Dose–response in direct comparisons of different doses of aspirin, ibuprofen and paracetamol (acetaminophen) in analgesic studies

Abstract

AimsEstablishing the dose-response relationship for clinically useful doses of aspirin, ibuprofen and paracetamol has been difficult. Indirect comparison from meta-analysis is compromised by too little information at some doses. MethodsA systematic review of randomized, double-blind trials in acute pain comparing different doses of aspirin, ibuprofen and paracetamol was therefore under taken. ResultsFifty trials were found. Numerical superiority of higher over lower dose was found by the original authors in 37/50 trials (74%) and statistical superiority in 11/50 (22%). Twenty-eight trials had design, quality and data reporting characteristics to allow pooling of common doses; in 3/28 (11%) of the individual trials our calculations showed statistical superiority of higher over lower dose. Pooled comparison of 1000/ 1200 mg aspirin over 500/600 mg was statistically superior, with a number-neededto-treat (NNT) for higher over lower dose of 16 (8 to > 100). Pooled comparison of 400 mg ibuprofen over 200 mg was statistically superior, with an NNT for higher over lower dose of 10 (6-23). Pooled comparison of 1000 mg paracetamol over 500 mg was statistically superior, with an NNT for higher over lower dose of 9 (6-20). ConclusionsUse of trials making direct comparison of two different doses of target drugs revealed the underlying dose-response curve for clinical analgesia.

Factors associated with efficacy of an ibuprofen/pseudoephedrine combination drug in pharmacy customers with common cold symptoms

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Evaluation of Toxicological Profile of Ibuprofen in Wistar Albino Rats

“…The first, second and third groups were given standard therapeutic dose equivalent of ibuprofen [12]: 20 mgkg -1 daily (in two divided doses) for 7, 14 and 28 days, respectively. The fourth, fifth and sixth groups were given 40 mgkg -1 of ibuprofen daily (in two divided doses) for 7, 14 and 28 days, respectively.…”

Strategies Aimed at Preventing Chronic Post-surgical Pain: Comprehensive Perioperative Pain Management after Total Joint Replacement Surgery

“…93,94 Using a dose-response study design, McQuay and Moore demonstrated that 1 g of acetaminophen produced greater benefits than a dose of 600-650 mg, with a number needed to treat (NNT) of 9. 95 When acetaminophen was combined with codeine, the NNT decreased to 2.2. 95 One systematic review that compared acetaminophen versus NSAIDS revealed mixed results; 96 the authors concluded that the treatment of postoperative pain was superior when the agents were combined than when either single agent was administered alone.…”

“…95 When acetaminophen was combined with codeine, the NNT decreased to 2.2. 95 One systematic review that compared acetaminophen versus NSAIDS revealed mixed results; 96 the authors concluded that the treatment of postoperative pain was superior when the agents were combined than when either single agent was administered alone. Acetaminophen's efficacy in treating mild to moderate pain, combined with its relatively benign side-effect profile (no gastric irritation or platelet aggregation effects), explains why it continues to be widely used as part of postoperative multi-modal pain regimens.…”