Do acetaminophen and an NSAID combined relieve osteoarthritis pain better than either alone?
Buescher, Jennifer J.
Meadows, Susan E.
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Combining nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen for short courses provides more relief of pain in osteoarthritis without an increase in side effects (strength of recommendation [SOR]=B). Combining acetaminophen at 4 g/d with an NSAID can also decrease the daily dose of NSAID required for pain relief, thus reducing the potential risk from higher-dose NSAID therapy (SOR=B). Over the long term, however, this combination may increase the risk of upper gastrointestinal (GI) bleeding more than that conferred by the NSAID alone (SOR=B). If combination therapy is necessary, limiting the dose of acetaminophen to ≤2 g/d minimizes gastrointestinal toxicity. Acetaminophen alone at the lowest dose to provide pain relief is the safest pharmacologic choice for patients with osteoarthritis.
Clinical Inquiries, 2004 (MU)
Journal of Family Practice, 53(6) 2004: 501-503.