Panacombo Dual Action Pain Relief 200mg/500mg 10 Tablets combine ibuprofen 200 mg and paracetamol 500 mg in each film-coated tablet, for the temporary relief of mild to moderate pain in adults aged 18 and over. It is meant for pain that has not been relieved by ibuprofen or paracetamol taken on its own. In clinical studies, the combination gave stronger pain relief than ibuprofen 400 mg or paracetamol 1000 mg alone.

Key Features

• Two painkillers in one tablet: Ibuprofen is an anti-inflammatory painkiller (NSAID) that reduces pain, swelling and high temperature, while paracetamol relieves pain and fever in a different way.
• Relief for many types of pain: Panacombo is used for migraine, headache, backache, period pain, dental pain, rheumatic and muscular pain, cold and flu symptoms, sore throat and fever.
• Faster relief than ibuprofen alone: In studies of pain after dental surgery, a 2-tablet dose gave noticeable pain relief in a median of 18.3 minutes, compared with 23.8 minutes for ibuprofen 400 mg.
• Longer-lasting relief than paracetamol alone: In the same studies, pain relief from a 2-tablet dose lasted 9.1 hours, compared with 4 to 5 hours for paracetamol alone.

Do I need to try ibuprofen or paracetamol on its own first?

Yes. Panacombo should only be used after trying either ibuprofen or paracetamol on its own. On the first day, take a single-ingredient painkiller as directed on its pack. If it has not relieved your pain during that day, you can start Panacombo the next day.

Can I take Panacombo with other painkillers?

No. Do not take Panacombo with any other medicine containing paracetamol, ibuprofen or another NSAID, or with aspirin at doses above 75 mg a day. If you take low-dose aspirin (up to 75 mg a day), speak to your doctor or pharmacist before taking Panacombo.

Should I take Panacombo with food?

Yes. Taking Panacombo with food reduces the likelihood of side effects. Food can delay when the ingredients reach their peak level in the blood, but the total amount absorbed stays the same.

Active ingredients: Each film-coated tablet contains ibuprofen 200 mg and paracetamol 500 mg.

Other ingredients: Croscarmellose sodium, hydroxypropylcellulose, microcrystalline cellulose, colloidal anhydrous silica, stearic acid, magnesium stearate. Film coating: polyvinyl alcohol, calcium carbonate (E170), carmellose sodium, microcrystalline cellulose, stearic acid.

Additional information: Each tablet contains less than 1 mmol sodium (23 mg), so is essentially sodium-free.

For adults aged 18 and over. For oral, short-term use only.

1. Only start Panacombo after first trying ibuprofen or paracetamol on its own for a day without relief.
2. Take 1 tablet with water and with food, up to 3 times a day. Leave at least 6 hours between doses.
3. If 1 tablet does not control your symptoms, you can take a maximum of 2 tablets up to 3 times a day.
4. Do not take more than 6 tablets in 24 hours (equivalent to 3000 mg paracetamol and 1200 mg ibuprofen).
5. Do not take Panacombo for longer than 3 days. If your symptoms worsen or persist, see your doctor.

Use the lowest dose that works, for the shortest time needed. If you forget a dose, take it as soon as you remember and leave at least 6 hours before the next one. Do not take a double dose.

Read the patient information leaflet before use. The most important safety information is below.

