.
• Impaired Liver: If you are suffering from liver impairment and other diseases related to liver, extreme caution is the order of the day. A close watch on the liver function and Combiflam dosage adjustments may be contemplated. You still stand the risk of adverse effect on your liver, and a suitable alternative may be required depending on your clinical assessment.

Rules to follow for Combiflam use:

• You should drink sufficient water to reduce the chances of stomach discomfort, irritation or bleeding.
• If you are planning to start a family, consult your doctor and plan your pregnancy accordingly. Use of Combiflam tablets makes it harder to conceive.
• Always consume the tablet with food or milk to reduce the risk of stomach upset and distress. Always take your doctor into confidence about your health concerns.
• You must avoid prolonged use of Combiflam tablets to obviate medical conditions from emerging.

General Instructions to follow for Combiflam Tablets:

• Store the tablets below 25o C away from light and heat.
• As directed by your doctor, the medicines should be taken.
• Stick to the dosage prescribed by him and do not take higher or lower quantities other than directed.
• If you are pregnant, this medicine is not recommended for you. If your doctor feels it is necessary, only then you may use it.
• If you are a breastfeeding woman, this medicine is not recommended for you until necessary after discussion with your doctor.
• Consult your doctor immediately in case of any side effects emerging.
• It is necessary that you complete the entire course prescribed by your doctor.
• Consult your doctor if you need to stop the medicine.

Summary:

Combiflam Tablet is a common analgesic, anti-inflammatory and antipyretic used in India because of the properties of the combination of Ibuprofen and Paracetamol. Its use is confined to the treatment of mild to moderate pains of different origins and fever. Though there are risks of side effects, it is a relatively safe drug when consumed under professional medical supervision.