multiple pain meds at once?

[sweetieann]

Ok, there is patient on my floor ordered both PRN Motrin and PRN excedrin migraine (contains aspirin and tylenol). Got me thinking as to which meds could be given in close proximity to one another?

I'm thinking aspirin & tylenol is ok; tylenol & motrin ok; aspirin and motrin ok (unless on the aspirin to prevent clots or something, as i think ibprofen can decrease aspirin's effects); naproxen and tylenol ok; percocet and motrin ok; vicodin and motrin ok. What about naproxe and motrin??

So say the patient had a toothache and got prn motrin...then an hour or so later got a migraine...it would be (in theory) ok for them to have gotten both the prn excedrin migraine and prn motrin within an hour of each other (given they have no Hx of GI bleeds, etc)?

Thoughts?

Thanks all :)

[mesa1979, BSN, RN]

I think that is fine, I mean so long as it's on the MAR and you monitor the VS before and during tx.........If the VS are questionable, then I would hold one or the other and recheck in an hour.........

[caliotter3]

I've seen a tylenol and ibuprofen alternating order for peds patients often. Somewhere I read the rationale for this, but don't remember where. Someone questioned it one time and I can't remember how it was explained to this person.

[leslie :-D]

I've seen a tylenol and ibuprofen alternating order for peds patients often. Somewhere I read the rationale for this, but don't remember where. Someone questioned it one time and I can't remember how it was explained to this person.

they're 2 different classifications:

tylenol, an analgesic and antipyretic;

motrin, an nsaid

leslie:)

[kcalohagirl]

I would say naproxen and motrin should not be given in conjunction with each other.

Not being able to find my drug book after my recent move, I can't tell you the rationale behind this, I just know that on every MAR or order I've seen, Ibuprofen is always discontinued when Naproxen is initiated and vice versa.

[mablackbear]

Naproxen and Motrin both increase risks for GI bleeds, which increases again if you take them with Aspirin (which is in Excedrin):

http://www.medscape.com/viewarticle/538386

They're both NSAIDS, so that's probably why you see docs who won't prescribe both at the same time. And I would look at other risk factors...do they have a history of GI problems?

Having said that, I take all of the above, but I rarely take a full doses all at the same time. I also have headaches, and sometimes Excedrin is the only thing that will work. Headache sufferers generally know what works, and if the patient has a preference and you're not sure, run it by the doctor. It would be good for them to know what the patient's usual routine is, anyway. And document it.

[sissiesmama, ASN, RN]

they're 2 different classifications:

tylenol, an analgesic and antipyretic;

motrin, an nsaid

leslie:)

Hey leslie _ I have given tylenol and Motrin together, especially as a loading dose type thing, the alternatin the Tylenol q 4 hours, and the the Motrin q 6 hours, especially in peds, with a MDs order.

Anne, RNC

[edisongirl25]

I've seen a tylenol and ibuprofen alternating order for peds patients often. Somewhere I read the rationale for this, but don't remember where. Someone questioned it one time and I can't remember how it was explained to this person.

I use this for my daughter pretty often. She has chronic high fevers, up to over 104 degrees F. Just one or the other won't bring it down low enough long enough because before the next dose would be due, her fever is still very high. We alternate them every 3 hours and since Tylenol can be given every 4 hours and Motrin can be given every 6 hours, you aren't exceeding the dose for either. Motrin is metabolized in the kidneys and Tylenol is metabolized in the liver, so you aren't overworking either organws. Since she is getting something every 3 hours, it doesn't have time to go back really high and it's easier to get it under control. Usually, we have to do this for about 3 days.

[SuesquatchRN, BSN, RN]

I've often seen them prescribed together, not so much for adjuvant effect, but because pain can be better managed by two meds when you need the daily max safe dose of both for adequate pain control.

(acetominophen and an NSAID)

[hypocaffeinemia, BSN, RN]

why do NSAIDS cause bleeding in general and what is special about aspirin?

NSAIDS impair coagulation in a similar, though lesser, manner as ASA.