• Stop taking Panacombo and contact a doctor or emergency services immediately if you notice signs of an allergic reaction, such as breathing problems, swelling of the face or neck, or chest pain.
• Talk to a doctor at once if you take too much, even if you feel well. Too much paracetamol can cause delayed, serious liver damage.
• Do not take with any other medicine containing paracetamol, ibuprofen or another NSAID painkiller (including COX-2 inhibitors), or with aspirin above 75 mg a day.
• Do not take if you are allergic to ibuprofen, paracetamol, aspirin, other NSAID painkillers or any of the ingredients.
• Do not take if you have, or have ever had, an ulcer or bleeding in your stomach or duodenum.
• Do not take if you have a blood clotting disorder, or heart, liver or kidney failure.
• Do not take in the last 3 months of pregnancy. In the first 6 months of pregnancy, only take Panacombo if your doctor advises it.
• Do not take if you are breastfeeding.
• Not for children or adolescents under 18.
• Speak to your doctor or pharmacist before use if you are elderly, have or have had asthma, have kidney, heart, liver or bowel problems, have lupus (SLE) or another connective tissue disease, have ulcerative colitis or Crohn's disease, or are planning a pregnancy.
• Speak to your doctor or pharmacist before use if you have heart problems, have had a heart attack or stroke (including a mini-stroke), or have high blood pressure, diabetes, high cholesterol, a family history of heart disease or stroke, or smoke. Medicines like ibuprofen may be linked to a small increased risk of heart attack or stroke, especially at high doses.
• Check with your doctor or pharmacist before taking Panacombo with other medicines, such as corticosteroids, blood thinners (e.g. warfarin), blood pressure medicines, diuretics, lithium, SSRI antidepressants, methotrexate, ciclosporin, tacrolimus, zidovudine or some antibiotics.
• Tell your doctor straight away if you have a severe illness (such as severe kidney problems or sepsis), malnutrition or chronic alcoholism, or are taking the antibiotic flucloxacillin, as a serious blood condition called metabolic acidosis has been reported in these situations.
• Panacombo may hide signs of an infection, such as fever and pain. If you have an infection and your symptoms persist or get worse, see a doctor without delay.
• Taking more than the recommended dose, or for longer than recommended, can seriously harm the stomach, gut and kidneys and cause very low potassium levels, which can be fatal.
• Ibuprofen may make it more difficult to become pregnant. This is reversible when you stop taking it.

Like all medicines, Panacombo can cause side effects, although not everybody gets them.

Stop taking Panacombo and tell your doctor if you notice:

• heartburn or indigestion
• signs of bleeding in the stomach or gut, such as severe stomach pain, vomiting blood or what looks like coffee granules, blood in your stools, or black tarry stools
• signs of a severe allergic reaction, such as swelling of the face, tongue or throat, difficulty breathing or worsening asthma
• serious skin reactions, such as red target-like or circular patches (often with blisters), peeling skin, or ulcers in the mouth, throat, nose, genitals or eyes, sometimes after fever and flu-like symptoms
• a widespread rash with fever and swollen glands, or a red, scaly rash with blisters in skin folds and fever
• signs of inflammation of the brain lining, such as a stiff neck, headache, feeling or being sick, fever or disorientation
• liver problems, such as yellowing of the skin or the whites of the eyes
• kidney problems, such as passing more or less urine than usual, or swollen legs
• high blood pressure, fluid retention, or heart failure causing breathlessness and swelling
• skin that becomes sensitive to light

Common (may affect up to 1 in 10 people): stomach pain or discomfort, feeling or being sick, diarrhoea, excessive sweating, and raised liver enzymes or changes in kidney function shown in blood tests.

Uncommon (may affect up to 1 in 100 people): headache, dizziness, wind, constipation, skin rashes, swelling of the face, itching, and changes in red blood cell or platelet levels.

Very rare (may affect up to 1 in 10,000 people): a drop in blood cells causing sore throat, mouth ulcers, flu-like symptoms, severe exhaustion, unexplained bleeding, bruising or nosebleeds (stop taking Panacombo and contact a doctor at once), visual disturbances, ringing in the ears, a spinning sensation, confusion, depression, hallucinations, tiredness, feeling generally unwell, mouth ulcers, inflamed pancreas, worsening of ulcerative colitis or Crohn's disease, pins and needles, and inflammation of the optic nerve.

Frequency not known: chest pain, which can be a sign of a serious allergic reaction called Kounis syndrome, and metabolic acidosis in people with severe illness.

This is not a complete list. If you get any side effects, talk to your doctor, pharmacist or nurse. You can also report side effects through the MHRA Yellow Card Scheme.