pain management advice ..best way to take dihydracodeine, paracetemol and ibuprofen?

[OneArmedBandit]

i have intense shoulder pain at night as i had surgery a week ago.

i have 30mg dihydracodeine plus regular paracetemol and ibuprofen.

any suggestions re timing the dosages throughout the night to maximise relief? i took 60mg dihydr last night but woke in agony less than 2 hours later. i then took paracetemol a bit later.... and ibupr a couple of hours later.

should i be taking them differently/ together?

i take nothing during the day except one dose ibupr as i have little/ no day time pain.

any experts/ pharmacists out there?

Hope last night was better for you.

You can take all 3 of those painkillers together up to the maximum that each is prescribed.
So you can take paracetamol, 1g four times per 24hours, ibuprofen 400mg three times (unless higher dose prescribed) and the dihydocodeine as prescribed.
You can take all 3 together when you go to bed, unless you've already had that days maximum.

Yes, you can definitely take them together. Had hip replacement surgery recently and after the first night with morphine button next day it was onto paracetamol and ibuprofen. This was given out to be taken together and sometimes a codine (spelling) if required.

Am waiting for the other hip to be done so on the same pills at the same time, together. Just doesn't give the same results when they are staggered. Hope you get a bit of night time relief soon.

Doctors also advised me to take them altogether,not to bother staggering the doses.

Don't take more than 30mg dihydrocodeine at once as it has a ceiling analgesic effect at that dose. By taking 60 mg at once you'll end up with twice the side effects but not twice the benefits.

I would suggest you take 1g paracetamol and 30mg dihydrocodeine 4 times per day then take your ibuprofen 3 times a day with food. You can then top up with another 2 doses of dihydrocodeine last thing at night and then if you wake early or in the night.

Not an expert but I'd try taking the paracetamol and codine together. Then you can take the ibuprofen inbetween your codine/paracetamol doses so you shouldn't get breakthrough pain.

Drs in hospital often write up 60mg of dihydracodeine. Is that not good practice then?

Viva - current pain from acute pain team in my hospital re. Dihydrocodine is 30 mg up to 4 times day with paracetamol. Additional doses for breakthrough pain. As I mentioned twice the side effects at higher doses but rarely does 60 mg help or last any longer than 30 mg. You are better off taking more frequently than taking bigger doses.

Thanks, Penguin - that's interesting. Must admit if a Dr has written 30-60mg I normally just give 30mg and will give a further 30mg later on if initial does hasn;t helped. Partly because I think taking regular doses of 60mg will not help with constipation.

this is such a big help, thanks so much for the advice.

i am almost pain free in the day, but nights still tricky.

i found that co dydramol is almost as good for my pain as dihydracodeine but with less side effects (feel more lucid on co dydramol). maybe the lower codeine content suits me better.

my experience supports penguin's advice... 60mg was no more help than 30mg as pain relief. i wonder why gp said to take 2 tablets at once then?

penguin...i cannot take dihydracodeine in the day as it wipes me out and also pain levels low anyway... is taking it at night ineffective for me as it is not building up in my system therefore has no cumulative effect, i wonder?
i dont really understand why 30mg isnt really helping me.or is it simply that i should be taking paracet with it?

also, if i take dihydracodeine at night for 3 weeks, does anyone know if insomnia is likely when i stop?

thanks all x

rubbish dihydrocodine has no ceiling effect hence drugs users can take unto 5,000 mg per day

Taking paracetamol with anything codeine/morphine based increases the strength of the paracetamol effect, so that would be my advice. While you can take ibuprofen at the same time it doesn't leave you with anything for breakthrough pain so I would use that to stagger doses.

I'd take the NSAID regularly at mealtimes because ibuprofen shouldn't be taken on an empty stomach, and schedule the other two together in-between.

So, for example if you breakfast at 7:30am then take ibuprofen with food.

Codeine and paracetamol at 9:30

Ibuprofen at 12:30

Codeine and paracetamol at 13:30 and again at 17:30

Ibuprofen at 19:00 with food

Codeine and paracetamol at 23:00

If you wake at night needing a dose of anything then I would change the daytime Codeine and paracetamol from 13:30 and 17:30 to one dose at 14:30-15:30, to free up a night time dose around 3am if needed.

One thing about pain control is that you need to keep on top of it. So don't wait until you're in a lot of pain I medicate. Use the ibuprofen regularly to keep your pain lowered.