With ibuprofen, liver damage isn't the concern; it's stomach damage.
Paracetamol in large amounts can cause terrible - and fatal - liver damage though.
In the interests of harm reduction, i encourage you to CWE anything above the recommended dosage of either paracetamol/ibuprofen or both.
But if what you're taking falls within the recommended daily maximums of para/ibu - then you should be ok (i just wouldn't keep up a regime like that long-term).
If you're going to take codeine meds with any sort of frequency, cold water extraction is wise.
Your liver is a pretty tough organ - but it's worth remembering that paracetamol ODs are very drawn out, painful deaths...so when in doubt, cwe it out
With ibuprofen, liver damage isn't the concern; it's stomach damage.
Paracetamol in large amounts can cause terrible - and fatal - liver damage though.
In the interests of harm reduction, i encourage you to CWE anything above the recommended dosage of either paracetamol/ibuprofen or both.
But if what you're taking falls within the recommended daily maximums of para/ibu - then you should be ok (i just wouldn't keep up a regime like that long-term).
If you're going to take codeine meds with any sort of frequency, cold water extraction is wise.
Your liver is a pretty tough organ - but it's worth remembering that paracetamol ODs are very drawn out, painful deaths...so when in doubt, cwe it out
If you're taking each med at it's recommended dose, there should be no real extra harm in combining them. A CWE seems a bit excessive for 3 or 4 pills.
I personally would never take more than a couple of grams of paracetamol at once.
To me 10 pills or 15 pills is well worth a CWE, and i don't even take other potentially liver damaging substances (ie i don't drink).
As for mixing ativan with the codeine - yeah, keeping the dose low (of each) is a wise move. Risk of liver damage from paracetamol aside, mixing codeine and benzos carries risks of respiratory depression; but in the doses you've mentioned you should be ok unless you are completely opiate naive or highly sensitive to either.
I personally would never take more than a couple of grams of paracetamol at once.
To me 10 pills or 15 pills is well worth a CWE, and i don't even take other potentially liver damaging substances (ie i don't drink).
As for mixing ativan with the codeine - yeah, keeping the dose low (of each) is a wise move. Risk of liver damage from paracetamol aside, mixing codeine and benzos carries risks of respiratory depression; but in the doses you've mentioned you should be ok unless you are completely opiate naive or highly sensitive to either.
Yeah, i hope that gives you some pain relief.
The thing a lot of folks that do CWEs of OTC codeine sometimes forget is that paracetamol and ibuprofen are very useful analgesics in their own right; sometimes opioid painkillers are less effective for certain types of pain than para/ibu.
Sure, they don't get you high, but they can certainly help relieve pain, fever, inflammation, etc.
So the combination of all of the above should hopefully help your back pain.
Having a bad back really sucks, so i hope it helps you get a good night's sleep.
Strictly speaking, paracetemol is not an NSAID, its its own beast.
Be cautious with NSAID's like ibupfrofen though. Some people react poorly to them. My mate, who doesn't do any codeine or CWE, was prescribed Voltaren after hurting his back. He was taking recommended dosees for about 1.5 weeks, but wasn't taking it with food, and ended up with a pretty bad ulcerated stomach. I have had stomach problems from my own use, but I have been foolish and lucky I think- he was obviously sensitive in a way he wouldn't have discovered otherwise- so be cautious even using recommended doses of these medicines.
Side note, but my dog was prescribed NSAID's due to hip dysplasia (he was a big male Rottweiler). They shut his kidney down and he died because of this. He was old, but he went down rapidly, and the damage persisted long after we took him off them. Sadly, his last days were him being forced to take tramadol and than vomiting/pain/death. Life, you fucking life.
Strictly speaking, paracetemol is not an NSAID, its its own beast.
Be cautious with NSAID's like ibupfrofen though. Some people react poorly to them. My mate, who doesn't do any codeine or CWE, was prescribed Voltaren after hurting his back. He was taking recommended dosees for about 1.5 weeks, but wasn't taking it with food, and ended up with a pretty bad ulcerated stomach. I have had stomach problems from my own use, but I have been foolish and lucky I think- he was obviously sensitive in a way he wouldn't have discovered otherwise- so be cautious even using recommended doses of these medicines.
