The other day I read a study that measured the effectiveness of opiate pain killers against the effectiveness of over the counter pain medicines. These were the dosing groups; 5 mgs Hydrocodone and 325 acetaminophen versus 1000 mgs of acetaminophen and 800 mgs of ibuprofen. At 2 hours, both groups had essentially the same pain levels. The reason I read it is because someone told me if they were the same, why wasn’t I using them instead of hydrocodone.
Even if we ignore that I can’t take NSAIDs orally, let’s talk about those two different medication doses. 5/325 hydrocodone can be taken every 4 hours for acute pain such as a broken arm. 1000 mgs of acetaminophen coupled with 800 mgs of ibuprofen can be taken every 6 hours. And there is no room for error, because the maximum dose levels for ibuprofen in a day are 3,200 mgs and 4,000 of acetaminophen. But and here’s the big thing, let’s say you take 1000 mgs of acetaminophen at 3 pm. If say you forget the precise time and take another 1000 mgs at 7 pm, you’ve just put yourself in a position to cause liver problem – which might be temporary or might be permanent.
Same with ibuprofen, if you take 800 mgs at 3 pm and forget and take another 800 mgs at 7 pm, you are running the risk of damaging your kidneys and GI tract.
This does depend on the health of these organs, but I have a feeling it’s why I stopped being able to take NSAIDs orally quite suddenly. This may require a bit of explanation. In 2007, I was working for the Boone County Historical Society. I enjoyed the job. It was an event night, which meant lots of little things to be done to prepare and I had a migraine according to my migraine journal, I took 3 – 200 mg Advil before it started. It should be noted; I can’t keep track of time when I have a migraine. According to my journal, the event actually started at 6 pm. Sometime after the event started, but before it ended around 8 pm, I took another 600 mgs because the music being played was making my migraine worse.
Music events were usually 2 hours with a 15 minute intermission around the 1 hour mark. Using that information, I can guess that I took the first 600mgs somewhere between 5 and 5:30 pm. And if I stuck to my normal habit of taking meds while busy, I probably wolfed down a quick bite to eat at the end of intermission and took the second dose of 600 mgs of Advil during the time I ate around 7 pm. That means I probably took 1,200 mgs of Advil in less than 4 hours.
Now, this might not be an issue for a person if they did it once, but I’m positive this wasn’t the first time I’d gone over the 800 mg dose limit for 6 hours. I practically lived on Advil and Excedrin Migraine at this time because I can function on them, but not Imitrix which was my prescribed migraine medication at the time and Imitrix was already starting to cause chest pains at the time.
I specifically went looking for an incident like this because I got to thinking about it after reading the study and ibuprofen was the first NSAID to be struck from my list of medications I could take, but it should have been aspirin if it had truly been a GI problem. But, I wouldn’t have to give up Excedrin Migraine until 2013, which contains 200 mgs of aspirin and 500 mgs of acetaminophen. Aspirin is an NSAID that is much rougher on your stomach than ibuprofen, but I wrote in one spot that I bought aspirin powder while traveling to a dart tournament in 2012. It’s nasty, but it works fast.
And as a PS to this, my journal also mentions that I had taken the max dose of Excedrin Migraine that day before I started popping plain Advil. Meaning my actual total intake of NSAIDs is kind of a question mark for the day, because while Excedrin Migraine says to take only 2 caplets in 24 hours and I don’t know that I always followed that on days I had to work.
The point was, that 1,000 mgs of acetaminophen coupled with 800 mgs of ibuprofen, isn’t actually the same as 5/325 hydrocodone/acetaminophen because it can’t be repeated as often as need be and it is only marginally safer. Especially since people only think of “days” not 24 hour periods. I know someone who will argue to their last breath that those max “daily doses” only apply to waking hours. So if she is awake from 6 am to 10 pm, she will take 3,200 mgs of ibuprofen during that day and do the exact same thing the next day. And if she has to take any during the night, she says it doesn’t count because it isn’t “day”.