Side note, but my dog was prescribed NSAID's due to hip dysplasia (he was a big male Rottweiler). They shut his kidney down and he died because of this. He was old, but he went down rapidly, and the damage persisted long after we took him off them. Sadly, his last days were him being forced to take tramadol and than vomiting/pain/death. Life, you fucking life.
I miss you still Henry.
Sorry to hear that man.
I still remember losing my dog that I grew up with, I cried like a baby.
At least I have a scar to remember him by on my wrist as a result of playing to rough with him.
combining the two is a great idea, that way you don't get too much of either nurofen or panadol!
It's technically "safe" to ingest up to 4mg of panadol in a 24 hour period, and I've gone higher than that but the risk of liver da,age is huge and a dose that is fine for one person could kill another.
As for nurofen, you can basically swallow all the tablets you want, it's the long term use of nurofen that's damaging. I sometimes still crush the nurofen plus pills, mix with water, and then either just add cordial and down it or do a very simple filter through a piece of clothing. But this is because sometimes I have trouble eating 20+ pills, and for some reason I find drinking crushed pills mixed in liquid easier.
tl;dr nurofen and panadol are safe to take together, they do it in hospital and now there's a product on the market for this combination
If you're otherwise healthy, and don't do it everyday for years and years, you should be good to take up to 1 gram of paracetamol and up to, as I recall, 800mg of ibuprofen, together at one time. But not again for at least 4 hours, and not more than about 4 times total throughout the day. According to Australian standards. Someone else can verify it for me but I can say from personal experience, with a test sample of one person, with regular liver function checks. That following those rules did no harm over a period of a few years. Should equate to 2 panadeine forte or generic, and 4 Nurofen plus.
The nurofen box will say no more than 2 tablets (400mg), but that's because it reflects the standard for unprescribed ibuprofen. The standard safe dose according to prescription ibuprofen is double that. So 4 tablets (800mg)
Stay safe. Anything above the standard I just mentioned should be CWEd. And I make no guarantees, especially in case of people prone to problems with ibuprofen, other nsaids, or stomach ulcers generally. Or people with existing liver problems.
combining the two is a great idea, that way you don't get too much of either nurofen or panadol!
It's technically "safe" to ingest up to 4mg of panadol in a 24 hour period, and I've gone higher than that but the risk of liver da,age is huge and a dose that is fine for one person could kill another.
As for nurofen, you can basically swallow all the tablets you want, it's the long term use of nurofen that's damaging. I sometimes still crush the nurofen plus pills, mix with water, and then either just add cordial and down it or do a very simple filter through a piece of clothing. But this is because sometimes I have trouble eating 20+ pills, and for some reason I find drinking crushed pills mixed in liquid easier.
tl;dr nurofen and panadol are safe to take together, they do it in hospital and now there's a product on the market for this combination
While i agree with the rest of your post, the bit i've highlighted in bold is not really good advice, in regards to harm reduction.
I'm far from being an expert on the acute toxicity of ibuprofen, but i'm fairly sure that high doses - that is, doses above recommended maximums - have some pretty serious health risks associated with them.
I just did a quick search about ibuprofen overdose, and found this:
Do not take more than your recommended dose. An ibuprofen overdose can damage your stomach or intestines. The maximum amount of ibuprofen for adults is 800 milligrams per dose or 3200 mg per day (4 maximum doses). Use only the smallest amount needed to get relief from your pain, swelling, or fever.
The risks of taking too much ibuprofen seem to be primarily generally related to damage of your digestive system - ulcers and tissue damage leading to bleeding - but there is also potential harm to your renal function, among other complications.
Ibuprofen overdose has become common since it was licensed for OTC use. Many overdose experiences are reported in the medical literature, although the frequency of life-threatening complications from ibuprofen overdose is low.[30] Human response in cases of overdose ranges from absence of symptoms to fatal outcome despite intensive-care treatment. Most symptoms are an excess of the pharmacological action of ibuprofen, and include abdominal pain, nausea, vomiting, drowsiness, dizziness, headache, tinnitus, and nystagmus. Rarely, more severe symptoms, such as gastrointestinal bleeding, seizures, metabolic acidosis, hyperkalaemia, hypotension, bradycardia, tachycardia, atrial fibrillation, coma, hepatic dysfunction, acute renal failure, cyanosis, respiratory depression, and cardiac arrest have been reported.[31] The severity of symptoms varies with the ingested dose and the time elapsed; however, individual sensitivity also plays an important role. Generally, the symptoms observed with an overdose of ibuprofen are similar to the symptoms caused by overdoses of other NSAIDs.
Correlation between severity of symptoms and measured ibuprofen plasma levels is weak. Toxic effects are unlikely at doses below 100 mg/kg, but can be severe above 400 mg/kg (around 150 tablets of 200 mg units for an average man);[32] however, large doses do not indicate the clinical course is likely to be lethal.[33] A precise lethal dose is difficult to determine, as it may vary with age, weight, and concomitant conditions of the individual person.
Therapy is largely symptomatic. In cases presenting early, gastric decontamination is recommended. This is achieved using activated charcoal; charcoal adsorbs the drug before it can enter the systemic circulation. Gastric lavage is now rarely used, but can be considered if the amount ingested is potentially life-threatening, and it can be performed within 60 minutes of ingestion. Emesis is not recommended.[34] The majority of ibuprofen ingestions produce only mild effects and the management of overdose is straightforward. Standard measures to maintain normal urine output should be instituted and renal function monitored.[32] Since ibuprofen has acidic properties and is also excreted in the urine, forced alkaline diuresis is theoretically beneficial. However, because ibuprofen is highly protein-bound in the blood, renal excretion of unchanged drug is minimal. Forced alkaline diuresis is, therefore, of limited benefit.[35] Symptomatic therapy for hypotension, gastrointestinal bleeding, acidosis, and renal toxicity may be indicated. On occasion, close monitoring in an intensive-care unit for several days is necessary. A patient who survives the acute intoxication usually experiences no late sequelae.
Basically, i would defer to the common wisdom on the topic of taking large amounts of OTC codeine-containing preparations; if you are going to take a product containing ibuprofen, follow the instructions on the pack.
Large doses are not advisable - as they will increase the likelihood of physical harm or complications - and ibuprofen shouldn't be taken on an empty stomach.
If you are taking an OTC ibuprofen/codeine preparation with the intention of getting high (or pain relief) from the codeine, i would definitely recommend that people do a cold water extraction.
Paracetamol can obviously be fatal in instances of serious overdose, and while the same thing may not strictly be the case for ibuprofen, it's a drug that poses serious health risks of its own - risks that are likely to be increased if you take large doses.
The tendency towards complacent dosing of drugs available over the counter poses a risk to public health, because of the perception amongst less informed people (not directed at anyone here) that they are benign, due to their easy availability and minimal regulation.
But ibuprofen is not an entirely safe drug, so taking handfuls of nurofen plus really not advisable.
Some people may get away with recklessly using ibuprofen without serious consequences - but i wouldn't count on that being true for everyone - or anyone - all the time.
The health implications of ibuprofen related harm are all rather unpleasant and, i imagine, painful - not something i'd personally be prepared to gamble with for the sake of a little inconvenience and waiting around for a CWE to dissolve and filter.
Tl:dr - I think it goes without saying that in terms of ibuprofen-related health problems, it is better to be safe than sorry (jeez, i sound like my mum...) - so be careful with it, and use as directed - but if you are going to take more than the recommended daily maximum dosage - do a cold water extraction first. The harms associated with ibuprofen use are pretty unpleasant, so i would take any measures possible to reduce the risk of suffering them.
I went through a phase of just eating nurofen+, and even at no more than 20 - 40 pills a day, and it definitely tore up my gut. At one point I would snack constantly just to prevent myself from having an empty stomach, because whenever my stomach felt empty I would get a massive, painful ache in it, like the acid was burning through the side of my stomach. I never actually figured out what happened, but it took the better part of a year for the pain to go away. Not recommended.
^That is exactly the symptoms of stomach ulcer, especially the eating relieving pain. Next time, don't wait a year as perforated ulcer can kill. Take a proton pump inhibitor or even ranitidine which is one treatment for ulcers.
Ouch. Yeah that's nasty.
Just because an 'overdose' won't necessarily kill you (straight away), it doesn't mean serious harm isn't being done.
Some of the implications of that kind of damage to your digestive tract can have life threatening implications, and cause problems that can seriously impact your life, comfort and general wellbeing.
